Background: Thunderclap headache (TCH) is a sudden headache (SH) with accepted criteria of severe intensity and onset to peak within one minute. It is a well-known presentation for subarachnoid hemorrhage (SAH) but most patients with TCH or SH run a benign course without identifiable causes. Reversible cerebral vasoconstriction syndrome (RCVS), a recently recognized syndrome characterized by recurrent TCH attacks, has been proposed to account for most of these patients.Methods: We recruited consecutive patients presenting with SH at our headache clinic. Computed tomography and/or magnetic resonance imaging with angiography were performed to exclude structural causes and to identify vasoconstriction. Catheter angiography and lumbar puncture were performed with patients consent. Reversibility of vasoconstriction was confirmed by follow-up study.Results: From July 2010 to June 2013, 31 patients with SH were recruited. Twenty-four (72.7%) of these SH patients exhibited headache fulfilling the TCH criteria. The diagnosis of RCVS was confirmed in 14 (45.2%) of patients with SH and 11 (45.8%) of patients with TCH. Other diagnoses were as follows: primary headaches (SH: 41.9%, TCH: 45.8%) and other secondary causes (SH: 12.9%, TCH: 8.3%). Compared with non-RCVS patients, patients with RCVS were older (50.8 ± 9.3 years vs. 40.8 ± 10.0 years,P = 0.006) and less likely to experience short headache duration of < 1 hour (23.1% vs. 78.6%,P = 0.007). Patients with RCVS were more likely to cite bathing (42.9% vs. 0%,P = 0.004) and less likely to cite exertion (0% vs. 29.4%,P = 0.048) as headache triggers.Conclusions: Reversible cerebral vasoconstriction syndrome is a common cause of SH and TCH. Considering the potential mortality and morbidity of RCVS, systemic examination of cerebral vessels should be performed in these patients.

Hypertension and pain are both prevalent conditions in the older adult population. We aimed to report the prevalence of pain discomforts and investigated the association between hypertension and pain discomforts among older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ≥ 65 years. Prevalence of bothersome pain, activity-limiting pain, locations of pain and usage of pain medicine were evaluated. Demographics, comorbidities, and other covariates were compared between older adults with hypertension and those without. Multivariate regression was further performed to yield adjusted odd ratios. Among 6825 older adults, 4533 of them had a history of hypertension while 2272 of them had not. Prevalence of bothersome pain (57.12% versus 44.81%, p < 0.001) and activity-limiting pain (56.21% versus 46.12%, p < 0.001) were significantly higher in the hypertension group. After adjusting for all covariates, hypertension demonstrated a significant association with activity-limiting pain (OR 1.63, 95% CI 1.06 to 2.52, p = 0.02). In conclusion, pain was more prevalent in older Americans with hypertension. The positive association between hypertension and pain suggested that routine pain assessment and proper treatment would be required to improve the function and quality of life among older adults especially with hypertension.

Our study aims to develop an effective integrated machine learning (ML) scheme to predict vascular events and bleeding in patients with nonvalvular atrial fibrillation taking dabigatran and identify important risk factors. This study is a post-hoc analysis from the Randomized Evaluation of Long-Term Anticoagulant Therapy trial database. One traditional prediction method, logistic regression (LGR), and four ML techniques—naive Bayes, random forest (RF), classification and regression tree, and extreme gradient boosting (XGBoost)—were combined to construct our scheme. Area under the receiver operating characteristic curve (AUC) of RF (0.780) and XGBoost (0.717) was higher than that of LGR (0.674) in predicting vascular events. In predicting bleeding, AUC of RF (0.684) and XGBoost (0.618) showed higher values than those generated by LGR (0.605). Our integrated ML feature selection scheme based on the two convincing prediction techniques identified age, history of congestive heart failure and myocardial infarction, smoking, kidney function, and body mass index as major variables of vascular events; age, kidney function, smoking, bleeding history, concomitant use of specific drugs, and dabigatran dosage as major variables of bleeding. ML is an effective data analysis algorithm for solving complex medical data. Our results may provide preliminary direction for precision medicine.

The new generation of nonvitamin K antagonists are broadly applied for stroke prevention due to their notable efficacy and safety. Our study aimed to develop a suggestive utilization of dabigatran through an integrated machine learning (ML) decision-tree model. Participants taking different doses of dabigatran in the Randomized Evaluation of Long-Term Anticoagulant Therapy trial were included in our analysis and defined as the 110 mg and 150 mg groups. The proposed scheme integrated ML methods, namely naive Bayes, random forest (RF), classification and regression tree (CART), and extreme gradient boosting (XGBoost), which were used to identify the essential variables for predicting vascular events in the 110 mg group and bleeding in the 150 mg group. RF (0.764 for 110 mg; 0.747 for 150 mg) and XGBoost (0.708 for 110 mg; 0.761 for 150 mg) had better area under the receiver operating characteristic curve (AUC) values than logistic regression (benchmark model; 0.683 for 110 mg; 0.739 for 150 mg). We then selected the top ten important variables as internal nodes of the CART decision tree. The two best CART models with ten important variables output tree-shaped rules for predicting vascular events in the 110 mg group and bleeding in the 150 mg group. Our model can be used to provide more visualized and interpretable suggestive rules to clinicians managing NVAF patients who are taking dabigatran.

Background: Herpes Zoster (HZ) reactivation following COVID-19 suggests immune dysregulation, posing a risk for long-term neuro-ophthalmic sequelae. This study investigates the relationship between post-COVID HZ and the subsequent hazard of uveitis and optic neuritis. Methods: This retrospective analysis used the TriNetX Research Network, following patients for 3 years. Propensity Score Matching (PSM) was performed on COVID-19 survivors, comparing the HZ-exposed group (n = 11,172) against a matched HZ-unexposed control group (n = 11,173). Cox proportional hazards models calculated the 3-year Hazard Ratios (HRs) for incident uveitis and optic neuritis. Results: Post-COVID HZ reactivation was associated with a significantly elevated and persistent risk of both outcomes. HZ was consistently related to a 3.06-fold increase in the hazard of uveitis (HR = 3.06; 95% CI, 2.56–3.65; p < 0.001) and a 2.10-fold increase in the hazard of optic neuritis (HR = 2.10; 95% CI, 1.62–2.71; p < 0.001). The relationships remained significant across sensitivity analyses, and the risk remained high even in the vaccinated subgroup. Conclusions: HZ reactivation after COVID-19 is related to a higher instantaneous risk of subsequent uveitis and optic neuritis, even among immunocompetent individuals. HZ may serve as a clinical marker for neuro-immune injury, supporting the consideration of targeted ophthalmic surveillance and timely antiviral intervention to prevent vision loss.

Radiation-induced stenosis of the carotid artery is a significant risk factor for large-vessel ischemic stroke, which usually leads to significant impairment of neurological function. We performed intra-arterial thrombectomy on a 63-year-old male patient who had laryngeal cancer and postradiation carotid stenosis. He presented with acute-onset dysarthria and left hemiplegia. Brain computed tomography perfusion scan showed right middle cerebral artery ischemic change. Angiography confirmed total occlusion of the right internal carotid artery. Intra-arterial mechanical thrombectomy with carotid stenting was performed immediately, and recanalization was achieved. The patient fully recovered and was discharged after a 1-week hospitalization. Our experience suggests that early intervention for radiation-related carotid stenosis might be essential and beneficial for the outcome of large-vessel ischemic stroke.