Concordant GRADE-3 Truncal Ataxia and Ocular Laterodeviation in Acute Medullary Stroke
Round 1
Reviewer 1 Report
· The manuscript is written in a very confusing fashion, with several mistakes and typos. Some sentences are connected without punctuation, likewise figure legends. Some acronyms are never spelled.
· The abstract and keywords are missing. The introduction looks like an extremely large abstract as it includes methods, results and discussion.
· Methods are not clear. It should be reported the aim of the review, clearly specifying which signs are included, which of them are used to asses specificity/sensitivity of bedside testing protocol (assessment of eye movements and ataxia, etc..) and which statistical analysis were conducted.
· The way results are reported is extremely confusing. It is hard to understand the percentage of patients exhibiting each different sign.
· In general, all the manuscripts should be rewritten to allow a better understanding of the aims of the paper and results.
· There are no Video 1 and 2 as supplementary material (as specified in lines 121 and 147). Where is it possible to see them?
Author Response
Reviewer 1: The manuscript is written in a very confusing fashion: The author agrees, I re-wrote the manuscript almost completely, with special attention to grammar and spelled the acronyms
It has an abstract and keywords
Clarified methods, this study is limited to a description of AVS patients with an eventually positive DWI MRI involving the medulla
Glitches in the submission process resulted in the absence of videos available for review. The new compressed MP4 files
Reviewer 2 Report
Dr Kattah has written a very interesting article based on cases of AVS and OLD. His findings are to be shared with the scientific community as they are relevant to the clinical evaluation of AVS patients. Certain issues need to be addressed before publication. Dr Kattah needs to write an abstract and include keywords. Some information seems to be repeated at the beginning. All figures must be improved. Clarity about the videos, are these videos going to be sent to the journal? Are you referencing the videos in your library? Please be clear about that. Certain grammatical errors as well. I am uploading a pdf with changes.
Comments for author File: 
Comments.pdf
certain changes, see pdf
Author Response
Reviewer 2 Thank you for your comments, abstract and keywords added. I cannot improve the images further; this is an inherent problem with DWI images. The Videos never uploaded! I hope that they will now!
Reviewer 3 Report
The article summarized the cases of truncal ataxia and ocular laterodeviation in acute medullary stroke. Although the content may be valuable for clinicians, the manuscript contains many errors including the template phrases and font sizes, and should be corrected before the reviews.
Author Response
Reviewer 3. I address your concerns. The manuscript underwent a complete new write -up
Round 2
Reviewer 1 Report
The author has correctly addressed the comments of the reviewers and the aper has been correctly revised.
Minor comments
Abstract
“medullary stroke (LMS)”: should medullary stroke be spelled “MS” or does LMS refer to “lateral medullary stroke”? If so, please correct
“Among them, n=10 /12 had grade 3 ataxia, and three had grade 2 ataxia”. Please, specify who are those 12 patients (are “12 previously described patients”?) and which group includes the 3 patients with grade 2 ataxia.
Please spell out OLD
Introduction
Please, spell out LMS at the first mention.
Throughout the manuscript, once spelled out ocular latero deviation (OLD), lateral medullary stroke (LMS) etc, please continue to spell out them as OLD and LMS every time you mention them.
Author Response
Reviewer 1
- We have three abbreviations: MS: Medullary stroke, 2. LMS lateral medullary stroke and MMMS medial medullary stroke
- We added those patients with grade 2 and grade 3 ataxia
- We spelled out OLD
Reviewer 2 Report
Dr Kattah has to improve the quality of all figures, specially the MRI pictures, they are too small and of low quality, they should also be marked clearly A, B, C etc
Author Response
- OLD is spelled when it first appears in the abstract
- Added percentages in all blackest
Reviewer 3 Report
The article summarized the cases of truncal ataxia and ocular laterodeviation in acute medullary stroke. The contents may be valuable for clinicians because these cases are hard to find in general practice.
The discussion is also decribed in detail.
Following concerns should be fixed before the acceptance of this manuscript.
Abstract
OLD should be spelled out at the first place.
Figure 1
Percentages should be shown in all blackets. Just 29.41% and 5.88% are shown.
Author Response
- Worked on improving the figures. Obviously, the spatial resolution of the DWI is suboptimal; however, I realized your point and added a T2 FLAIR image to localize the anatomic site. I added also a letter in each panel. I amended the figure legend as well. Thank you
