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Cerebrovascular Disease: Update on Diagnosis and Treatment

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A Special Issue of Neurology International (ISSN 2035-8377) belonging to the section "Brain Tumor and Brain Injury".

Deadline for manuscript submissions: closed (31 May 2026) | Viewed by 12338

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Editors

Dr. Marialuisa Zedde

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Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
Interests: cerebrovascular diseases; small vessel diseases; hemorrhagic stroke; cavernous angioma; cerebral amyloid angiopathy; CADASIL; FMD; gene
Special Issues, Collections and Topics in MDPI journals

Dr. Rosario Pascarella

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Guest Editor

Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Interests: MRI; angiography; small vessel disease; cerebral amyloid angiopathy; hemorrhagic stroke; gene
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cerebrovascular disease (CVD) encompasses a range of disorders affecting the blood vessels in the brain, leading to significant morbidity and mortality worldwide. Conditions such as stroke, transient ischemic attack (TIA), and vascular dementia represent major public health challenges. Accurate diagnosis and timely intervention are critical to improving patient outcomes and minimizing long-term disability. As our understanding of the pathophysiology of cerebrovascular diseases evolves, so too do the diagnostic and therapeutic approaches. This Special Issue aims to provide a comprehensive update on the latest advancements in the diagnosis and treatment of cerebrovascular disease, addressing both established and emerging strategies.

The primary aim of this Special Issue is to gather and disseminate cutting-edge research and clinical insights into the diagnosis and management of cerebrovascular diseases. We seek to explore innovative diagnostic modalities, including advanced imaging techniques and biomarkers, as well as new therapeutic interventions, such as novel pharmacological agents and interdisciplinary management approaches. The scope of this issue includes, but is not limited to, studies on acute stroke management, secondary prevention strategies, rehabilitation techniques, and the integration of technology in patient care. By providing a platform for the latest research, we hope to enhance clinical practice and inform future directions in cerebrovascular disease management.

Historically, the field of cerebrovascular disease has undergone significant transformations. Advances in neuroimaging technologies and a better understanding of risk factors have revolutionized the diagnosis of CVD. The introduction of thrombolytic therapy and endovascular interventions has changed the landscape of acute stroke treatment, while ongoing research continues to refine management strategies for chronic cerebrovascular conditions. Despite these advancements, challenges remain in the early detection of CVD and effective treatment modalities, particularly in diverse populations. This Special Issue will trace the history of cerebrovascular disease management, highlighting key milestones and current gaps that require further exploration.

This Special Issue will feature cutting-edge research that highlights the latest breakthroughs in the diagnosis and treatment of cerebrovascular diseases. We aim to include studies that utilize novel imaging techniques, such as perfusion MRI and machine learning algorithms for stroke prediction, as well as research on emerging therapeutic agents that target the underlying mechanisms of cerebrovascular pathology. Additionally, we welcome investigations into multidisciplinary approaches that integrate medical, surgical, and rehabilitation strategies to optimize patient outcomes. By showcasing these advancements, we hope to foster collaboration and innovation in the field of cerebrovascular disease.

We invite original research articles, reviews, clinical guidelines, and case studies that contribute to the understanding and management of cerebrovascular disease. Specifically, we seek the following:

Original research articles that present novel findings related to diagnostic techniques or treatment interventions;
Comprehensive reviews that synthesize current knowledge and highlight gaps in the literature, offering insights into future research directions;
Clinical guidelines or consensus statements that provide evidence-based recommendations for the diagnosis and management of cerebrovascular disease;
Case studies that illustrate unique clinical presentations, innovative treatment approaches, or successful management strategies in cerebrovascular disease. Through this Special Issue, we aim to create a collaborative space for researchers, clinicians, and healthcare professionals to share knowledge and advance the field of cerebrovascular disease diagnosis and treatment.

You may choose choose our Joint Special Issue in Brain Sciences.

Dr. Marialuisa Zedde
Dr. Rosario Pascarella
Guest Editors

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Keywords

ischemic stroke
SVD
vasculitides
fibromuscular dysplasia
thrombolysis
EVT
plaque imaging
intracranial stenosis

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15 pages, 677 KB

Open AccessArticle

Early Aneurysm Occlusion Outcomes After Endovascular Treatment: A Descriptive Single-Center Cohort Evaluation

by Yasar Ünsal, Kadir Çetinkaya, Mehmet Özgür Özates, Oktay Gürcan, Oktay Algın and Gıyas Ayberk

Neurol. Int. 2026, 18(9), 170; https://doi.org/10.3390/neurolint18090170 - 11 Sep 2026

Abstract

Background: Early residual or recurrent aneurysm filling remains an important limitation after endovascular treatment of intracranial aneurysms, particularly in large and complex lesions. This study descriptively evaluated 6-month early residual or recurrent filling after coil embolization, stent-assisted coiling, flow-diverting stents, and the Woven EndoBridge (WEB) device in a single-center cohort. Methods: We retrospectively analyzed 151 patients with 161 intracranial aneurysms treated between January 2019 and July 2023. Follow-up imaging at approximately 6 months was performed using computed tomography angiography or magnetic resonance angiography, with digital subtraction angiography when residual filling was suspected. Aneurysm occlusion was evaluated using the Raymond–Roy Occlusion Classification. Clinical, morphological, anatomical, and treatment-related variables associated with early residual or recurrent aneurysm filling were analyzed. Results: Complete occlusion was achieved in 149 aneurysms (92.5%), whereas early residual or recurrent filling occurred in 12 aneurysms (7.5%). Residual or recurrent filling was observed in 4/35 aneurysms treated with coil embolization (11.4%), 1/58 treated with flow-diverting stents (1.7%), 7/60 treated with the WEB device (11.7%), and none of the 8 aneurysms treated with stent-assisted coiling; overall rates did not differ significantly among treatment modalities (p = 0.104). Aneurysm height > 10 mm was significantly associated with early residual or recurrent filling (p = 0.005), and mean aneurysm height was greater in aneurysms with residual or recurrent filling than in completely occluded aneurysms (p = 0.048). In the ICA subgroup, residual or recurrent filling was more frequent after WEB treatment than after other endovascular modalities (p = 0.019). This subgroup signal was based on sparse observations. Conclusions: Aneurysm height > 10 mm was significantly associated with early residual or recurrent aneurysm filling. No statistically significant difference in early residual or recurrent filling was detected among treatment groups. Given the retrospective design, non-random treatment allocation, heterogeneous aneurysm phenotypes, and non-uniform imaging follow-up, these data should be interpreted as a descriptive institutional experience rather than evidence of comparative superiority or equivalence. The ICA subgroup finding is preliminary and hypothesis-generating. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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13 pages, 4212 KB

Open AccessArticle

Utility and Wearability of the hitoe^® Wearable ECG Monitoring System II for Detecting Covert Paroxysmal Atrial Fibrillation in Patients with Suspected ESUS Across Inpatient and Outpatient Settings: ACROSS-AF in ESUS

by Hisanao Akiyama, Yasutaka Watanabe, Takayuki Fukano, Takahiro Shimizu and Yoshihisa Yamano

Neurol. Int. 2026, 18(7), 134; https://doi.org/10.3390/neurolint18070134 - 13 Jul 2026

Viewed by 477

Abstract

Background/Objectives: Detecting covert paroxysmal atrial fibrillation (AF) in patients with suspected embolic stroke of undetermined source (ESUS) is important for secondary prevention. This study evaluated the feasibility, AF detection, and wearability of the hitoe^® wearable electrocardiogram (ECG) monitoring system II, a Holter-type device recording continuously for up to 14 days. Methods: Between March 2022 and October 2023, 31 patients with suspected ESUS were enrolled. After excluding two cases, 29 patients (mean age 74.7 ± 17.3 years; 16 men) underwent ECG monitoring. Clinical outcomes were analyzed in 27 acute-phase patients and wearability in 24 questionnaire respondents. ECG recordings and questionnaire responses were analyzed descriptively, with between-group comparisons. Results: In 29 monitored patients, the mean recording duration was 12.4 ± 3.7 days, the ECG acquisition rate was 64.0 ± 23.4% (median 72.1%), and the mean analyzable duration was 8.1 ± 3.7 days. In the 27 acute-phase patients, covert paroxysmal AF was detected in 2 patients (7.4%), on days 1, 3, and 15 in one patient and on day 7 in the other. In AF-positive patients, the mean ectopic burden was 1.33% for supraventricular and 0.24% for ventricular activity. Wearability was favorable: 77.8% reported no interference with daily activities, none reported sleep disturbance, and 72.7% adapted within 1–4 days. Conclusions: The hitoe^® wearable ECG monitoring system II enabled prolonged monitoring across inpatient and outpatient settings, detecting covert paroxysmal AF in 7.4% of acute-phase patients with suspected ESUS. These findings support garment-type wearable ECG monitoring as a non-invasive option for extended rhythm surveillance. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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16 pages, 1553 KB

Open AccessArticle

Novel Morphological Classification of Intracranial Aneurysm Wall Irregularity Associates Specific Features with Increased Size and Rupture Risk: A Retrospective Single-Center Cross-Sectional Study

by Kamil Krystkiewicz, Aleksander Kowal, Magdalena Krystkiewicz-Orzechowska, Filip Arczewski, Karol Dziedzic and Marcin Tosik

Neurol. Int. 2026, 18(7), 126; https://doi.org/10.3390/neurolint18070126 - 29 Jun 2026

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Abstract

Introduction/Objectives: Wall irregularity is a known risk factor in the evaluation of intracranial aneurysms, but the prognostic value of its subtypes remains unclear. Materials and methods: In this retrospective single-center cross-sectional study (2023–2025), we reviewed consecutive adult patients with intracranial aneurysms. Morphology was classified as daughter sac, multilobulated, or complex irregularity. We compared rupture status and calculated PHASES, ELAPSS, and UIATS scores. Principal Component Analysis (PCA), and logistic and linear regression were applied. Results: A total of 180 patients with 180 index aneurysms were included; mean age was 67.2 ± 12.1 years, and 72.2% were women. Overall, 43.3% of aneurysms were irregular, specifically: daughter sac (25.0%), multilobulated (36.1%), and complex irregularity (11.1%). SAH occurred in 40 patients (22.2%). Ruptured aneurysms had larger maximum diameter, size ratio, and aspect ratio (all p < 0.0001), plus higher 5-year PHASES (p = 0.0091) and ELAPSS growth scores (p < 0.0001). PCA identified three clusters with differing 5-year rupture risks; Cluster 3 had the highest risk (5.71 ± 5.25%) and was characterized by a higher proportion of daughter sac and multilobulated morphology (p = 1.65 × 10⁻⁷ and 8.80 × 10⁻¹⁶). Linear models showed each irregular subtype was associated with significantly larger aneurysm size. Conclusions: Irregular wall patterns were common and associated with larger aneurysm dimensions and higher risk scores. These findings support further investigation of refined morphological descriptors in rupture risk stratification. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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14 pages, 1157 KB

Open AccessArticle

White Matter Hyperintensities and Clinical Phenotype in Late-Onset Psychiatric Disorders: A Multidimensional Clinical-Neuroimaging Study

by Tânia Silva, Cesar Nunes, Andreia Ribeiro, Isabel Santana and Joaquim Cerejeira

Neurol. Int. 2026, 18(6), 105; https://doi.org/10.3390/neurolint18060105 - 26 May 2026

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Abstract

Background: White matter hyperintensities (WMHs) have been implicated in late-onset psychiatric disorders, but their contribution to this clinical phenotype remains insufficiently understood. Methods: We conducted a cross-sectional transdiagnostic study of 90 consecutively admitted acute patients with schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD) meeting the predefined inclusion criteria. Patients with a late onset were compared to earlier onset (EO) psychiatric patients. Late onset was defined as the median age of the disorder onset of the sample (≥40 years). Multidimensional clinical, cognitive, psychomotor, metabolic, and neuroimaging data were evaluated (WHM burden and cerebral atrophy), and a cognitive-psychopathologic composite index was derived. Correlations and sensitivity analysis were performed. A multivariable linear regression was performed to assess the independent effects of age, vascular risk factors, and WMH severity on cognitive performance and psychiatric symptoms. Results: In patients with LO psychiatric disorders, greater WMH burden was significantly associated with poorer global cognition and specific cognitive domains, lower delusional symptoms severity, and greater suicidal thoughts/behavior intensity. These associations were markedly weaker or not present in EO patients. The regression model explained 36.5% of the variance in the cognitive-psychopathologic composite index. After adjusting for age and cumulative risk factors, Fazekas was the only significant independent predictor (β = −0.495, p = 0.001). Conclusions: WMH burden was associated with differences in clinical characteristics in LO psychiatric disorders, including cognitive and neuropsychiatric symptoms. Our findings support a possible vascular-neuropsychiatric interaction in LO phenotypes. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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11 pages, 378 KB

Open AccessArticle

Association of Glucagon-like Peptide-1 Receptor Agonist Use with Stroke and Mortality Outcomes in Asymptomatic Intracranial Atherosclerotic Disease: Propensity Score-Matched Real-World Analysis

by Pranjal Rai, Daniel Mandel, Girish Bathla, Vidhi Dhaduk, Radhika Rajeev, Jay Kakadiya, Huanwen Alvin Chen, Hamza A. Salim, Ahmed Y. Azzam, Muhammed Amir Essibayi, Brian Connolly, Marc Buzzelli, Vivek S. Yedavalli, Majid Khan, Adam A. Dmytriw, David J. Altschul, Matthew K. McIntyre, Marco Colasurdo, Ajay Malhotra, Dheeraj Gandhi and Dhairya A. Lakhani Show full author list Hide full author list

Neurol. Int. 2026, 18(5), 98; https://doi.org/10.3390/neurolint18050098 - 21 May 2026

Cited by 1 | Viewed by 1070

Abstract

Background: Asymptomatic intracranial atherosclerotic arterial stenosis (ICAS) is an underrecognized entity for which vascular risk-factor optimization is the primary management strategy, with no current indication for routine antiplatelet therapy or endovascular intervention for primary stroke prevention. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events, including stroke, in high-risk cardiometabolic populations, but their association with outcomes in asymptomatic ICAS is yet to be evaluated. The present study aims to evaluate the association between GLP-1RA use and cerebrovascular outcomes in adults with asymptomatic ICAS. Materials and Methods: We used the TriNetX US Collaborative Network (71 healthcare organizations) to identify adults (≥18 years) with ICAS between 1 January 2016 and 31 December 2025, and excluded patients with prior cerebral infarction, intracranial hemorrhage, or cerebrovascular ischemic syndromes. Exposure was defined as initiation of any GLP-1 receptor agonist (lixisenatide, semaglutide, liraglutide, tirzepatide, dulaglutide) during the 6 months before or on the date of index ICAS diagnosis. Outcomes were assessed at 1 year, and included ischemic stroke, all-cause mortality, and a composite of ischemic stroke or mortality. Propensity-score matching (1:1) was performed, including demographics, vascular risk factors, comorbidities, antithrombotics, lipid/diabetes therapies, and cardiometabolic laboratory/physiologic measures. Results: Before matching, 1746 GLP-1RA users and 71,792 non-users met inclusion criteria; after matching, 1728 patients remained in each cohort. GLP-1RA use was associated with lower 1-year risk of ischemic stroke (4.40% vs. 6.10%; hazard ratio [HR] 0.70, 95% CI 0.52–0.95; p = 0.044), lower all-cause mortality (3.40% vs. 9.40%; HR 0.35, 95% CI 0.26–0.47; p < 0.001), and lower composite outcome risk (7.50% vs. 15.00%; HR 0.48, 95% CI 0.39–0.59; p < 0.001). Notably, these associations were observed despite matching for HbA1c, LDL cholesterol, BMI, and systolic blood pressure, suggesting potential effects beyond measured cardiometabolic risk profiles. Conclusions: In this large, propensity-matched cohort of adults with a-ICAS, GLP-1RA use was associated with lower ischemic stroke, all-cause mortality, and composite outcome at 1 year. These findings are hypothesis-generating and require further prospective studies to confirm this observation. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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13 pages, 1195 KB

Open AccessArticle

Individualized Upfront Treatment Selection for Aneurysmal Subarachnoid Hemorrhage and Functional Outcomes: A Single-Center Retrospective Before-and-After Cohort Study

by Atsushi Nakayashiki, Kunihiko Umezawa, Yasuo Nishijima, Ryutaro Suzuki, Michiko Yokosawa and Hidenori Endo

Neurol. Int. 2026, 18(5), 93; https://doi.org/10.3390/neurolint18050093 - 15 May 2026

Viewed by 750

Abstract

Background/Objectives: The optimal upfront modality selection for real-world aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. We evaluated outcomes after an institutional change from an endovascular treatment (EVT)-first default to a modality-neutral individualized pathway. Methods: This single-center retrospective before-and-after cohort study included consecutive patients with aSAH who underwent aneurysm securing during two fixed time periods (pre-change: 1 May 2023 to 31 July 2024; post-change: 1 August 2024 to 31 October 2025). The primary outcome was a favorable 90-day modified Rankin Scale (mRS) score of 0–2. The primary analysis used Firth penalized logistic regression adjusted for age, pre-morbid mRS ≥ 2, and World Federation of Neurosurgical Societies grade IV–V. Conventional logistic regression and ordinal mRS shift analysis were performed as sensitivity analyses. Results: A total of 104 patients were included (pre-change, n = 48; post-change, n = 56). EVT decreased from 79.2% to 37.5%, and microsurgery increased from 20.8% to 62.5% (p < 0.001). Favorable outcomes occurred in 25/48 patients (52.1%) in the pre-change period and 36/56 patients (64.3%) in the post-change period (p = 0.235). In adjusted analyses, the post-change period was associated with favorable outcome (aOR 3.82; 95% CI, 1.31–12.79; p = 0.009), consistent with the sensitivity analysis (aOR, 4.41; 95% CI, 1.43–15.95; p = 0.009). Shift analysis also favored the post-change period (adjusted common OR, 2.36; 95% CI, 1.15–4.91; p = 0.021). Secondary outcomes and procedure-related complications were similar between the two periods. Conclusions: A shift from an EVT-first default to a modality-neutral individualized pathway was associated with more favorable adjusted 90-day functional outcomes. Multicenter confirmation is warranted. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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11 pages, 1148 KB

Open AccessArticle

Posterior Communicating Artery Configuration and Laterality of Thalamic and Lenticulostriate Infarction

by Junpei Nagasawa, Masamichi Hozumi, Tatsuhiro Yokoyama, Makiko Ogawa, Junya Ebina, Mari Shibukawa, Takehisa Hirayama and Osamu Kano

Neurol. Int. 2026, 18(3), 61; https://doi.org/10.3390/neurolint18030061 - 22 Mar 2026

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Abstract

Background: Anatomical variations in the posterior communicating artery (PCoA) are common, but their association with ischemic stroke remains unclear. In this study, we investigated the relationship between PCoA configuration and the localization of perforator infarction. Methods: We conducted a single-center, retrospective observational study of consecutive patients admitted with acute ischemic stroke between April 2016 and July 2023. Patients with a single, unilateral lacunar infarction confined to the thalamic or lenticulostriate artery (LSA) territory were included. PCoA configuration was assessed using time-of-flight magnetic resonance angiography and dichotomized as present (normal PCoA or fetal-type posterior cerebral artery) or absent (hypoplastic or aplastic PCoA). Using a within-patient, hemisphere-based approach, the presence of PCoA on the infarcted side was directly compared with that on the contralateral side. McNemar’s test with continuity correction was used for laterality analysis. Results: A total of 64 patients met the inclusion criteria, including 45 with LSA infarction and 19 with thalamic infarction. The prevalence of PCoA presence on the infarcted hemisphere was 20.0% in the LSA group and 26.3% in the thalamic group, identical to that observed on the contralateral hemisphere in each group. Within-patient comparisons revealed no significant difference in PCoA presence between infarcted and non-infarcted hemispheres in either territory (all p > 0.05). Conclusions: In patients with unilateral perforator infarction involving the thalamic or LSA territories, PCoA configuration was not associated with infarct laterality. These findings suggest that variations in PCoA anatomy have a limited influence on hemispheric vulnerability to perforator infarction, supporting the predominant role of local small-vessel pathology rather than proximal collateral anatomy in the development of lacunar stroke. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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15 pages, 1352 KB

Open AccessArticle

Unruptured Intracranial Aneurysm Risk Scores Underperform in Predicting Subsequent Rupture: A Retrospective Single-Center Study

by Kamil Krystkiewicz, Aleksander Kowal, Magdalena Krystkiewicz-Orzechowska, Filip Arczewski, Karol Dziedzic and Marcin Tosik

Neurol. Int. 2025, 17(11), 189; https://doi.org/10.3390/neurolint17110189 - 20 Nov 2025

Cited by 2 | Viewed by 3148

Abstract

Background/Objectives: Risk-stratification tools, including the PHASES, UIATS, and ELAPSS, are commonly used to guide management of incidentally detected unruptured intracranial aneurysms (UIAs), but their predictive accuracy in real-world settings remains unclear. This study evaluated how these scores would have advised treatment in patients who subsequently presented with aneurysmal subarachnoid hemorrhage (aSAH). Methods: We retrospectively analyzed adults treated for aSAH at Copernicus Memorial Hospital (Łódź, Poland) between January 2022 and June 2024. For each ruptured aneurysm, we calculated PHASES (5-year rupture risk), UIATS recommendation, and ELAPSS (5-year growth risk) as if the lesion had been detected incidentally. Identical assessments were performed for UIAs that remained unruptured. Discrimination for rupture was evaluated using receiver-operating characteristic analysis (AUC). Results: Of 180 aneurysms (mean age 66.9 ± 11.3 years), 103 (57%) were ruptured. Patients with ruptured aneurysms were significantly older (69.9 vs. 64.0 years; p = 0.003), while sex, hypertension, smoking, and aneurysm morphology did not differ significantly. UIATS more frequently favored conservative management in ruptured aneurysms (56.3% vs. 39.0%; p = 0.046). PHASES (1.6% vs. 1.6%) and ELAPSS (3-year: 14.5% vs. 12.6%; 5-year: 22.6% vs. 20.0%) showed no significant differences between groups. Age was the only independent predictor of rupture (OR = 1.05/year; p < 0.001). The model’s cross-validated AUC was 0.731. Conclusions: Most ruptured aneurysms would not have been recommended for treatment based on UIATS. PHASES, ELAPSS, and UIATS did not reliably discriminate between ruptured and unruptured aneurysms, emphasizing the need for more precise and individualized risk assessment tools. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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19 pages, 2595 KB

Open AccessSystematic Review

Review and Meta-Analyses of the Effects of MLC601/MLC901 (NeuroAiD) on Post-Stroke Functional and Motor Recovery

by Narayanaswamy Venketasubramanian, Tsong-Hai Lee, Hou Chang Chiu, Liang Guo and Christopher Li Hsian Chen

Neurol. Int. 2026, 18(8), 141; https://doi.org/10.3390/neurolint18080141 - 23 Jul 2026

Viewed by 931

Abstract

Background: Post-stroke recovery varies widely, and pharmacological options to enhance rehabilitation outcomes remain limited. MLC601/MLC901 (NeuroAiD), a natural neurorestorative product, has been evaluated as an adjunct to standard care to improve functional and motor recovery after ischaemic stroke. This systematic review and meta-analysis assessed its efficacy using validated outcome measures. Methods: A systematic PubMed search identified randomised controlled trials comparing MLC601/MLC901 with placebo or active comparators in adults with ischaemic stroke. Functional outcomes included modified Rankin Scale (mRS), Barthel Index (BI), and Diagnostic Therapeutic Effects of Apoplexy (DTER) item 8 scores. Motor outcomes included Fugl–Meyer Assessment (FMA), DTER motor items, and National Institutes of Health Stroke Scale (NIHSS) motor scores. Data were pooled using fixed- and random-effects models. Odds ratios (ORs) and standardised mean differences (SMDs) were calculated. Risk of bias was assessed using the Cochrane RoB 1.0 tool. Results: Six publications reporting seven randomised clinical studies were included in the meta-analysis. Of the 7 studies, 5 were assessed as having a low risk of bias, while 2 were assessed as having an unclear risk. Altogether, 1535 participants for functional outcomes and 1774 for motor outcomes were analysed. Functional recovery significantly favoured MLC601/MLC901 at 1 month (OR 2.61; p = 0.004), 6 months (OR 1.38; p = 0.002), 12 months (OR 1.33; p = 0.03), and end-of-study (OR 1.40; p = 0.007), with benefits persisting up to 24 months. Motor recovery was assessed at months 1, 2 and 3 and at the end of the study. It also improved consistently over time, with the greatest effects during the first two months. Benefits were most evident in patients with moderately severe stroke (NIHSS 8–14). Clinical studies consistently indicate that NeuroAiD is safe and well-tolerated as an adjunct to standard ischaemic stroke care. Conclusions: MLC601/MLC901 is associated with improved functional independence and motor recovery after ischaemic stroke. Benefits appear within 1 month and may persist for up to 2 years, supporting early use alongside rehabilitation to optimise recovery. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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10 pages, 2782 KB

Open AccessCase Report

Ischemic Stroke as the First Manifestation of Takayasu Arteritis: A Case Report

by Dominika Jakubowicz-Lachowska, Magdalena Sarnowska, Monika Chorąży and Alina Kułakowska

Neurol. Int. 2026, 18(3), 57; https://doi.org/10.3390/neurolint18030057 - 18 Mar 2026

Viewed by 1477

Abstract

Introduction: Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due to arterial stenosis or thrombosis. Case Presentation: We report the case of a 26-year-old woman with a history of suspected rheumatoid arthritis and Lyme disease who presented with acute left-sided hemiparesis and dysarthria. At admission, large-vessel vasculitis had not yet been suspected, and the patient was treated according to standard acute stroke protocols. Computed tomography angiography (CTA) revealed occlusion of the right middle cerebral artery bifurcation and the right common carotid artery, with inflammatory changes involving the brachiocephalic trunk and subclavian arteries. Intravenous thrombolysis (iv rtPA) was followed by mechanical thrombectomy (MT), resulting in neurological improvement. Outcome: Further diagnostic work-up confirmed TA, and immunosuppressive therapy with cyclophosphamide and infliximab was initiated. Conclusion: This case underscores the importance of considering inflammatory large-vessel disease in young patients presenting with acute ischemic stroke and illustrates that endovascular reperfusion may be feasible in this clinical setting. Full article

(This article belongs to the Special Issue Cerebrovascular Disease: Update on Diagnosis and Treatment)

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