Scholars@Duke
Gabriel Torrealba-Acosta

Gabriel Torrealba-Acosta

Assistant Professor of Neurology
Neurology, Neurocritical Care
gabriel.torrealba-acosta@duke.edu
Department of Neurology, Box 2900, Duke University Medical Center, Durham, NC 27710

Scholarly Works

Pharyngeal Electrical Stimulation: Dysphagia Treatment Enters a New Age

Journal article Stroke Clinician · June 26, 2026 Dysphagia is a highly disabling stroke outcome that significantly impacts quality of life and produces social isolation that limits reintegration and resumption of valued life activities in stroke survivors and their families/caregivers. With dysph ... Full text Open Access Cite

Exploring MAPT-containing H1 and H2 haplotypes in Parkinson's disease across diverse populations.

Journal article NPJ Parkinsons Dis · June 24, 2026 Variation at the 17q21.31 locus, which contains the gene encoding microtubule-associated protein tau (MAPT), has been associated with neurodegenerative disorders, including Parkinson's disease (PD). This highly complex locus is characterized by two broadly ... Full text Link to item Cite

Clinical Reasoning: A 28-Year-Old Man With Seizures and Thalamic Lesions.

Journal article Neurology · June 9, 2026 This case involves a 28-year-old Black man who presented with new-onset seizures and bilateral medial temporal lobe hyperintensities on brain MRI, initially raising concern for viral encephalitis. CSF analysis revealed mild lymphocytic pleocytosis, but ext ... Full text Link to item Cite

2268-P: Distinct Risk Profiles for Cardiovascular and Cancer Mortality in People with Diabetes from the UK Biobank

Conference Diabetes · June 5, 2026 Introduction and Objective: Cardiovascular disease and cancer are leading causes of death in people with diabetes. We aimed to compare their associated risk profiles.Methods: We studied 28,043 adults with diabete ... Full text Cite

2266-P: Multimorbidity Phenotypes in Diabetes and Their Association with All-Cause Mortality: A Latent Class Analysis in the UK Biobank

Conference Diabetes · June 5, 2026 Introduction and Objective: Multimorbidity is common in diabetes and affects long-term survival. We aimed to identify multimorbidity phenotypes and their link to 10-year all-cause mortality.Methods: We applied la ... Full text Cite

2265-P: Multimorbidity Phenotypes in Diabetes and Their Association with 10-Year Dementia Risk: A Latent Class Analysis in the UK Biobank

Conference Diabetes · June 5, 2026 Introduction and Objective: Multimorbidity is common in diabetes and may impact cognitive risk. We used latent class analysis to identify multimorbidity phenotypes and their association with incident dementia.Met ... Full text Cite

2267-P: Shared Proteomic Pathways Linking Cardiovascular Disease and Cancer in People with Diabetes: A UK Biobank Cohort Analysis

Conference Diabetes · June 5, 2026 Introduction and Objective: People with diabetes frequently develop cardiovascular (CV) disease and cancer, but the shared biological pathways are unclear. We compared their proteomic signatures.Methods: We analy ... Full text Cite

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

<div> Multifactorial Cardiovascular Risk Control and All-cause Mortality in Older Adults: A Pooled&nbsp;<span>Cohort Study</span><span>&nbsp;from Costa Rica, Mexico, and the UK</span> </div>

Preprint · 2026 Background: Comprehensive control of cardiovascular risk factors (CVRFs) is a cornerstone of preventive care, yet its combined impact on long-term mortality in older adults across diverse populations remains insufficiently characterised. We aimed t ... Full text 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

Neurocritical Care

Book section · October 8, 2025 Authored and edited by Dr. Esteban Cheng-Ching, Dr. Eric P. Baron, Dr. Suraj Rajan, and Dr. Ahsan Moosa Naduvil Valappil, this updated guide features more than 1,200 comprehensive, multiple-choice questions covering every area of neurology ... ... 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

1263-P: Determinants of Cardiovascular Risk Factors in the Aging Costa Rican Population—Insights from an Ordered Logistic Regression Model in the Costa Rican Longevity and Healthy Aging Study

Conference Diabetes · June 14, 2024 Introduction: The Costa Rican Longevity and Healthy Aging Study (CRELES), initiated in 2005, captures the health and lifestyle of elderly Costa Ricans with survival data up to 2019. We explored the association between sociodemographic and clinical ... Full text Cite

54-PUB: Exploring Categories of Controlled Cardiovascular Risk Factors in the Elderly—Insights from the Costa Rican Longevity and Healthy Aging Study

Conference Diabetes · June 14, 2024 Introduction: The prospective cohort Costa Rican Longevity and Healthy Aging Study (CRELES) offers comprehensive data on the lifestyle of elderly Costa Ricans enrolled in 2005, with survival status up to 2019. We aimed to describe the characteristi ... Full text Cite

1262-P: Effect of Cardiovascular Risk Factor Control on Mortality in Older Adults—Findings from the Costa Rican Longevity and Healthy Aging Study

Conference Diabetes · June 14, 2024 Introduction: The Costa Rican Longevity and Healthy Aging Study prospective cohort examined older adults' health status in Costa Rica. We investigated the influence of goal attainment on controlling cardiovascular risk factors (CVRFs): BMI, A1C, ex ... Full text Cite

Abstract WMP9: Favorable Mechanical Thrombectomy Outcomes From The Latin American Stroke Registry (lase) And Resilient Trial Compared To A 90-day Functional And Mortality Predictive Model.

Conference Stroke · February 2023 Introduction: Except for RESILIENT, there is a paucity of randomized controlled trials (RCTs) for stroke from Latin America (LA), home to growing stroke burden. Comparison between stroke population ty ... Full text Cite

Abstract WP14: A Patient-level Data Euclidean-matched Analysis Of Reperfusion Therapies In Acute Ischemic Stroke From The Latin American Stroke Registry (lase)

Conference Stroke · February 2023 Introduction: As acute stroke therapies expand to less well-resourced regions, it is imperative to study real-world data to assess outcomes and the quality of stroke care. The present study analyzes c ... Full text Cite

Corrigendum: Clinical and genetic analysis of Costa Rican patients with Parkinson's disease.

Journal article Front Neurol · 2023 [This corrects the article DOI: 10.3389/fneur.2021.656342.]. ... Full text Link to item 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

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

Abstract P17: Outcomes After Thrombolysis for Ischemic Stroke in Costa Rica Compare Favorably With International Cohorts

Conference Stroke · March 2021 Background: More than 70% of strokes occur in resource-poor countries. Outcomes are often not well documented. rt-PA for acute ischemic stroke was approved in 2012 for use in Costa Rica (CR). A hub an ... Full text 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

Clinical and genetic analysis of Costa Rican patients with Parkinson’s disease

Preprint · 2020 Background Parkinson’s disease (PD) involves environmental risk and protective factors as well as genetic variance. Most of the research in genomics has been done in subjects of European ancestry leading to sampling bias and leaving Latin American ... Full text 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 J Cancer Epidemiol · 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 Link to item Cite

Preliminary effects of real-world factors on the recovery and exploitation of forensic impurity profiles of a nerve-agent simulant from office media.

Conference J Chromatogr A · December 28, 2012 Dimethyl methylphosphonate (DMMP) was used as a chemical threat agent (CTA) simulant for a first look at the effects of real-world factors on the recovery and exploitation of a CTA's impurity profile for source matching. Four stocks of DMMP having differen ... Full text Link to item Cite

Impurity profiling to match a nerve agent to its precursor source for chemical forensics applications.

Journal article Anal Chem · December 15, 2011 Chemical forensics is a developing field that aims to attribute a chemical (or mixture) of interest to its source by the analysis of the chemical itself or associated material constituents. Herein, for the first time, trace impurities detected by gas chrom ... Full text Link to item Cite