Objective and consistent assessment of locomotion recovery remains challenging in rodent spinal cord injury (SCI). We, therefore, studied the validity and relevance of the CatWalk XT^® gait analysis as a tool for assessing functional outcome in a clinically relevant cervical SCI model in rats. In total, 20 Wistar rats were randomly assigned to either a C6 clip compression/contusion SCI or a sham laminectomy. Locomotion recovery was assessed weekly using the CatWalk XT^® gait analysis and the BBB open field score. Six weeks after SCI, the percentage of preserved spinal cord tissue was measured by glial fibrillary acidic protein (GFAP) immunohistochemistry (IHC) staining. Statistical analyses were performed to assess the correlation of the BBB and the percentage of preserved tissue with 30 different CatWalk XT^® parameters. SCI caused a bilateral and significant functional impairment in all studied CatWalk XT^® parameters. Similar to the BBB, a significant spontaneous recovery could be observed in most of the CatWalk XT^® parameters in the following weeks. Correlation between the hindlimb CatWalk XT^® parameters and the BBB was good (53% of r values > 0.6) while the correlation between the forelimb and the hindlimb CatWalk XT^® parameters and the percentage of preserved tissue was even stronger (83% of r values > 0.6). The CatWalk XT^® gait analysis is closely correlated with tissue damage after cervical contusion/compression SCI and can be used as an objective and consistent tool for assessing locomotion recovery.

Background: Detecting and treating neuropsychological deficits after aneurysmatic subarachnoid hemorrhage (aSAH) play a key role in regaining independence; however, detecting deficits relevant to social and professional reintegration has been difficult and optimal timing of assessments remains unclear. Therefore, we evaluated the feasibility of administering the Neuropsychological Assessment Battery screening module (NAB-S) to patients with aSAH, assessed its value in predicting the ability to return to work and characterized clinical as well as neuropsychological recovery over the period of 24 months.Methods: A total of 104 consecutive patients treated for aSAH were recruited. After acute treatment, follow up visits were conducted at 3, 12 and 24 months after the hemorrhage. NAB-S, Montreal Cognitive Assessment (MoCA) and physical examination were performed at each follow up visit.Results: The NAB-S could be administered to 64.9, 75.9 and 88.9% of the patients at 3, 12 and 24 months, respectively. Moderate impairment of two or more neuropsychological domains (e.g speech, executive function, etc.) significantly correlated with inability to return to work at 12 and 24 months as well as poor outcome assessed by the extended Glasgow Outcome Scale (GOSE) at 3, 12 and 24 months. The number of patients with favorable outcomes significantly increased from 25.5% at discharge to 56.5 and 57.1% at 3 and 12 months, respectively, and further increased to 74.1% after 24 months.Conclusion: The NAB-S can be administered to the majority of patients with aSAH and can effectively detect clinically relevant neuropsychological deficits. Clinical recovery after aSAH continues for at least 24 months after the hemorrhage which should be considered in the design of future clinical trials.

Background: It remains unclear whether neurobehavioral testing adds significant information to histologic assessment of experimental traumatic brain injury (TBI) and if automated gait assessment using the CatWalk XT^®, while shown to be effective in in the acute phase, is also effective in the chronic phase after experimental TBI. Therefore, we evaluated the correlation of CatWalk XT^® parameters with histologic lesion volume and analyzed their temporal and spatial patterns over four weeks after trauma induction. Methods: C57Bl/6 mice were subjected to controlled cortical impact (CCI). CatWalk XT^® analysis was performed one day prior to surgery and together with the histological evaluation of lesion volume on postoperative days one, three, seven, 14 and 28. Temporal and spatial profiles of gait impairment were analyzed and a total of 100 CatWalk XT^® parameters were correlated to lesion size. Results: While in the first week after CCI, there was significant impairment of nearly all CatWalk XT^® parameters, impairment of paw prints, intensities and dynamic movement parameters resolved thereafter; however, impairment of dynamic single paw parameters persisted up to four weeks. Correlation of the CatWalk XT^® parameters with lesion volume was poor at all timepoints. Conclusion: As CatWalk XT^® parameters do not correlate with focal lesion size after CCI, gait assessment using the CatWalk XT^® might add valuable information to solitary histologic evaluation of the injury site. While all CatWalk XT^® parameters can be used for gait assessments in the first week after CCI, dynamic single paw parameters might be more relevant in the chronic phase after experimental TBI.

The effect of the intraarterial administration of nimodipine as a rescue measure to treat delayed vasospasm after aSAH remains understudied; therefore, we evaluated its effect on short- and long-term functional and neuropsychological outcomes after aSAH. In this prospective observational study, a total of 107 consecutive patients treated for aSAH of WFNS grades I–V were recruited. At follow-up visits 3-, 12- and 24-months after the hemorrhage, functional outcome was assessed using the Extended Glasgow Outcome (GOSE) and modified Rankin (mRS) scales, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). The outcome of patients, who had received rescue therapy according to the local standard treatment protocol (interventional group, n = 37), and those, who had been treated conservatively (conservative group, n = 70), were compared. Even though significantly more patients in the interventional treatment group suffered from high-grade aSAH (WFNS Grades IV and V, 54.1% vs. 31.4%, p = 0.04) and required continuous drainage of cerebrospinal fluid at discharge (67.7% vs. 37.7%, p = 0.02) compared to the control group, significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE > 4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p < 0.001 and p = 0.01 for the interventional and control group, respectively). Thereafter, group differences were no longer significant. While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 29.2%, p = 0.04 and 0.05, respectively) and were unable to work (5.9% vs. 38.1%, p = 0.03 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long-term follow-up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint. In conclusion, despite initially being significantly more impaired, patients treated with intraarterial administration of nimodipine reached the same functional and neuropsychological outcomes at medium- and long-term follow-up as conservatively treated patients suggesting a potential beneficial effect of intraarterial nimodipine treatment for delayed vasospasm after aSAH.

Background: Even though mechanical recanalization techniques have dramatically improved acute stroke care since the pivotal trials of decompressive hemicraniectomy for malignant courses of ischemic stroke, decompressive hemicraniectomy remains a mainstay of malignant stroke treatment. However, it is still unclear whether prior thrombectomy, which in most cases is associated with application of antiplatelets and/or anticoagulants, affects the surgical complication rate of decompressive hemicraniectomy and whether conclusions derived from prior trials of decompressive hemicraniectomy are still valid in times of modern stroke care. Methods: A total of 103 consecutive patients who received a decompressive hemicraniectomy for malignant middle cerebral artery infarction were evaluated in this retrospective cohort study. Surgical and functional outcomes of patients who had received mechanical recanalization before surgery (thrombectomy group, n = 49) and of patients who had not received mechanical recanalization (medical group, n = 54) were compared. Results: The baseline characteristics of the two groups did significantly differ regarding preoperative systemic thrombolysis (63.3% in the thrombectomy group vs. 18.5% in the medical group, p < 0.001), the rate of hemorrhagic transformation (44.9% vs. 24.1%, p = 0.04) and the preoperative Glasgow Coma Score (median of 7 in the thrombectomy group vs. 12 in the medical group, p = 0.04) were similar to those of prior randomized controlled trials of decompressive hemicraniectomy. There was no significant difference in the rates of surgical complications (10.2% in the thrombectomy group vs. 11.1% in the medical group), revision surgery within the first 30 days after surgery (4.1% vs. 5.6%, respectively), and functional outcome (median modified Rankin Score of 4 at 5 and 14 months in both groups) between the two groups. Conclusions: A prior mechanical recanalization with possibly associated systemic thrombolysis does not affect the early surgical complication rate and the functional outcome after decompressive hemicraniectomy for malignant ischemic stroke. Patient characteristics have not changed significantly since the introduction of mechanical recanalization; therefore, the results from former large randomized controlled trials are still valid in the modern era of stroke care.