Vallamchetla, Sai Krishna

Background Studies suggest that hypoperfusion from heart failure (HF) may contribute to cognitive decline. However, the relationship between the HF subtypes and cognition remains poorly described in real‐world populations. Methods We conducted a cross‐sectional study of patients aged ≥18 years seen at the Mayo Clinic in 2022 who underwent echocardiogram and cognitive assessment within 1 year. HF was classified per the 2022 American Heart Association as no HF, HF with preserved ejection fraction (EF), HF with mildly reduced EF, and HF with reduced EF. Cognitive impairment was categorized using the Montreal Cognitive Assessment score as normal (≥26), mild (18–25), and moderate to severe (<18). Linear regression assessed EF–Montreal Cognitive Assessment correlation and logistic regression the association between HF subtypes and cognitive dysfunction, adjusting for age, sex, race, and vascular risk factors. Results A total of 1592 patients met inclusion criteria (mean age, 75.7±13.8 years; 48.5% women). Lower EF was associated with worse cognitive performance (postadjustment β=0.033, P =0.013). Patients with HF with reduced EF and patients with HF with preserved EF had significantly lower Montreal Cognitive Assessment scores than those without HF (17.6±6.2 and 18.9±5.8 versus 19.9±6.0, P <0.001). The prevalence of moderate to severe cognitive impairment was highest in HF with reduced EF (43.3%), followed by HF with preserved EF (34.4%), no heart failure (28.6%), and HF with mildly reduced EF (23.4%) (adjusted trend P =0.032). Conclusions HF, independent of ejection fraction alone, is associated with cognitive impairment. Further studies should confirm these findings and evaluate the impact of interventions targeting EF and HF subtypes on cognitive outcomes.

Introduction Guillain-Barré syndrome (GBS) is an autoimmune polyradiculopathy linked to various triggers. Recently, several case reports described GBS development following intracranial hemorrhage (ICH), posing diagnostic and therapeutic challenges. Methods PubMed and EMBASE were searched from inception till February 2023 for case reports. Two reviewers independently screened the articles and extracted data using a standardized form. The extracted data were then analyzed narratively. Quality was assessed with the JBI Checklist for Case Reports. Results Twenty-three cases from 11 countries were identified (14 males, mean age of 60.1 years). Onset of GBS occurred after a median of 9 days (range 2–24) post-ICH, with intracerebral hemorrhage being the most common antecedent (39.1%), followed by subarachnoid (26.1%) and subdural hemorrhage (21.7%). Electrophysiology showed predominantly axonal variants, while CSF consistently demonstrated albuminocytologic dissociation with positive antiganglioside antibodies in five cases. The clinical course was severe, marked by rapid progression to nadir (median 2.5 days), profound functional impairment (average Hughes Functional Grading Scale: 4.57 ± 0.66), and a high rate of respiratory failure requiring mechanical ventilation (78.3%). Axonal variants were associated with higher rates of mechanical ventilation and poorer outcomes than demyelinating forms. Among the 21 patients who received immunomodulatory treatment, 3 (14.3%) showed complete recovery, 13 (61.9%) had partial recovery, 3 (14.3%) had a poor recovery, and 2(9.5%) died at last follow up. Conclusion GBS may complicate recovery after ICH and appears to present with an aggressive course, particularly in axonal variants. Clinicians should consider GBS when patients with ICH develop progressive, symmetrical weakness unexplained by the initial brain injury, as prompt initiation of immunotherapy may improve outcomes.