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How to apply online to the NWU

• Saturday May 4, 2024
• Posted in Guides , North-West University (NWU)

In this guide, we'll go over how to apply to the North-West University (NWU) online.

Here's what you'll need:

• An email account. Here's how to create a Gmail account .
• Your cellphone number.
• Your grade 11 term 4 results (if you are currently in Grade 12)
• Your Matric/Grade 12 results (statement or certificate) if you've completed grade 12/matric
• A qualification in mind that you'd like to apply for. If undecided, you can use our NWU APS Calculator to find out your score and use the latest prospectus to see what you may qualify for.

Once you've got all that, let's apply!

Step 1: Visit Application Portal

Visit the NWU application portal by typing in https://apply.org.za/applytonwu in your browser. This will take you to the new application portal . (See image below)

Step 2: Create an Account

If this is your first time applying, create an account on the new portal and click on the submit button. Users who have used the previous VSS portal will also need to register a new account. Your username will be your email address. (See image below)

Step 3: Check your email for a temporary password

You will receive an email from the NWU with your new temporary password. Sometimes it may take up to 2 hours to receive the email. (See example image below)

Copy the new temporary password. Then click on the here text in the email to log in and change the password. In the old password box enter the temporary password you copied from the email. (Make sure to enter the password exactly as you received it). Then create a new secure password (If you are using Chrome use the suggested secure password as Google will remember it for you in case you forget it).

Step 4: Log in with your new password

Now, log in with the new password you created. The username is your email address.

Step 5: Start a new application

Click on the Apply Now button in purple to begin your application.

Step 6: Choose a qualification

On this page, enter your preferred method of learning and choose the qualification you'd like to apply for.

Presentation is how you'd like to study with Contact being located at an NWU campus and Distance being from home or remotely.

You will then choose the programme you'd like to apply for by searching for it then selecting it. Then hit the Save and Continue button.

Step 7: Enter your Personal Details

Once choosing your programme you will be taken to add details about yourself. Make sure to complete all required information.

You will then after adding all your information and contact details then Proceed to the next section.

Step 8: Add education experience

You will then add information about your previous education if you have studied at other institutions.

Step 9: Add School Subjects and Marks

You will then add your school subjects and the marks you received for each subject. You will search for your school and choose whether you'd like to add Grade 11 or 12 marks. Please DO NOT enter your grade 12 term 1 or 2 marks if you are currently in grade 12 .

If you come across the “Error in adding new row” error (shown in the image below), just refresh the page and everything will work well.

Step 10: Add funding source

In the next Additional Information tab, enter the source of how you'll expect to fund your studies. If you plan on applying for NSFAS, choose the NSFAS option. You should also specify if you'd like to apply for on-campus student accommodation.

Step 11: Upload Documents

We're just about to finish, we discussed at the beginning of the guide that some documents will be required. You will then upload them here. See the screenshot on how to do this.

If you are in grade 12, upload your grade 11 term 4/final results. If completed grade 12, upload your matric certificate/statement. If at another university, upload your first semester results under Additional Supporting Document .

Step 12: Sign Declaration

You will need to sign the declaration that everything you submitted is true then submit your application. YOU WILL NOT be able to edit your application after submission so make sure everything is completed an correct before submitting.

Phew, you're done! You have now completed your online NWU application with UniApplyForMe ! You will receive a confirmation email from the NWU that you've submitted your application and your application reference.

Please help others by sharing this article with them and following us on social media.

Should you need help with anything you can ask a question on https://answers.apply.org.za/add-question and our team and the UniApplyForMe Answers community will answer you. You can also send us content suggestions and other feedback at [email protected] .

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Nuclear Engineering

Post graduate diploma in nuclear science and technology.

We would love to hear from you and answer any questions you may have.

In the past, our Master's degrees followed a structured format (Option-B), encompassing all theoretical nuclear engineering modules along with a research mini-dissertation. However, there has been a recent transition to pure research Master's degrees, where the emphasis is solely on a comprehensive dissertation without including any theoretical modules. As a result, the theoretical components have been relocated to our two Postgraduate Diplomas (PGDips). Information on these Postgraduate Diplomas is provided below:

1.1 Postgraduate Diploma in Nuclear Science and Technology:

About this postgraduate diploma.

Curriculum: I501P

Qualification code: 7DC D01

Delivery mode: Distance

This programme supplies students all the theoretical knowledge required by the NWU’s research Masters of Science in Engineering Sciences with Nuclear Engineering.

The field of Nuclear Engineering comprises the technical aspects, such as nuclear reactor design, and the nuclear technology management aspects, such as nuclear Project Management, nuclear policy and financial management.

The present programme focuses on the theoretical knowledge underlying the said technical aspects, especially nuclear reactor design, while another programme will focus on the technology management aspects.

This programme provides learners with:

• a broader and more in-depth knowledge of Nuclear Engineering sciences
• advanced education in the field of Nuclear Engineering
• problem-solving ability
• integration of knowledge across fields
• the ability to execute a project in the field of Nuclear Engineering and to communicate the results orally and in writing

List of modules:

Refer to General Academic Rule 1.14.

The minimum term of study is one (1) year and the maximum term of study is two (2) years.

Minimum Admission requirements for the qualification

• A degree such as the BEng or BIng, BSc (Eng), or equivalent qualification that exits at NQF level 8, or
• A three-year B.Sc. degree with Physics at third year level and at least one of Mathematics, Applied Mathematics or Computer Science at at least second year level (exits at NQF level 7), or
• A BTech (Engineering) degree that exits at NQF level 7 with an average grade of at least 60% for the final year. (Since BTech degrees have been replaced by Advanced Diplomas (NQF level 7) and are seen as equivalent, Advanced Diplomas in Engineering with an average grade of at least 60% for the final year were also accepted), or
• A BEngTech (Engineering) degree that exits at NQF level 8 with an average grade of at least 60%.

Method of presentation

The modules are presented by means of a distance-contact method. The elearning platform e-Fundi, with an interactive site for each module, enables students to participate in well-structured self-study learning activities prior to attending the contact lecture session.

Six to eight weeks, of which one week is a contact session, are scheduled for each module.

All lectures of a specific module are normally presented in one block-week of contact lectures. The other weeks are used for self-study, assignments, assessment and guidance via online learning. During this period students have access to a facilitator who will provide support as required.

Curriculum outcomes

On completion of the qualification, the student should be able to demonstrate:

• A comprehensive and systematic knowledge base in nuclear engineering, as well as a depth of knowledge in nuclear physics and thermal fluid sciences.
• A coherent and critical understanding of the principles and theories of nuclear engineering; an ability to critique current research and advanced scholarship in an area of nuclear engineering; an ability to make sound theoretical judgements based on evidence and an ability to think epistemologically (i.e. from a sound knowledge framework). 17
• An ability to identify, analyse and deal with complex and/or real world problems and issues using evidence-based solutions and theory-driven arguments in the field of nuclear engineering.
• Efficient and effective information-retrieval and processing skills; the identification, critical analysis, synthesis and independent evaluation of quantitative and/or qualitative data; an ability to conduct research.
• An ability to present and communicate academic professional work effectively.

Compilation of curriculum

In accordance with General Academic Rule 3.1.1., the postgraduate diploma consists of a number of modules with a total credit value of 128 at NQF level 8.

One credit represents 10 notional study hours, which suggests that a student should expect to spend at least 1280 study hours on the programme.

The curriculum comprises of 8 core modules.

1.2 Postgraduate Diploma in Nuclear Science and Technology with Nuclear Technology Management:

Qualification code: 7DC D02

This programme supplies students all the theoretical knowledge required by the NWU’s new research Masters of Science in Engineering Sciences with Nuclear Engineering and Nuclear Technology Management, which the International Atomic Energy Agency (IAEA) assisted the NWU in developing and recently endorsed.

The field of Nuclear Engineering comprises the technical aspects, such as nuclear reactor design, and the nuclear technology management aspects, such as Nuclear Project Management, nuclear policy and nuclear economics.

The most of the modules of the present programme overlap with those of the Postgraduate Diploma in Nuclear Science and Technology and, therefore, it supplies similar technical Nuclear Engineering knowledge. Therefore it also meets the minimum admission requirements of the Masters of Science in Engineering Sciences with Nuclear Engineering. However, it focusses more on Nuclear Technology Management, namely: nuclear policy, nuclear technology management and nuclear economics and financial management aspects.

• advanced education in the field of Nuclear Technology management, including Nuclear Project Management, nuclear policy, and the economics of nuclear projects

• A coherent and critical understanding of the principles and theories of nuclear engineering; an ability to critique current research and advanced scholarship in an area of nuclear engineering; an ability to make sound theoretical judgments based on evidence and an ability to think epistemologically (i.e. from a sound knowledge framework).
• An ability to identify, analyze, and deal with complex and/or real-world problems and issues using evidence-based solutions and theory-driven arguments in the field of nuclear engineering.
• Efficient and effective information-retrieval and processing skills; the identification, critical analysis, synthesis, and independent evaluation of quantitative and/or qualitative data; an ability to conduct research.
• In-depth knowledge of Nuclear Technology Management, namely: nuclear policy, nuclear technology management, and nuclear economics and financial management aspects, and the ability to apply it to practical problems in this field.
• If you believe that you meet the minimum admission requirements, you can start your online application process by clicking  here .
• Applications for the 2024 academic year close on 31 December 2023.

Need more information?

View the Engineering Postgraduate Yearbook or please feel free to contact us:

• [email protected]
• [email protected]

Faculty of Education

2024 first-year students.

Welcome to this virtual orientation. Below you will find interactive presentations help students from each of our qualifications in their registration process.

NB! If you were accepted for the contact program, you need to register for the contact program. Make sure that you still register for the contact mode of delivery.

You only register as a distance student if you were accepted as a distance student.

R&O Programme

Welcome to the Faculty of Education Beehive where you Bee-long

Important registration information

• First year students from the Faculty of Education are encouraged to register online from 22 January 2024.
• All registrations, curriculum control and student requests will be able to be done by students themselves online.
• Ensure that you are familiar with the registration process.
• Find the 2024 Registration and Orientation (R&O) programme for the NWU  here

Registration

• Check your application status here
• Payable fees here
• Online registration here
• Class timetables here

How to register

Foundation phase, intermediate phase, bed.senior and fet-phase registration.

Mahikeng Campus

Potchefstroom Campus

Vanderbiljpark Campus

Distance students, book a meeting.

If you are struggling, please book a one-on-one Google meet session with one of the personnel listed below. Make sure you select someone within the phase and the campus where you will be studying:

Foundation Phase

• Sandra Fourie (Distance Learning)
• Inonge Kakula (Mahikeng)
• Ellen Nkwe (Mahikeng)
• Sadie Rapoo (Mahikeng)
• Elsabe Wessels (Mahikeng)
• Rachel Masemola (Potchefstroom)
• Nellytia Motaung (Potchefstroom)
• Sam Mabena (Vanderbijlpark)
• Susan Maree (Vanderbijlpark)

Intermediate Phase

• Erika Potgieter (Distance Learning)
• Jerome Howard (Potchefstroom)
• Rochelle Marais-Botha (Vanderbijlpark)
• Lorraine Lehilhi (Vanderbijlpark)

Senior and FET

• Marike Annandale (Potchefstroom Program Leader)
• Hendrik du Plessis (Distance)
• Boitumelo Gopane (Mahikeng)
• Thapelo Mokgadi   (Mahikeng)
• Marian Roscher (Potchefstroom)
• Natasha de Witt (Vanderbijlpark)
• Matthys Uys  (Vanderbijlpark)

Please contact us should you require any assistance.

Covid-19 disrupted our lives, affecting all our futures. Online teaching-and-learning replaced conventional face-to-face contact, with teachers and students being forced to adapt. Many students persevered and achieved success.  You are amongst those who worked hard and can confidently enter the next phase of your life. I commend you on your achievements.

You might believe that you have reached the mountain top in your career, however, you have only arrived at base-camp. The journey ahead will be tough, but also very satisfying. I welcome you to the Faculty of Education and to the teaching profession. You have chosen a noble calling - remember, the ultimate goal is to improve the lives of every child in South Africa. This is one of the most satisfying occupations, if you are prepared to go beyond the call of duty.

Wishing you all the best and thank you for entrusting NWU FEDU with your future.

Prof Lloyd Conley Executive Dean: Faculty of Education (FEDU)

Make use of the videos and material provided on this page to help you start your journey at NWU (there will be no live sessions).

Important dates

Apart from curriculum control and registrations, the following dates will be announced soon:

• Registration period (including curriculum control)
• Official welcoming of first-year students.
• Teaching for first-year students start (keep informed with the  latest official COVID-19 communiques )
• Make use of  Adds&Drops DIY  app for module / qualification changes for first-years
• Please consult the   DIY Adds & Drops how-to guide   for students  
• See student request forms and electronic procedure  

Curriculum control and registration

 The registration period for online registrations is 8 March to 9 April 2021. The below presentations represent our different qualification programmes, and will give you guidance for choosing your subjects and getting registered:

Vanderbijlpark Campus

• Unit for Open Distance Learning
• Unit for Open Distance Learning - Life Skills and Social Sciences
• Vanderbijlpark Campus - Life Skills and Social Sciences
• Vanderbijlpark Campus -  Mathematics, Science and Technology
• Potchefstroom Life Skills and Social Sciences
• Potchefstroom Mathematics, Science and Technology
• Mahikeng Campus ( download PowerPoint slideshow )
• Potchefstoom Campus ( download PowerPoint slideshow )
• Vanderbijlpark Campus   ( download PowerPoint slideshow )

Orientation of first-year students

Please watch this word of welcome!

We would also like to invite you to work through the below videos at your own convenience to help you find your feet at our faculty, and to gain some insight about this new journey that you have embarked on.

YouTube videos are not zero-rated and data charges will therefore apply :

• Introduction to fhe Faculty of Education
• My journey of becoming a teacher
• Ice-breaker and self-directed learning
• Work integrated learning teaching practice
• Academic advising
• Coping with stress
• Work integrated learning self care
• The art of becoming a reflective practitioner
• Academic reading and writing skills
• Social justice and diversity
• Meeting the Challenges of the Education profession
• Faculty of Education’s Language Plan and Multilingualism
• Basic financial principles for first year students
• Grievance procedure in the Faculty of Education
• Work Integrated Learning: Excursions
• Reflection, evaluation and closure

Contact details for assistance

Office hours are  07:30 - 16:30 on weekdays.

Boitumelo Gopane - 018 3892668

• Jerome Howard - 018 299 4714
• Lebohang Dikoebe - 018 299 4785 
• Marian Roscher - 018 299 4756 

Suzette Enslin - 016 910 3060

• Graphic Design
• Power Point Presentation

Presentation Method: Indispensable in Imparting Knowledge in Educational Institutions at all Levels

• November 2020

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Master of Pharmacy in Pharmacy Practice

The purpose of the MPharm in Pharmacy Practice qualification is to equip postgraduate students to practise at a highly functional level as pharmacists. They can act as role models in both the performance and future development of pharmacy practice, pharmaceutical systems, pharmaceutical public healthcare, pharmacovigilance, pharmacoepidemiology, and pharmaceutical and health economics. This qualification also aims to prepare graduates for further study at NQF level 10.

Through the years the research entity Medicine Usage in South Africa (MUSA) identified the areas below as the most relevant areas of specialisation in Pharmacy Practice. This motivates us to provide the postgraduate student with the option to choose between three internal programmes in the following three areas:

• Pharmacovigilance and Pharmacoepidemiology
• Pharmaceutical Economics and Policy
• Pharmaceutical Public Healthcare Governance

The three internal programmes build upon the knowledge, skills, views, and competence gained from an accredited professional Pharmacy degree programme. Each of the three programmes consists of four core modules (16 credits each) and a dissertation of 116 credits.

All three programmes are presented on a full-time and part-time basis in English.

The minimum duration for the study is one year and the maximum duration two years.

Applications close on 31 August.

Master of Pharmacy in Pharmacy Practice with Pharmacovigilance and Pharmacoepidemiology

The Master of Pharmacy in Pharmacy Practice with Pharmacovigilance and Pharmacoepidemiology addresses the increasing need for well-informed professionals to work in all areas relating to the assessment of drug safety and risk benefit of drug use. This programme will help health professionals to acquire advanced clinical knowledge and to train a new generation of healthcare professionals who will advance this specialised field.

The structure of the programme is as follows:

Qualification and programme code: 8ED P01; Curriculum code: G801P

Contact us:

Prof Johanita R Burger

• (018) 299 2285
• [email protected] 

Prof Martie S Lubbe

• (018) 299 2288             
• [email protected] 

Master of Pharmacy in Pharmacy Practice with Pharmaceutical Economics and Policy

The purpose of the Master of Pharmacy in Pharmacy Practice with Pharmaceutical Economics and Policy is to provide specialised training in the theory and practice of economics as applied to the delivery of healthcare services, diseases and medicine. This provides the experience and skills needed for informed healthcare service decision-making, advanced research and academic capacity in this discipline. The programme covers issues such as health and healthcare systems, methods of economic evaluation, setting priorities using health and pharmaceutical economics, pharmacoepidemiology, and the interface between health and pharmaceutical economics and health and pharmaceutical policy.

Qualification and programme code: 8ED P02; Curriculum code: G801P

Dr Rianda Joubert

• (018) 299 4290
• [email protected]  

Master of Pharmacy in Pharmacy Practice with Pharmaceutical Public Healthcare Governance

The Master of Pharmacy in Pharmacy Practice with Pharmaceutical Public Healthcare Governance programme is designed with the needs of the 21st-century pharmaceutical public-healthcare practitioner in mind. This programme will help postgraduate students to acquire the ability to apply specialised knowledge and professional skills to understand issues surrounding the governance of pharmaceutical public-health and medicine supply management in healthcare systems.

Qualification and programme code: 8ED P03; Curriculum code: G801P

Dr Irma Kotzé

• (018) 299 2239
• [email protected] 
• [email protected]

Admission requirements of the qualification

• A BPharm degree or a relevant health-science qualification approved by the Senate is required.
• Admission to the programme/curriculum is determined through selection by the MUSA scientific committee.
• Selection is subject to academic performance, practical considerations and capacity and expertise available in the research entity and subject group.
• Prospective students are recommended to have achieved at least an average of 60% in the first semester of the final year of the BPharm degree (preferably for fourth-year BPharm students), or to provide equivalent evidence of competency (e.g. international students).
• Practice experience and prior learning in the field of pharmacy will be an advantage.

Unit for Distance Learning

Unit for distance learning - university preparatory programme.

Undertaking Form

Application

Applications are now closed

Applications and Registrations Administrator:

UnivPrep Office - 018 285 2814

Latest Updates!

16 February 2024: Please note that applications close on 23 February 2024. The programme will commence on 04 March 2024.

Important Notification

Please take note that UnivPrep applications will be processed using an online portal and you are therefore not required to submit application documents via email. 

In the interim, kindly ensure you prepare the following documents for upload when applications open:

• Certified copies of your Identity Document
• Certified National Senior Certificate
• Undertaking form (see “Downloads” above)

Please remember to attach the Undertaking Form when applying online.

University Preparatory Programme (UnivPrep)

UnivPrep is a one-year preparatory programme which provides participants, who do not meet the minimum requirements for admission to degree study, with an opportunity to demonstrate that they can successfully complete the programme and that they can be admitted to formal degree study based on their UnivPrep results.

Programmes available

• UnivPrep BA participants who completed the programme successfully, can apply for admission to one of the following BA degrees:
• Public Administration which is offered full-time (at one of the NWU campuses where the degree is offered).
• Public Governance (with Policing Practice) which is offered only in the distance mode of delivery.
• UnivPrep BCom participants who complete the programme successfully, can apply for admission to a BCom degree in full-time studies at one of the NWU campuses.

Important: The successful completion of the UnivPrep BCom programme does not guarantee admission to ALL the BCom degrees offered at the NWU.

• UnivPrep BTh participants who complete the programme successfully, can apply for admission to the BTh degree either by means of distance education or full-time study at one of the NWU campuses where the degree is offered.

Admission requirements

Programme Fee

The total programme fee for 2024 is R15 700 (Excluding Study Material).

• In order to be registered for the programme, successful applicants must pay a non-refundable registration fee of R6 600.

As of 2024 NWU will not be providing textbooks to students, a list of the prescribed study material will be made available to the registered participants that they will have to procure on their own behalf.

How to apply

Via the "Application Link" at the top of this page.

Please note that you will be required to create or use a gmail account, to access the application portal.

UnivPrep: Bachelor of Commerce (BCom)

• All UnivPrep programmes are only available in  English  as a medium of instruction.
• The duration of the programme is  one year  and it comprises academic modules as well as academic development modules. 

The Bachelor of Commerce (BCom) Degree is currently not being offered by the NWU by means of distance education.  After successful completion of the BCom UnivPrep programme, prospective students wishing to enrol for a BCom Degree, have to enrol for full-time studies at one of the NWU campuses .

• The UnivPrep BCom programme is aimed at providing ACCESS to BCom degree study at the NWU, but that does not mean that UnivPrep participants who completed the programme successfully will qualify for admission to ALL the BCom degrees offered at the NWU. Admission to formal BCom degree study and granting of recognition of prior learning will be based on faculty discretionary decision as well as the academic performance of the UnivPrep participant.
• UnivPrep is a one-year preparatory programme which provides participants, who do not meet the minimum requirements for admission to degree study, with an opportunity to demonstrate that they can successfully complete the programme and that they can be admitted to formal degree study based on their UnivPrep results. Participants in a preparatory programme who did not take part in all the modules and who did not manage to pass all the modules in one year will not be able to re-register for the complete programme for a second year. Only those UnivPrep BCom participants who passed all their formative modules will qualify to re-register for a maximum of two outstanding academic modules. 

Minimum Admission requirements

• National Senior Certificate (NSC) certified by Umalusi with university admission to Diploma- or Bachelor’s degree study, or equivalent qualification.
• Admission Points Score (APS) of 20, otherwise admission per Senate Discretionary rule. 
• Grade 12 level Mathematics 30% or Technical Mathematics 35% or Mathematical Literacy 65% or equivalent qualification.

​ Specific Requirements:

To allow participation in learning and assessment activities, the following requirements are COMPULSORY for admission to the UnivPrep program:

• Possession of a laptop (or equivalent device) and mobile phone that meet the minimum specifications of the NWU namely: Wi-Fi enabled, Windows-, Android- or Apple operating system, 4G enabled (preferably) and 32 Gig
• Personal access to the internet
• Basic computer literacy

Modules/Curriculum

Academic Modules: Compulsory

• Bridging the Mathematical Gap (1st and 2nd Semester)
• Financial Accounting Special (1st and 2nd Semester)
• Introduction to Micro-economics (1st semester)
• Introduction to Macro-economics (2nd semester)

NB:  UnivPrep participants who are accepted for the UnivPrep BCom Programme and who were enrolled in  Mathematical Literacy  in Grade 12 as well as those who did not take  Accounting  in school, are STRONGLY ADVISED to take extra Maths and Accounting classes for additional support.

Academic Development Modules: Compulsory

• Academic Literacy Development  (1st and 2nd semester)
• Strategic Reading in the Content Areas (1st semester)
• Critical Thinking Skills (2 nd semester)
• The programme will run from February 2024 at which time the full academic calendar will be provided. (Please note these start periods are subject to change and official dates will be communicated to ACCEPTED applicants only during January 2024).
• Assignments should be submitted as per the academic calendar.
• Continuous assessments will take place during June/July and October/November 2024. No second opportunity assessments will be provided.

UnivPrep: Bachelor of Theology (BTh)

The Bachelor of Theology degree is also offered in the distance mode of delivery. After successful completion of the UnivPrep programme, UnivPrep participants will be able to apply for the BTh degree either by means of distance education or by means of full-time study at one of the NWU campuses where the degree is offered.

UnivPrep is a one-year preparatory programme which provides participants, who do not meet the minimum requirements for admission to degree study, with an opportunity to demonstrate that they can successfully complete the programme and that they can be admitted to formal degree study based on their UnivPrep results. Participants in a preparatory programme who did not take part in all the modules and who did not manage to pass all the modules in one year will not be able to re-register for the complete programme for a second year. Only those UnivPrep BTh participants who passed all their formative modules will qualify to re-register for a maximum of one outstanding academic module.  

Specific Requirements:

Academic Modules: compulsory          

• Introduction to the New Testament: History and General Canonics (1st and 2nd Semester)
• Introduction to Old Testament: Origin and Structure (1st and 2nd Semester)
• Pastoral Counselling (1st and 2nd Semester)

PLEASE NOTE: The three Theology specific modules, namely Introduction to Old Testament (AAAA173/OTES171), Introduction to New Testament (AAAA172/NTES171) and Pastoral Counselling (AAAB122/PAST121) are eLearning-based and UnivPrep participants will not attend lecture sessions in these modules. UnivPrep students will be able to interact with lecturers and access all study material (including videos in which concepts are explained) by means of interactive eFundi sites.

• Academic Literacy Development  (1st and 2nd semester)
• Critical Thinking Skills (2nd semester)

UnivPrep: Bachelor of Arts (BA) Degree in Public Governance (with Policing Practice)

• All UnivPrep programmes are only available in English as a medium of instruction.
• The duration of the programme is one year and it comprises academic modules as well as academic development modules.
• UnivPrep BA participants who completed the programme successfully, can apply for admission to full-time BA degrees in Public Administration (at one of the NWU campuses where these degrees are offered) or for the BA Degree in Public Governance (with Policing Practice) which is offered only in the distance mode of delivery.
• UnivPrep is a one-year preparatory programme which provides participants, who do not meet the minimum requirements for admission to degree study, with an opportunity to demonstrate that they can successfully complete the programme and that they can be admitted to formal degree study based on their UnivPrep results. Participants in a preparatory programme who did not take part in all the modules and who did not manage to pass all the modules in one year will not be able to re-register for the complete programme for a second year or the outstanding modules. You only have one opportunity to pass. 
• Admission Points Score (APS) of 20, otherwise admission per Senate Discretionary rule.
• Minimum achievement of 50% for English at Grade 12 level.

Specific Requirements: COMPULSORY!

Modules / Curriculum

Academic Modules: compulsory                                 

• Policing Management: Crime Prevention (1st semester)
• Policing Management: Community Service Centre Management (2nd semester)
• Professional Skills Development (1st semester)
• Communication Skills in the Workplace (2nd semester)

Academic Development Modules: Compulsory                   

• Critical Thinking Skills (2nd semester)

Additional Information

Admission to formal degree study, recognition of prior learning (rpl) and re-registration.

• Upon successful completion of the UnivPrep programme, i.e. passing ALL modules with 50%, participants may APPLY for admission to formal degree study at the NWU.
• In terms of the NWU enrolment plan, a limited number of students can be admitted to the various degree programmes at the NWU each year and Faculties reserve the right to approve applications for admission to formal degree study based on (amongst others) the academic performance of the UnivPrep participant.
• Admission to degree study after successful completion of the Univprep programme will be based on discretionary decision by the Faculty and the academic performance of the UnivPrep participant will be a determining factor.
• UnivPrep is a one-year preparatory programme which provides participants, who do not meet the minimum requirements for admission to degree study, with an opportunity to demonstrate that they can successfully complete the programme and that they can be admitted to formal degree study based on their UnivPrep results. Participants in a preparatory programme who did not take part in all the modules and who did not manage to pass all the modules in one year will not be able to re-register for the complete programme for a second year. Only for UnivPrep BCom and BTh participants who passed all the formative modules will have an opportunity to re-register for one or two (depending on the UnivPrep programme) outstanding academic modules for a second year. UnivPrep BA participant will not be allowed to reregister for any outstanding academic modules for a second year and only get one opportunity to complete the programme.
• The Preparatory Programme is designed for students to get access to formal studies at our(NWU) institution only, this programme is not on an NQF level, does not provide a certificate of completion and cannot guarantee accreditation or access at any other institution. Upon completion a participant will only be provided with a statement of results reflecting their performance during the programme. .

Method of delivery

IMPORTANT : UnivPrep is presented in distance learning only and is FULLY online meaning that you do not need access to the campus to take part in the programme. Student support will be provided in the following methods:

• Lecturers sessions will be presented by means of live and pre-recorded online classes.
• All lectures sessions are recorded and saved on the Internet and can be viewed afterwards by participants as frequently as required.
• Additional support for participants is provided by means of eFundi which is the Learner Management system of the NWU. A Learner Management system supports communication between lecturers and participants. Academic information such as subject content, discussion forums, important dates and additional resources are advised on e-Fundi.
• UnivPrep participants are expected to do independent self-study to ensure that they are thoroughly prepared when attending contact sessions. 

Examinations

Conventional sit-down examinations have been replaced with continuous assessments as the programme will be administered FULLY online. The lecturers will make detailed assessment plans available on eFundi.

Internet and technology

• Internet and Technology are used extensively in delivering distance education programmes and it is therefore of utmost importance that UnivPrep participants have access to the Internet by means of a computer or laptop.
• UnivPrep participants have to access study guides and programme related information, submit assignments, complete assessments, interact with lecturers and other participants through live chats and keep track of important events and due dates by means of eFundi which is the online learning management system (LMS) of the NWU.
• Communication between the NWU and UnivPrep participants occurs extensively through electronic communication media such as eFundi (LMS), Email’s, SMS’s (mobile phones) and social media.
• It is COMPULSORY , and the responsibility of the participant to obtain the necessary technology such as a computer and mobile phone that meet the minimum specifications of the NWU namely: Wi-Fi enabled, Windows-, Android- or Apple operating system, 3G enabled (preferably) and 32 Gig (preferably) as well as the prescribed textbooks.
• The total programme fee for 2024 is R15 700 (including registration and excluding textbooks).
• As of 2024 NWU will not be providing textbooks to student, a list of the prescribed study material will be made available to the registered participants that they will have to procure on their own behalf.
• The balance (due after registration) is payable in monthly instalments, from February 2024 and the full programme fee must be paid by 30 September 2024.
• Please note: due to the fact that UnivPrep is a preparatory programme and not a formal qualification, UnivPrep participants do not qualify for NSFAS funding.

The purpose of this information is to provide a broad overview of the UnivPrep Programmes. 

The information was compiled for introduction purposes and is subject to change.

The North-West University reserves the right to make changes to the programme details (e.g. curricula, admission requirements etc.) and accepts no liability for inaccuracies due to changes that may occur in this guide.

Student Support

• UnivPrep participants can access their study guides via eFundi.
• All lecture sessions are recorded and saved on the Internet to be viewed by UnivPrep participants as frequently as required.
• Lecturers are keen to provide support and assistance and participants are encouraged to make contact with lecturers by means of telephone, e-mail or personal appointments.
• UnivPrep participants are expected to do independent self-study to ensure that they are thoroughly prepared when attending contact sessions.

NWU Presentation – North-West University

NWU Presentation: North-West University Presentation in South Africa.

 Through this article, we have provided all the details related to  NWU Presentation. Check here for North-West University Presentation details. The North-West University is a public research university located on three campuses in Potchefstroom, Mahikeng and Vanderbijlpark in South Africa. The head offices of the university are located on the Potchefstroom campus.

North-West University (NWU) offers courses and programs leading to officially recognized higher education degrees such as bachelor degrees, master degrees, doctorate degrees in several areas of study. NWU also provides several academic and non-academic facilities and services to students including a library, housing, sports facilities, financial aids and/or scholarships, study abroad and exchange programs, online courses and distance learning opportunities, as well as administrative services.

NWU Presentation – Check Here

For more information, NWU dates and useful links, please visit http://www.nwu.ac.za/

Wish you all the best for your future !

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Imaging biomarkers of cerebral edema automatically extracted from routine CT Scans of large vessel occlusion strokes

1 Department of Neurology, Washington University School of Medicine, Saint Louis, MO

Yasheng Chen

Yelyzaveta begunova.

2 Department of Neurology, Yale School of Medicine, New Haven, CT

Madelynne Olexa

Ayush prasad, grace carey, isabella gonzalez, kunal bhatia, mohammad hamed.

3 Department of Neurology, The Ohio State University, Columbus, OH

Laura Heitsch

4 Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO

Shraddha Mainali

5 Department of Neurology, Virginia Commonwealth University, Richmond, VA

Nils Petersen

Jin-moo lee, background and purpose:.

Volumetric and densitometric biomarkers have been proposed to better quantify cerebral edema after stroke, but their relative performance has not been rigorously evaluated.

Patients with large vessel occlusion stroke from three institutions were analyzed. An automated pipeline extracted brain, CSF and infarct volumes from serial CTs. Several biomarkers were measured: change in global CSF volume from baseline (ΔCSF); ratio of CSF volumes between hemispheres (CSF ratio); and relative density of infarct region compared with mirrored contralateral region (net water uptake, NWU). These were compared to radiographic standards, midline shift and relative hemispheric volume (RHV) and malignant edema, defined as deterioration resulting in need for osmotic therapy, decompressive surgery, or death.

We analyzed 255 patients with 210 baseline CTs, 255 24-hour CTs, and 81 72-hour CTs. Of these, 35(14%) developed malignant edema and 63(27%) midline shift. CSF metrics could be calculated for 310(92%) while NWU could only be obtained from 193(57%). Peak midline shift was correlated with baseline CSF ratio (ρ=−0.22) and with CSF ratio and ΔCSF at 24 hours (ρ=−0.55/0.63) and 72 hours (ρ=−0.66/0.69), but not with NWU (ρ=0.15/0.25). Similarly, CSF ratio was correlated with RHV (ρ=−0.69/−0.78), NWU was not. Adjusting for age, National Institutes of Health Stroke Scale, tissue plasminogen activator treatment, and Alberta Stroke Program Early CT Score, CSF ratio [Odds Ratio (OR) 1.95 per 0.1, 95% Confidence Interval (CI) 1.52–2.59] and ΔCSF at 24 hours (OR 1.87 per 10%, CI 1.47–2.49) were associated with malignant edema.

Conclusion:

CSF volumetric biomarkers can be automatically measured from almost all routine CTs and correlate better with standard edema endpoints than net water uptake.

Introduction:

Most patients with hemispheric strokes develop cerebral edema over the first few days after the ischemic insult. Cerebral edema is not only a major source of death and deterioration in the acute setting, but increased severity of edema has been independently related to worse long-term outcomes. 1 , 2 Midline shift of variable degrees develops in almost half of all large vessel occlusion (LVO) strokes in the anterior circulation. 3 While this may begin to be visible by 24 hours, it is primarily a manifestation of decompensated late-stage edema, peaking two to four days post-stroke. Detection of edema before midline shift and clinical deterioration occurs has been the subject of increasing interest. 4 This would allow selection of patients for targeted interventions to reduce the impact of edema after stroke. 5 Furthermore, quantification of edema across its full spectrum would facilitate a broader understanding of its biologic basis and contribution to stroke outcomes. 6

Prior approaches proposed to quantify edema have required advanced imaging, either comparison of diffusion-weighted imaging and fluid-attenuated inversion recovery volumes on serial MRI examinations, or by measuring the relative hemispheric volume (RHV) on MRI, using the increase in size of the ipsilateral hemisphere as a surrogate of stroke-related swelling. 7 , 8 Accurate automated CT-based measures would facilitate more widespread applications, as CT is the primary imaging modality after stroke. Infarct volume alone cannot be used to measure edema, as the infarct-related hypodensity comprises a variable combination of infarcted tissue and resulting edema. It is the excess water that contributes to hemispheric swelling and eventually results in midline shift. Several biomarkers that quantify water accumulation or hemispheric or global brain swelling have been developed over the past five years including net water uptake and those based on changes in CSF volume. 9 – 13 Net water uptake (NWU) measures the relative density of the stroke lesion compared with a matching contralateral region as a surrogate for water accumulation. 13 . It has been applied primarily in the acute setting, where early edema formation on baseline CT has been related to worse collaterals, hyperglycemia, and to risk of malignant edema. 9 , 14 – 16 Fewer studies have evaluated NWU as a marker of evolving edema on follow-up CTs; in fact, a recent evaluation of NWU challenged its validity in relation to reference standards of midline shift and RHV in the LVO population undergoing thrombectomy. 17 Furthermore, measurement of NWU typically requires manual delineation of the infarct lesion, limiting ease of measurement. 18 A second approach focuses on the volumetric assessment of swelling using the surrogate of global or hemispheric reductions in CSF volumes. 10 – 12

Both these densitometric and volumetric CT-based approaches have been proposed as means of better quantifying edema in order to predict midline shift and subsequent clinical deterioration (including the need for decompressive surgery) and as a therapeutic biomarker to assess response to emerging anti-edema interventions. 4 , 9 , 19 Such tools could facilitate both clinical and research endeavors to mitigate the consequences of cerebral edema after stroke. However, it remains unclear how these two classes of biomarkers are related and whether one or the other better capture brain swelling and risk of deterioration, as no side-by-side studies have been performed. In this study, we used an automated image analysis pipeline recently developed to measure both NWU and CSF volumes on serial CTs, the primary imaging modality used at most centers, 20 to extract these biomarkers from a large multi-institutional cohort of anterior circulation LVO patients. We hypothesized that volumetric biomarkers such as global displacement of CSF (change in global CSF volume from baseline, ΔCSF) and hemispheric CSF ratio would relate to established radiographic and clinical edema outcomes better than densitometric markers of edema like NWU.

Cohort and Subject Selection

We retrospectively collected clinical and imaging data from three institutional stroke cohorts encompassing consecutive patients presenting between June 2016 to November 2019. The collection of data for each cohort was approved by the respective institution’s human studies review board with a waiver of consent. Imaging data were collected in a central stroke repository. 21 They were analyzed using an image analysis pipeline, described below. Subjects were included in this analysis if they were diagnosed with stroke due to an acute occlusion of the internal carotid or middle cerebral artery and had follow-up imaging performed in the first week after stroke. Time of last seen normal was used when exact stroke onset time was unknown. We selected follow-up CTs performed at least 12 hours after stroke onset and within one week. The majority of patients had routine follow-up imaging performed at 24 hours after thrombolysis and/or thrombectomy per site protocol. A baseline CT was also available for most patients, allowing calculation of ΔCSF. Clinical variables were abstracted from medical records (including structured stroke team notes) at each site by trained study investigators. These included demographics, last seen normal time, admission National Institutes of Health Stroke Scale (NIHSS), treatment with tissue plasminogen activator (tPA) and/or endovascular thrombectomy, reperfusion (using modified thrombolysis in cerebral infarction scale grading, reported at the time of thrombectomy), and development of malignant cerebral edema, defined as radiographic evidence of brain swelling (i.e. midline shift) in association with both clinical deterioration and resulting in either death, surgical intervention, or treatment with osmotic drugs.

Imaging Analysis

We refined a stroke edema pipeline to extract multiple edema biomarkers. This included segmentation of CSF using a machine learning approach, 22 followed by extraction of the brain using BET (from the FSL package), 23 and delineation of the two cerebral hemispheres by registering the brain midline to a standard CT atlas and then translating the midline on the atlas back to the patient’s image. 24 This allowed the separation of CSF and brain regions into hemispheres and the calculation of brain and CSF hemispheric ratios. 10 The RHV was the ratio of the volume of the brain in the stroke-affected hemisphere versus the contralateral hemisphere and the CSF ratio was the ratio of the volume of CSF in the stroke-affected hemisphere versus the contralateral hemisphere. 7 We recently expanded the pipeline to automatically extract NWU from routine follow-up CTs by: 1) segmenting the hypodense region of acute cerebral infarction using a deep learning algorithm trained on 335 manually labeled examples 20 ; and 2) measuring the density of the infarct region and a mirrored region placed in the contralateral hemisphere, using the brain midline for reflection. Measurement of NWU was further refined by removing voxels of CSF from the infarct and mirror regions to avoid contamination, as well as thresholding the infarct region at 40 Hounsfield Units to remove high-density regions that could represent hemorrhagic transformation or contrast staining and would otherwise contaminate measurement (as recently demonstrated). 17 This pipeline was validated against manual measurement of NWU (both full-infarct and sampling-based methods) in a recent publication. 20 The final imaging results for an example patient are shown in Figure 1 .

Output of image analysis for a follow-up CT at 72 hours after stroke for a patient with large right hemispheric infarction. The first column shows three axial slices from the non-contrast head CT (note: there are several regions of petechial hemorrhagic transformation and there was 3-mm of midline shift measured). The second column shows the extracted brain mask with automated delineation of the midline, separating the brain into right (ipsilateral) and left (contralateral) hemispheres. This allows calculation of the relative hemispheric volume (1.165). The third column shows the automated cerebrospinal fluid (CSF) segmentation, with hemispheric CSF separated using the same midline. The ratio of hemispheric CSF volumes is 0.07. In the final column, the orange region highlights the automated infarct segmentation. White regions within this represent areas thresholded out (i.e. Hounsfield units above 40). The purple region is the mirror of the infarct region within the contralateral hemisphere. The white regions within this represent areas of CSF not included in the mean density calculation. The ratio of infarct to mirror region densities is the net water uptake. Abbreviations: CSF = cerebrospinal fluid, ml = milliliters, HU = Hounsfield units, NWU = Net Water Uptake

We applied this pipeline to calculate ΔCSF, the hemispheric CSF ratio, RHV, and NWU from this multi-institutional cohort of anterior circulation LVO patients. We applied it to both baseline and follow-up CTs, though we excluded those without visible infarction from NWU but not CSF calculation, as NWU cannot be calculated in the absence of a visible lesion (no infarct was present in 45% of scans at 24 hours and 21% at 72 hours; NWU could be measured from all but eleven of those with infarcts, representing a total of only 193 follow-up CTs or 57%). We performed manual review of the automated imaging results for quality control and exclusion of: 1) cases where CSF segmentation or midline delineation failed (5 baseline, 15 24-hour CTs, and 9 72-hour CTs failed segmentation, ratio could not be obtained from one additional baseline and two scans at 24 hours – failed in 6% of 546 CTs ); 2) cases without visible infarct or where automated infarct segmentation failed to capture the majority of the lesion. Midline shift was measured manually as the displacement of the midpoint of the septum pellucidum at the level of its maximal displacement (evaluating over several slices around the level of the frontal horns) and presence/severity of hemorrhagic transformation was ascertained. 25

Statistical Analysis

The first CT performed within 12 hours of stroke onset was considered the baseline. Follow-up CTs were categorized into those closest to 24-hours (12–36 hours) and those closest to 72 hours (36–168 hours). The change in CSF volume between the baseline and each follow-up time point was calculated (ΔCSF). The peak midline shift was the maximal measured shift on all follow-up CTs. Correlations of biomarkers were performed using Spearman rho (ρ) given their non-parametric distribution. Partial correlations, adjusting for infarct volume, were also performed. Logistic regression was used to evaluate the independent association of each biomarker with malignant edema, adjusting for baseline variables, as well as tPA treatment and reperfusion status (in those undergoing thrombectomy). We compared the performance of midline shift and other biomarkers by: i) comparing the Aikake Information Criterion (AIC) performance of each model to one using midline shift to predict malignant edema; ii) adjusting the biomarker-based model for midline shift to determine if the association persisted. Given the a priori concern that the performance of NWU may differ in those undergoing thrombectomy and in those with hemorrhagic transformation, we performed sensitivity analyses stratified by thrombectomy and hemorrhagic transformation status. To evaluate the temporal evolution of each biomarker across the three time points, we constructed linear mixed models to analyze the repeated measurements, stratified by malignant edema groups. We used the actual time (not time bins) to each scan as the time variable and the measurement of each biomarker at each time point as the dependent variable. We evaluate the interaction of time and grouping, adjusting for the intra-subject correlations as random effects. All analyses were performed in R (version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria) using packages corrplot, ppcor, and lmerTest.

Subjects, Scans, and Clinical Characteristics:

Of 392 stroke patients evaluated, forty-seven were excluded for unknown stroke onset time, no LVO present on review of CT angiography, or occlusion not in the internal carotid artery (ICA) or middle cerebral artery (MCA) vessels ( Figure 2 ). No imaging was available for seven of the remaining 352 anterior circulation LVO subjects, and an additional eleven had no usable images after excluding poor quality or technically unusable scans. Among the remaining 334, 79 had only baseline CTs or no follow-up CTs beyond 12 hours, leaving 255 subjects with required follow-up imaging available. All had scans around 24 hours after stroke onset [median 25.8 hours, Interquartile Range (IQR) 21–30] and 81 had additional follow-up scans around 72 hours (median 70 hours, IQR 55–87). No baseline CT was available in 45 cases, primarily because it had been performed at another outside facility or in cases of delayed presentation (i.e. when first CT was beyond 12 hours). The median time to baseline CT from stroke onset was 2.2 hours (IQR 0.9–4.3).

Flow of Subjects within this Study. FU, follow-up; ICA, internal carotid artery; LVO, large vessel occlusion; MCA, middle cerebral artery; N, number

The mean age in this cohort was 69 (standard deviation ± 15) years, 118 (46%) were female, and 59 (23%) were non-white or Hispanic, by self-report. Baseline NIHSS was 15 (IQR 10–21) and glucose on presentation was 121 mg/dl (IQR 109–144). Forty patients had an occlusion of the internal carotid artery, in 129 it involved the proximal MCA, and in 84 the M2 or M3. Thrombolytic therapy was given in 110 (43%) and endovascular thrombectomy was attempted in 159 patients (62%). Successful reperfusion was recorded in 128 (80%). Malignant edema developed in 35 patients (12%) and parenchymal hematoma (PH)-1 or PH-2 hemorrhagic transformation in 35 (14%). A comparison of the cohort demographics and clinical features divided by malignant edema status is shown in Table 1 . There were no differences in age, sex, racial identification, admission glucose or blood pressure between the groups. NIHSS was higher and Alberta Stroke Program Early CT Score (ASPECTS) was lower in those developing malignant edema. Baseline CTs were available in 25 of 35 of the malignant edema group compared with 175 of 210 in the non-edema group. There was no difference in the rate of thrombolytic or endovascular treatment between the groups but successful reperfusion was significantly less likely in the malignant edema group. These patients were also more likely to have ICA or first segment of the middle cerebral artery segment occlusions. Few (4 of 45) of those with malignant edema had experienced clinical deterioration at 24 hours, and all 24-hour follow-up imaging was performed at or prior to the time of deterioration.

Comparison of demographic, clinical, and imaging features in those with versus without malignant edema in this study cohort

Values in parenthesis represent percentages of each group (%),standard deviation (SD), or interquartile range (IQR), as indicated.

ASPECTS, Alberta Stroke Program Early CT Score; ICA, internal carotid artery; LVO, large vessel occlusion; M1, first segment of the middle cerebral artery; n, number; NIHSS, National Institutes of Health Stroke Scale, PH, parenchymal hematoma; tPA, tissue plasminogen activator; ΔCSF, change in CSF volume from baseline.

Measurement of Biomarkers

The values for each biomarker measured at each of the three time points are shown in Table 2 . Midline shift was present in 55 patients (22%) at 24 hours and in 63 patients (27%) overall, although the median midline shift was still zero at both time points. RHV was significantly different from one on the baseline scan (i.e. two hemispheres were not equal in volume, p<0.001) but asymmetry increased further at follow-up. The median reduction in CSF volume at 24 hours was 24 ml (IQR 8–49), representing a 14% change from baseline (IQR 6–30). In those with 72-hour scans, the total ΔCSF was 34 ml (13–74) or 22% (9–41%). The CSF ratio was significantly below 1.0 at baseline (p<0.001) and was correlated with RHV at all three time points ( Figure 3A for 24-hour time point, ρ=0.74).

A) Correlation of hemispheric CSF ratio and relative hemispheric brain volume on 24-hour CT scans (line represents linear regression with 95% confidence interval); B) Plot of hemispheric CSF ratio and midline shift on 24-hour CT (line represents quadratic regression with 95% confidence interval)

Descriptive summary of edema biomarkers measured at baseline and on follow-up CTs at 24- and 72-hours

Values in parentheses represent the interquartile range for each measurement.

n, number; N/A, not applicable.

Correlations between Biomarkers

Figure 4 shows the correlation matrix between the various biomarkers of edema. Peak midline shift was correlated most strongly with the CSF ratio at both 24- and 72 hours (rho=0.65 and 0.69) but also with ΔCSF. In contrast, there was only weak correlation between peak MLS and NWU at 24 hours (ρ=0.14, p=0.1) and at 72 hours (ρ=0.27, p=0.042). Evaluating the relationship of decreasing CSF ratio with midline shift suggested that when the ratio fell below 0.50 there was a sharp rise in midline shift ( Figure 3B ). Even the CSF ratio on baseline CT was weakly correlated with peak midline shift (ρ=0.23, p=0.001) while baseline RHV was not. The association of CSF ratio at 24 hours with midline shift remained significant even after adjusting for infarct volume (partial correlation 0.48, p<0.0001) as it did for ΔCSF (−0.35, =0.0001).

Correlation matrix showing relationships between all edema biomarkers. Blue indicates positive correlations and red negative correlations. Darker colors indicate stronger correlations. Significance of correlations represented by stars: one star indicates p<0.05, two stars p<0.001, and three stars p<0.0001. CSF, cerebrospinal fluid; hr = hour; NWU, net water uptake; RHV, relative hemispheric volume; ΔCSF, change in CSF volume (from baseline).

Association of Biomarkers with Malignant Edema

The hemispheric CSF ratio was lower in those destined to develop malignant edema even on baseline CT (0.88 vs. 0.95, p=0.02) while RHV was not (1.014 vs. 1.007, p=0.09). We did not have enough baseline NWU (nine cases, of which two had edema) measurements to compare it between edema groups. The total displacement of CSF (ΔCSF) was significantly greater (49% vs. 12%) and the CSF ratio significantly lower (0.37 vs. 0.83, both p<0.0001) at 24 hours, while NWU was similar ( Table 1 ). Adjusting for age, NIHSS, tPA treatment, and ASPECTS, 24-hour CSF ratio was strongly associated with malignant edema [Odds Ratio (OR) 1.95 per 0.1 decrease, 95% Confidence Interval (CI) 1.52–2.59] while baseline CSF ratio was not (OR 1.23 per 0.1 decrease, 95% CI 0.87–1.87). Notably, neither NIHSS nor ASPECTS were independently predictive of malignant edema after incorporating CSF ratio. The association of 24-hour hemispheric CSF ratio and malignant edema persisted after adjusting for actual degree of midline shift at 24 hours (OR 1.48, 95% CI 1.08–2.08) and the model with CSF ratio (without midline shift) had a lower AIC to predict malignant edema than the model incorporating midline shift with the same clinical variables (127.0 vs. 131.8).

Similarly, ΔCSF was independently associated with malignant edema (OR 1.87 per 10% decrease, 95% CI 1.47–2.49), while NWU was not (p=0.49). In fact, both CSF-based biomarkers had stronger associations than the reference standard, RHV. In those undergoing thrombectomy, successful reperfusion was associated with a lower risk of malignant edema (OR 0.21, 95% CI 0.07–0.60), adjusting for age, NIHSS, tPA, and ASPECTS. However, the CSF ratio at 24 hours remained significantly associated, even adjusting for reperfusion status (OR 1.89 per 0.1 decrease, 95% CI 1.41–2.67). Similarly, ΔCSF was associated with progression to malignant edema (OR 2.21 per 10%, 95% CI 1.53–3.65), while NWU was not. Finally, even excluding those who underwent thrombectomy, NWU was still not associated with edema, while CSF parameters were. Similarly, excluding the 38 patients with PH type of HT, there was still no correlation of NWU with midline shift or association with malignant edema.

We then constructed linear mixed models of each biomarker over time, separated by malignant edema groups. The CSF ratio was 0.92 at time 0 and went down linearly over time (0.003/hour across all subjects), but those with malignant edema had lower CSF ratio (by 0.07) and a steeper slope of change in CSF ratio over time (0.01 per hour, p<0.0001; Figure 5A ). Similarly, the total CSF started from baseline volume of 161 ml, went down over time, but with a steeper slope of ΔCSF in those with malignant edema (1.6 ml/hour vs. 0.4 ml/hour, p<0.0001; Figure 5B ). These effects were similar to that seen for midline shift (baseline 0, slope 0.01/hour versus 0.15/hour in those with edema, p<0.0001; Figure 5C ). However, there was no association of malignant edema with slope of NWU over time, with both groups exhibiting a similar increase in NWU over time ( Figure 5D ).

Spaghetti plots showing the trajectories of each edema biomarker (A, CSF Ratio; B, Total CSF Volume; C, Midline Shift; D, Net Water Uptake, NWU) over time, plotted for each subject at each available time point, with linear group averages plotted with 95% confidence intervals (grey regions), separated between those without malignant edema (left panel, red) and in those with malignant edema (right panel, blue).

In this analysis of 255 patients with stroke due to anterior circulation LVO, we demonstrated that CSF-based volumetric biomarkers on serial head CTs correlate strongly with established imaging measures of edema and with the clinical outcome of malignant cerebral edema. A lower hemispheric CSF ratio at baseline and 24-hours was associated with greater midline shift and higher risk for malignant edema, as was a greater displacement of CSF (ΔCSF). Moreover, asymmetry of CSF between the two hemispheres (i.e. low CSF ratio) could be evaluated in all those with edema, even on admission, while midline shift was visualized in less than one quarter of patients at 24 hours. Evaluating CSF displacement offers an earlier imaging window into the evolution of edema than possible using midline shift or waiting till clinical deterioration occurs. In contrast, the densitometric biomarker, net water uptake, did not exhibit a relationship to any of these established measures. Furthermore, we demonstrated that the volumetric biomarkers could be obtained from almost all CT scans while NWU could be measured in just over half, restricted to cases when a clear infarct was visible.

We employed a comprehensive pipeline to automatically extract both classes of biomarkers from serial routine head CTs obtained at three different institutions. Both classes of biomarkers have gained traction in the evaluation of post-stroke edema. However, there have not been prior studies comparing CSF-based volumetric to density-based biomarkers. NWU has demonstrated promise in evaluating early edema progression, measured on baseline CT, including as an early marker of malignant edema. 9 Fewer studies have studied NWU on follow-up CT to evaluate whether greater water accumulation (measured per unit volume infarction) relates meaningfully to the development of clinically significant brain swelling. 26

Further, several limitations of NWU have been raised. Measurement of NWU requires manually outlining the region of infarction, slice-by-slice, and then mirroring this region to the contralateral hemisphere; an approach impractical for bedside assessment or for use in large cohort studies. We surmounted this obstacle by developing a NWU algorithm that automatically segments the hypodense infarct region and creates the mirror region. 20 The second is that NWU assessment at follow-up is particularly susceptible to contamination from regions of hemorrhagic transformation or contrast within the infarct (for example, in those undergoing thrombectomy). In fact, a recent study of 144 large hemispheric strokes demonstrated that NWU did not correlate with RHV (both manually measured), but did so weakly after excluding those with hemorrhage (ρ=0.21) or all those undergoing thrombectomy (ρ=0.45). The exclusion of such patients limits its broad applicability to study edema after a severe stroke. Our NWU method attempts to mitigate this by thresholding the region of infarction at an upper limit of 40 Hounsfield Units; while we observed a slightly stronger correlation to midline shift and RHV when excluding patients with hemorrhage or thrombectomy, it was still not significantly correlated with reference standards of edema. This suggests that NWU on follow-up CT does not capture the key aspects of brain swelling that are associated with deterioration. Instead, it may reflect different aspects of edema, perhaps the early ionic shifts that cause progressive tissue hypodensity but may not lead to as much brain swelling as the cytotoxic and vasogenic edema pathways that precipitate volumetric increases in the ipsilateral hemisphere and can lead to herniation. These are more strongly captured by measuring the displacement of hemispheric and global CSF. Both global and the ratio of hemispheric CSF volumes were reduced linearly over the first 96 hours after stroke onset, but much more rapidly in those who later would develop malignant edema. These volumetric biomarkers are more widely measurable at early time points (i.e. do not require a visible infarct or concurrent estimation of infarct from CT perfusion) and are strongly linked to clinically significant outcomes. Further studies should assess how incorporating these biomarkers, measured at 24 hours or even earlier after stroke, can enable more accurate and earlier prediction of those who may require surgery for malignant edema than conventional measures such as NIHSS and midline shift. 4

Our study has limitations, including some bias in which patients underwent CTs at each time point. All institutions performed CTs around 24 hours after stroke in those undergoing thrombectomy, mitigating selection bias in this subgroup. However, it is likely that the non-thrombectomy patients who underwent repeat CT represent a more severe subset than those who did not. Similarly, the smaller cohort of 72-hour scans represents clinical selection based on patient status and likely selects those with more edema. Nonetheless, our side-by-side imaging comparison of several biomarkers in parallel is unlikely to be substantially skewed by this bias. Our clinical outcome measure of malignant edema is also prone to variability based on physician/institutional practices in when and in whom to initiate therapies or perform surgery. To mitigate against such biases, we included patients from three diverse centers with varying practices and so our findings are likely more generalizable. Nevertheless, given our automated multi-phenotype pipeline, our findings can be easily further tested in even larger and diverse cohorts. The current work is applicable only to anterior circulation LVOs affecting the ICA and MCA and cannot be generalized to occlusions and strokes in other locations. Accurate quantitative biomarkers will enable a deeper understanding of how biologic factors and interventions, including reperfusion, blood pressure, and hyperglycemia, mitigate or worsen cerebral edema across the spectrum of severities. This work suggests that the choice of biomarkers may depend on what aspect of edema or outcome is being interrogated.

Acknowledgements

This study was supported by grants from the NIH (K23NS099440 and R01NS121218)

Disclosure:

The authors have no relevant conflicts of interest to disclose.