Scholars@Duke
Gabriel Torrealba-Acosta

Gabriel Torrealba-Acosta

Assistant Professor of Neurology
Neurology, Neurocritical Care
gabriel.torrealba-acosta@duke.edu
311 Research Drive, Room 201G, Durham, NC 27710

Selected Publications

Identifying a proteomics signature of cognitive impairment and dementia in blood and cerebrospinal fluid through a mediation analysis framework.

Journal Article Neurobiol Aging · January 2026 This study aimed to identify CSF and plasma proteins that mediate the association between age and mild cognitive impairment (MCI) and Alzheimer's disease using mediation analysis. By focusing on proteins significantly associated in both CSF and plasma, we ... Full text Link to item Cite

Checklist conundrum: are we checking the right boxes?

Journal Article BMJ Qual Saf · December 15, 2025 Full text Link to item Cite

Assessing the Clinical Relevance of Blood Pressure Measures in Spontaneous Intracerebral Hemorrhage: A Post Hoc Analysis of ATACH-2.

Journal Article Neurocrit Care · December 2025 BACKGROUND: Recent American Heart Association guidelines have relied on post hoc subgroup analyses to identify summary blood pressure measures for targets in early management of acute intracerebral hemorrhage. To our knowledge, measurement error has not be ... Full text Link to item Cite

Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial.

Journal Article JAMA Neurol · September 1, 2025 IMPORTANCE: Small studies show that 0° head positioning of patients with large vessel occlusion (LVO) stroke improves penumbral blood flow and clinical stability. Understanding whether 0° head position maintains clinical stability would allow for optimal p ... Full text Link to item Cite

Sex differences in the diagnosis latency of Parkinson's disease in Latin America.

Journal Article Parkinsonism Relat Disord · May 2025 BACKGROUND: Age and sex are known risk factors for Parkinson's Disease (PD), but it remains controversial if there are sex differences in the diagnosis latency. The objective of this study was to examine these sex differences in Latin America. METHODS: The ... Full text Link to item Cite

A methodological assessment of randomization integrity in alteplase for acute ischemic stroke individual patient data meta-analyses.

Journal Article PLoS One · 2025 OBJECTIVES: Little is known about the integrity of randomization for randomized controlled trials (RCT) included in alteplase for stroke meta-analyses. If the RCTs were not properly randomized, the results could not be accepted at face value. The objective ... Full text Link to item Cite

Improve time to anti-coagulation reversal for hemorrhagic strokes.

Journal Article J Stroke Cerebrovasc Dis · December 2024 BACKGROUND: Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely be ... Full text Link to item Cite

Corrigendum: Clinical and genetic analysis of Costa Rican patients with Parkinson's disease (Front. Neurol., (2022), 12, 656342, 10.3389/fneur.2021.656342)

Journal Article Frontiers in Neurology · January 1, 2023 In the published article, there was an error. The stated number of protocols needed to be corrected. These errors were identified after an audit conducted by the CONIS (Consejo Nacional de Investigacion en Salud) of Costa Rica. A correction has been made t ... Full text Cite

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study.

Journal Article BMJ Open Qual · December 2022 BACKGROUND AND OBJECTIVES: Structured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU) and assessed its effe ... Full text Link to item Cite

Thrombolysis Experience in Costa Rica Compared Against Individual Patient Data from two Randomized Controlled Trials.

Journal Article J Stroke Cerebrovasc Dis · August 2022 OBJECTIVES: We sought to compare thrombolysis outcomes from the Costa Rican Stroke Registry Program (CRSRP) with published individual patient data from NINDS and CLOTBUST-ER trials using matching and outcome modeling from randomized clinical trials (RCTs). ... Full text Link to item Cite

A Neurostimulation-Triggered Trigeminal Neuralgia-like Pain: Risk Factors and Management

Journal Article Neurology Clinical Practice · October 1, 2021 Consider TNP in a differential diagnosis of a sudden onset of dental or mandibular pain ipsilateral to the VNS insertion site, especially if it follows a recent stimulation therapy adjustment. ... Full text Cite

Acute encephalitis, myoclonus and Sweet syndrome after mRNA-1273 vaccine.

Journal Article BMJ Case Rep · July 26, 2021 A patient presented with fever, generalised rash, confusion, orofacial movements and myoclonus after receiving the first dose of mRNA-1273 vaccine from Moderna. MRI was unremarkable while cerebrospinal fluid showed leucocytosis with lymphocyte predominance ... Full text Link to item Cite

Clinical and Genetic Analysis of Costa Rican Patients With Parkinson's Disease.

Journal Article Front Neurol · 2021 Background: Most research in genomics of Parkinson's disease (PD) has been done in subjects of European ancestry, leading to sampling bias and leaving Latin American populations underrepresented. We sought to clinically characterize PD patients of Costa Ri ... Full text Link to item Cite

High-Density Lipoprotein, Mean Platelet Volume, and Uric Acid as Biomarkers for Outcomes in Patients With Sepsis: An Observational Study.

Journal Article J Intensive Care Med · July 2020 BACKGROUND: We conducted an observational study evaluating the association between uric acid, mean platelet volume (MPV), and high-density lipoprotein (HDL) with complications and outcomes of patients with sepsis in a critical care setting. METHODS: We fol ... Full text Link to item Cite

Sex Differences Among Participants in the Latin American Stroke Registry.

Journal Article J Am Heart Assoc · February 18, 2020 Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods ... Full text Link to item Cite

Non-invasive brain stimulation for fine motor improvement after stroke: a meta-analysis.

Journal Article Eur J Neurol · August 2018 The aim of this study was to determine whether non-invasive brain stimulation (NIBS) techniques improve fine motor performance in stroke. We searched PubMed, EMBASE, Web of Science, SciELO and OpenGrey for randomized clinical trials on NIBS for fine motor ... Full text Link to item Cite

Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients.

Journal Article J Stroke Cerebrovasc Dis · May 2018 BACKGROUND: Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. METHODS: We analyzed 1319 patients enrolled over a 7-year period, w ... Full text Link to item Cite

Profile of acute ischemic stroke patients at a tertiary referral hospital in Costa Rica

Journal Article Neurologia Argentina · April 1, 2018 Introduction: Stroke is a public health concern worldwide, a leading cause of mortality and the main reason for disability. Although approximately 85% of all stroke deaths occur in developing countries, few publications have analyzed this entity in the reg ... Full text Cite

A rare neurological complication of Waldenstrom's Macroglobulinemia.

Journal Article J Clin Neurosci · February 2018 Bilateral and simultaneous facial nerve palsy (FNP) is a rare clinical condition occurring in 0.3-2.0% of facial palsy cases and is typically a manifestation of an underlying systemic disease. We here describe a case of a 67-year-old Hispanic man with a kn ... Full text Link to item Cite

Pituitary apoplexy presenting as an intraventricular hemorrhage: An infrequent neurovascular emergency

Journal Article Interdisciplinary Neurosurgery Advanced Techniques and Case Management · December 1, 2017 Pituitary macroadenomas may present with a pituitary apoplexy, commonly with associated hemorrhage, but rarely large enough to show an intraventricular bleeding. This is a case report of a 66-year-old woman with a 3-month history of headache, hyporexia, as ... Full text Cite

Spinal epidural empyema extending from a pleural empyema: case description and anatomical overview.

Journal Article BMJ Case Rep · November 8, 2017 We present a case of a patient with diabetes with a pleural empyema originated from a pyomyositis process established after a central line procedure. This empyema later on extended into the spinal canal deriving into an epidural empyema, leading towards a ... Full text Link to item Cite

First clinical and genetic description of a family diagnosed with late-onset Pompe disease from Costa Rica.

Journal Article Neuromuscul Disord · October 2017 Glycogen storage disease type II, also known as Pompe disease, is an autosomal recessive disorder caused by deficiency of enzymatic activity of acid alpha-glucosidase. The wide phenotypical variation of this disease relates to the amount of residual enzyma ... Full text Link to item Cite

Effect of insulin therapy and dietary adjustments on safety and performance during simulated soccer tests in people with type 1 diabetes: study protocol for a randomized controlled trial.

Journal Article Trials · July 20, 2017 BACKGROUND: Despite the reduction in glycemic derangement in patients with type 1 diabetes mellitus (T1D) through dietary and therapeutic adjustments implemented before, during and after continuous exercise, evidence for its effectiveness with intermittent ... Full text Link to item Cite

Does non-invasive brain stimulation modify hand dexterity? Protocol for a systematic review and meta-analysis.

Journal Article BMJ Open · June 22, 2017 INTRODUCTION: Dexterity is described as coordinated hand and finger movement for precision tasks. It is essential for day-to-day activities like computer use, writing or buttoning a shirt. Integrity of brain motor networks is crucial to properly execute th ... Full text Link to item Cite

Genetic and Clinical Features of Medullary Thyroid Carcinoma: The Experience of a Single Center in Costa Rica

Journal Article Journal of Cancer Epidemiology · January 1, 2016 Background. Activating mutations in the RET gene leads to medullary thyroid carcinoma (MTC). Guidelines encourage performing RET analysis in subjects with hereditary and sporadic disease. Materials and Methods. Design. Observational, case series report stu ... Full text Cite