Yes / Endothelial dysfunction and damage underlie cerebrovascular disease and ischemic stroke. We undertook corneal confocal microscopy (CCM) to quantify corneal endothelial cell and nerve morphology in 146 patients with an acute ischemic stroke and 18 age-matched healthy control participants. Corneal endothelial cell density was lower (P<0.001) and endothelial cell area (P<0.001) and perimeter (P<0.001) were higher, whilst corneal nerve fbre density (P<0.001), corneal nerve branch density (P<0.001) and corneal nerve fbre length (P=0.001) were lower in patients with acute ischemic stroke compared to controls. Corneal endothelial cell density, cell area and cell perimeter correlated with corneal nerve fber density (P=0.033, P=0.014, P=0.011) and length (P=0.017, P=0.013, P=0.008), respectively. Multiple linear regression analysis showed a signifcant independent association between corneal endothelial cell density, area and perimeter with acute ischemic stroke and triglycerides. CCM is a rapid non-invasive ophthalmic imaging technique, which could be used to identify patients at risk of acute ischemic stroke. / Qatar National Research Fund Grant BMRP20038654

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Layer 3 (L3) pyramidal neurons are involved in intrinsic and extrinsic corticocortical communications that are integral to area specific cortical functions. The functional and morphological properties of these neurons are altered in the lateral prefrontal cortex (LPFC) of aged rhesus monkeys, changes which parallel the decline of working memory (WM) function. What is not yet understood is the time course of these neuronal alternations during the aging process, or the impact of neuronal changes on the function of local networks that underlie WM. By comparing the properties of L3 pyramidal neurons from the LPFC of behaviorally characterized rhesus monkeys over the adult lifespan using whole cell patch clamp recordings and neuronal reconstructions, the present dissertation demonstrates that WM impairment, neuronal hyperexcitabilty and spine loss begin in middle age. We use bump attractor models to predict how empirically observed changes affect performance on the Delayed Response Task and Delayed Recognition Span Task (spatial). The performance of both models is affected much more by neuronal hyperexcitability than by synapse loss. In a separate study, we examine pathological changes of L3 pyramidal neurons in the perilesional ventral premotor cortex following acute ischemic injury to the primary motor cortex. Neurons from lesioned monkeys exhibit hyperexcitability and changes the excitatory:inhibitory synaptic balance in favor of inhibition. As oxidative stress and inflammation are known to exacerbate both age-related and injury-induced neuronal pathology, we characterize neuronal properties in both conditions after administering therapeutic interventions which target inflammatory pathways and which have previously been shown to ameliorate behavioral deficits. Chronic dietary curcumin treatment dampens neuronal hyperexcitability in middle-aged subjects, but the neuronal changes are not correlated with WM improvements. Treatment with mesenchymal-derived extracellular vesicles lowers firing rates and restores excitatory:inhibitory synaptic balance, and importantly, these changes correlate significantly with motor function.

Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke (n=86) had a larger overall oriented bounding box (OBB) volume (p=0.003) and a higher number of brain lesion components (p=0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p<0.001), age (OR 2.13, 95%CI 1.52–3.06, p<0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p=0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.

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