Cognitive impairment in isolated subtentorial stroke
Bibliographic record
Abstract
BACKGROUND: Recent case reports have implicated subtentorial lesions of the brainstem or cerebellum as part of the neurocognitive circuitry. AIM: To determine whether cognitive impairment is part of the neurological deficit in isolated brainstem (IBSS) or cerebellar stroke (ICS), using bedside screening and formal neurocognitive assessment of higher cortical function. METHODS: Accrual occurred through a hospital based stroke registry. Cognitive bedside tests and neuropsychological tests were employed for the detection of higher cortical function. Scores from each test were converted to age and education based z-scores. Scores at or below -1.5 SD were clinically defined 'impaired'. Scores were averaged across tests in each functional area. RESULTS: Of the stroke patients (n = 1360), the infarct was isolated within the brainstem (IBSS) in (45 of 120 or 38%) and isolated within the cerebellum (ICI) in (37 of 79 or 46.8%). Comparison of the IBSS patients with cognitive impairment in one or more domains to those with brainstem (24 of 45 or 53%) and hemispheric cerebral infarcts: (43 of 72 or 58%) (Pearson Chi Square) was not significantly different (P = 0.49). The admission Canadian Neurological Score (mean 10.2, 95% CI: 9.7-10.2) and Rankin score at 1 month (mean 1.7, 95% CI: 2.1-1.4). Comparison of the number of ICI patients with cognitive impairment in one or more domains (13 of 37 or 35.1%) to those with cerebellar and hemispheric cerebral infarcts who had abnormal cognitive testing in one or more domains (16 of 36 or 44.4%) (Pearson Chi Square) was not significantly different (P = 0.41). The mean admission Canadian Neurological Scores for the ICI cases was 10.9 (95% CI: 10.5-11.2) on average. Their mean admission Rankin score was 1.7 (95% CI: 1.4-2.1). Neuropsychological testing for frontal/executive skills, immediate and delayed memory, and visuospatial abilities (n = 15), revealed that frontal abilities were most impacted by the isolated strokes in these patients (average frontal impairment index = -1.29 +/- 0.79) followed by delayed recall of verbal and visual information (mean = -1.18 +/- 1.17). Immediate memory (-0.51 +/- 0.75) and visuoconstructive skills (-0.06 +/- 0.88) were relatively spared. Overall, 47% of the patients showed impairment on frontal tasks while 40% had significant impairment in delayed recall. In contrast, only 13% had scores below the cutoff for immediate memory and none fell below the cutoff for visuoconstructive skills. CONCLUSION: Cognitive impairment is a common sequel of isolated subtentorial stroke. The frequency of impairment is similar either because of isolated brainstem or isolated cerebellar infarct, and similar to cognitive impairment with cerebral hemispheric lesions. Frontal networks or metacognition is the most frequently involved domain.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".