The Neuralert Stroke Monitor Pilot Trial

Inclusion Criteria:

• Age ≥ 22 years

• Admitted to or planned admission to the Hospital of the University of Pennsylvaniaand followed by the Cardiothoracic (CT) Surgery or Vascular Surgery services

• Considered at high risk for stroke while in the hospital based on:

1. Interventions or procedures performed during the hospitalization including:Intracardiac surgical or endovascular procedures including valve replacement,ascending aorta or aortic arch surgical or endovascular repair, and opensurgical or endovascular carotid revascularization

2. Other CT surgery or Vascular surgery procedures in patients with high riskcharacteristics including: Atrial fibrillation, prior stroke/TIA,hypercoagulable state (i.e., prior clotting events attributed to activemalignancy or a diagnosed thrombophilia) requiring lifelong anticoagulation,severely reduced left ventricular cardiac ejection fraction (i.e., <30%) oranterior left ventricular wall akinesis, or age ≥ 80.

Exclusion Criteria:

• Any medical or psychological conditions that, in the opinion of the investigator,would compromise the subject's safety or successful participation in the study.

• Baseline asymmetric upper extremity weakness as assessed by the study team at timeof enrollment, defined as an NIHSS upper extremity motor score >0 in either arm.

• A limb amputation above the wrist in the upper extremities

• Unwilling to provide informed consent and no legally authorized representativewilling to provide informed consent if the patient is unable