This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.

The superiority of the bridging strategy of intravenous thrombolysis (IVT) plus endovascular therapy (EVT) to EVT alone for the anterior circulation with tandem vascular occlusion (TO) has not been specifically addressed by a single randomized trial. Analysis of 15 studies (n = 1857 patients) revealed that 90 Day good functional outcomes (MRS≤2) were better for bridging therapy (IVT + EVT) than for dEVT (OR:1.39, 95%CI: 1.09-1.79, p = 0.008); 90-day mortality was lower for IVT + EVT than for dEVT (OR: 0.57; 95%CI: 0.40-0.81, p = 0.002) and rates of successful recanalization were higher for IVT + EVT than for dEVT (OR: 1.79, 95%CI: 1.36-2.36, p<0.0001). However, there was no significant difference in the incidence of symptomatic. intracranial hemorrhage (sICH) between groups (OR 0.91, 95%CI 0.64-1.31, p = 0.62).In conclusion, Patients receiving IVT + EVT have a better functional outcome, lower death rate and a higher rate of successful recanalization than those receiving dEVT but there was no difference in sICH risk between the two treatments.

Headache is one of the most common diseases in epilepsy, with affected patients experiencing various types of headaches. This study aimed to investigate differences in headache types across epilepsy types, comparing pain levels among epilepsy patients with multiple headache types, and exploring associations between headache characteristics and epilepsy prognosis. We retrospectively analyzed consecutive adult epilepsy patients with headache, collecting comprehensive sociodemographic, epilepsy-related, and headache-related data, as well as data on headache-attributed lost time and quality of life. The overall prevalence of headache in epilepsy patients was determined, and we compared clinical characteristics, quality of life, and headache-attributed lost time across different epilepsy types. Based on the temporal relationship between headache and seizures, headache related to epilepsy were classified into inter-ictal headache (Inter-IH), ictal headache, pre-ictal headache (Pre-IH), and post-ictal headache (Post-IH) for subgroup analysis to explore differences in clinical characteristics by headache type. We conducted multiple logistic regression and receiver operating characteristic (ROC) analyses to calculate the area under the curve (AUC), assessing correlations between headache characteristics and epilepsy prognosis and the predictive accuracy for drug-resistant epilepsy (DRE). A total of 539 epilepsy patients were included, comprising 233 with Inter-IH (43.22%), 38 with Pre-IH (7.05%), and 423 with Post-IH (78.48%); no patients had ictal headache. Among those with Inter-IH, 58 (10.76%) met the diagnostic criteria for migraine, and 87 (16.14%) met the criteria for tension-type headache. In our cohort, 7 patients (1.30%) experienced both Inter-IH and Pre-IH, 112 (22.08%) had both Inter-IH and Post-IH, 7 (1.30%) experienced Inter-IH, Pre-IH, and Post-IH, and 18 (3.34%) had both Pre-IH and Post-IH. The study included 382 patients with focal epilepsy (70.87%), 40 with generalized epilepsy (7.42%), and 117 with epilepsy of unknown origin (21.71%), with temporal lobe epilepsy being the most common focal type, representing 46.07% of cases. Patients with focal epilepsy reported lower quality of life than those with epilepsy of unknown origin (QOLIE-10, p < 0.05) and had a lower proportion of bilateral Post-IH than those with epilepsy of unknown origin (p < 0.05). The proportion of patients with level 1 Headache-Attributed Lost Time-90 Days (HALT-90) was higher in generalized epilepsy than in focal (87.50% vs. 66.23%, p < 0.05) and unknown origin (87.50% vs. 64.96%, p < 0.05). With migraine and HALT-90 were associated with DRE (p < 0.05), although predictive accuracy was low (AUC = 0.539; AUC = 0.566, respectively). The most common type of epilepsy with headache was focal epilepsy, with patients experiencing poorer quality of life than those with epilepsy of unknown origin. Clinical characteristics of headache related epilepsy did not vary significantly by epilepsy type, but patients of generalized epilepsy with headache had the least time lost. Post-IH was the most common type of headache in epilepsy patients. With migraine and HALT-90 were associated with DRE, but the predictive accuracy for DRE was insufficient.