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Brain Sciences
Special Issues
Management of Acute Stroke
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Management of Acute Stroke

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Systems Neuroscience".

Deadline for manuscript submissions: 30 January 2026 | Viewed by 1064

Special Issue Editors

Prof. Dr. Christian Tanislav

E-Mail
Guest Editor
Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
Interests: stroke; clinical neurology; neurological diseases; neuroimaging; stroke imaging; adult neurology; neurologic examination; neurodegenerative diseases; neurodegeneration; brain diseases
Dr. Ali Hammed

E-Mail Website
Co-Guest Editor
Neurology and Geriatrics, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
Interests: stroke; thrombectomy; neurology; neurosurgery

Special Issue Information

Dear Colleagues,

In recent decades, substantial advances in the understanding and treatment of acute stroke have significantly impacted patient care. The establishment of specialized stroke units marked an important milestone, followed by the advent of intravenous thrombolysis and, more recently, mechanical thrombectomy as interventional procedures.

As seen in recent clinical trials, these treatments have substantial benefits for patients who experienced acute ischemic stroke. However, only a subset of patients qualify for these advanced therapies. Barriers to eligibility, including delays in stroke recognition, variability in emergency response systems, and limited access to specialized stroke care facilities, often arise in the prehospital phase. Acute stroke management is therefore a dynamic and evolving field, with each phase of care being subject to continuous quality improvement. Emerging evidence informs the implementation of novel interventions and promotes the enhancement of treatment infrastructure.

This Special Issue addresses key challenges in the management of acute stroke and presents new insights aimed at improving outcomes in acute cerebrovascular care.

Prof. Dr. Christian Tanislav
Guest Editor

Dr. Ali Hammed
Co-Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


Keywords

  • management in acute stroke care
  • thrombolysis
  • mechanical thrombectomy
  • epidemiology in stroke care
  • stroke unit
  • cerebral infarction
  • intracranial bleeding
  • therapy in acute stroke

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Published Papers (3 papers)

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Research

10 pages, 940 KiB  
Article
Premorbid Comorbidities as Predictors of Outcome in Ischemic Posterior Fossa Stroke: A Retrospective Evaluation Using the Age-Adjusted Charlson Comorbidity Index
by Francesca Culaj, Toska Maxhuni, Stefan T. Gerner, Anne Mrochen, Tobias Braun, Priyanka Boettger, Maxime Viard, Hagen B. Huttner, Martin Jünemann and Omar Alhaj Omar
Brain Sci. 2025, 15(8), 892; https://doi.org/10.3390/brainsci15080892 - 21 Aug 2025
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Abstract
Background: Posterior cranial fossa (PCF) infarctions are associated with elevated mortality rates; however, evidence regarding the prognostic value of comorbidity indices in this context remains scarce. This study investigates the association between the age-adjusted Charlson Comorbidity Index (aCCI) and clinical outcomes in patients [...] Read more.
Background: Posterior cranial fossa (PCF) infarctions are associated with elevated mortality rates; however, evidence regarding the prognostic value of comorbidity indices in this context remains scarce. This study investigates the association between the age-adjusted Charlson Comorbidity Index (aCCI) and clinical outcomes in patients with PCF infarctions, aiming to evaluate the aCCI as a prognostic indicator. The aCCI is a validated scoring system that quantifies a patient’s burden of chronic diseases, adjusting for age, to estimate overall comorbidity risk. Methods: In this retrospective, single-center analysis spanning two years, patient data were assessed to determine correlations between aCCI scores and clinical outcomes at discharge, specifically the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS). Structural equation modeling (SEM) was employed to elucidate the relationships among these variables. Results: SEM demonstrated that higher pre-stroke comorbidity burden, as quantified by the aCCI, was significantly associated with increased stroke severity and poorer functional outcomes at discharge. The aCCI exhibited strong direct effects on both NIHSS (path coefficient: 0.70) and mRS (path coefficient: 1.43). Conclusions: Premorbid comorbidities, as measured by the aCCI prior to stroke onset, are significantly correlated with both neurological deficit and functional outcome at discharge in patients with PCF infarctions. These findings underscore the potential utility of the aCCI as a prognostic tool for outcome prediction in this patient cohort. Full article
(This article belongs to the Special Issue Management of Acute Stroke)
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11 pages, 770 KiB  
Article
Acute Ischemic Stroke Treatment in Germany (2015–2023): Nationwide Trends in Thrombolysis and Thrombectomy by Age and Sex
by Sara Hirsch, Karel Kostev, Christian Tanislav and Ali Hammed
Brain Sci. 2025, 15(8), 832; https://doi.org/10.3390/brainsci15080832 - 2 Aug 2025
Viewed by 516
Abstract
Background: The implementation of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) has proven effective, offering significant benefits for patient outcomes. We therefore investigated trends in the implementation of IVT and MT in Germany between 2015 and 2023. Methods: [...] Read more.
Background: The implementation of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) has proven effective, offering significant benefits for patient outcomes. We therefore investigated trends in the implementation of IVT and MT in Germany between 2015 and 2023. Methods: We conducted a retrospective analysis using German Diagnosis-Related Group (DRG) statistics from 2015 to 2023. Treatment numbers were analyzed annually based on OPS codes. We examined the age and sex distribution of patients undergoing these treatments. Additionally, we analyzed all hospital cases coded with ICD-10 for acute ischemic stroke (AIS). Results: Between 2015 and 2023, the number of AIS cases in Germany slightly declined from 250,802 to 248,107 (−1.1%), with the largest annual decrease (−4.3%) occurring during the COVID-19 pandemic (2019–2020). Despite this, the use of IVT increased from 40,766 cases (16.25%) in 2015 to 48,378 (19.50%) in 2023. MT usage rose even more sharply, from 7840 cases (3.13%) to 22,445 (9.05%). Among MT recipients, the proportion of patients aged ≥80 years rose significantly, from 27.2% to 42.1%. In this age group, women consistently comprised the majority of MT patients—65.4% in 2015 and 65.5% in 2023. Conclusions: Despite a stable stroke incidence, the use of IVT—and particularly MT—continued to increase in Germany from 2015 to 2023, even during the COVID-19 pandemic. MT usage nearly tripled, especially among patients aged ≥80 years. These trends highlight a resilient stroke care system and underscore the need for future planning to meet the rising demand for endovascular treatment in an aging population. Full article
(This article belongs to the Special Issue Management of Acute Stroke)
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12 pages, 899 KiB  
Article
Combining Coronal and Axial DWI for Accurate Diagnosis of Brainstem Ischemic Strokes: Volume-Based Correlation with Stroke Severity
by Omar Alhaj Omar, Mesut Yenigün, Farzat Alchayah, Priyanka Boettger, Francesca Culaj, Toska Maxhuni, Norma J. Diel, Stefan T. Gerner, Maxime Viard, Hagen B. Huttner, Martin Juenemann, Julia Heinrichs and Tobias Braun
Brain Sci. 2025, 15(8), 823; https://doi.org/10.3390/brainsci15080823 - 31 Jul 2025
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Abstract
Background/Objectives: Brainstem ischemic strokes comprise 10% of ischemic strokes and are challenging to diagnose due to small lesion size and complex presentations. Diffusion-weighted imaging (DWI) is crucial for detecting ischemia, yet it can miss small lesions, especially when only axial slices are employed. [...] Read more.
Background/Objectives: Brainstem ischemic strokes comprise 10% of ischemic strokes and are challenging to diagnose due to small lesion size and complex presentations. Diffusion-weighted imaging (DWI) is crucial for detecting ischemia, yet it can miss small lesions, especially when only axial slices are employed. This study investigated whether ischemic lesions visible in a single imaging plane correspond to smaller volumes and whether coronal DWI enhances detection compared to axial DWI alone. Methods: This retrospective single-center study examined 134 patients with brainstem ischemic strokes between December 2018 and November 2023. All patients underwent axial and coronal DWI. Clinical data, NIH Stroke Scale (NIHSS) scores, and modified Rankin Scale (mRS) scores were recorded. Diffusion-restricted lesion volumes were calculated using multiple models (planimetric, ellipsoid, and spherical), and lesion visibility per imaging plane was analyzed. Results: Brainstem ischemic strokes were detected in 85.8% of patients. Coronal DWI alone identified 6% of lesions that were undetectable on axial DWI; meanwhile, axial DWI alone identified 6.7%. Combining both improved overall sensitivity to 86.6%. Ischemic lesions visible in only one plane were significantly smaller across all volume models. Higher NIHSS scores were strongly correlated with larger diffusion-restricted lesion volumes. Coronal DWI correlated better with clinical severity than axial DWI, especially in the midbrain and medulla. Conclusions: Coronal DWI significantly improves the detection of small brainstem infarcts and should be incorporated into routine stroke imaging protocols. Infarcts visible in only one plane are typically smaller, yet still clinically relevant. Combined imaging enhances diagnostic accuracy and supports early and precise intervention in posterior circulation strokes. Full article
(This article belongs to the Special Issue Management of Acute Stroke)
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