Search Results (397)

Background/Objectives: Young-onset ischemic stroke shows substantial etiologic heterogeneity. However, the value and diagnostic yield of advanced cardiac and autoimmune evaluations in young adults remain uncertain. Methods: Patients aged 25–55 years admitted with acute ischemic stroke to King Fahd University Hospital in Saudi Arabia between January 2020 and December 2025 were included. Evaluation followed a multidisciplinary young-stroke pathway, incorporating neurovascular imaging, cardiac assessment, and targeted autoimmune and rheumatologic investigations. A Clinically Meaningful Diagnostic Yield (CMDY) was defined as a diagnostic finding that resulted in etiologic reclassification, management modification, or changes to secondary prevention strategy. Results: A total of 480 patients were included (median age, 40 years; 67.7% men). CMDY was observed in 200 (41.7%) patients. Among 79 patients initially classified as having embolic stroke of an undetermined source, 35 (44.3%) were assigned a determined etiologic mechanism following evaluation and follow-up. Patients with undetermined stroke etiology decreased from 16.5% after first-pass evaluation to 9.2% after diagnostic completion. Patent foramen ovale/atrial septal defect-associated stroke mechanisms were identified in 61 patients (12.7%), autoimmune/inflammatory stroke mechanisms in 26 patients (5.4%), and atrial fibrillation-related cardioembolic stroke in 18 patients (3.8%). Clinically relevant mechanisms were identified in 169 patients (35.2%) whose primary etiologic classification remained unchanged. Independent predictors of CMDY were hypertension, prior stroke or transient ischemic attack, multi-territory infarction, and cortical infarction. Conclusions: Etiologic evaluation yielded clinically meaningful findings in over two-fifths of young adults with ischemic stroke and influenced etiologic assessment, treatment, and secondary prevention. Diagnostic yield was greatest among patients with prior cerebrovascular events and cortical or multi-territory infarctions, supporting a selective, phenotype-driven approach that warrants prospective multicenter validation. Full article

Background: Intracerebral haemorrhage (ICH) requires rapid multidisciplinary assessment, yet access to neurological and neurosurgical expertise may be uneven. Although telemedicine is established in acute ischaemic stroke (AIS), evidence regarding its role in ICH remains limited. This review describes the organisational framework of the Slovenian TeleKap network and examines its potential application to ICH care. Methods: PubMed/MEDLINE, Scopus, and Google Scholar were searched for literature concerning telemedicine, telestroke, ICH, neurosurgery, acute stroke care, and the Slovenian TeleKap network. Relevant guidelines, reviews, clinical studies, and publications describing telemedicine implementation were narratively synthesised, with emphasis on organisational workflow and neurosurgical consultation. Results: TeleKap connects regional hospitals with tertiary neurological and neurosurgical centres through audiovisual consultation and remote access to clinical and imaging data. In ICH, it provides an organisational mechanism for specialist input into assessment, triage, transfer decisions, preoperative planning, local management, and continuity of care. These functions constitute organisational capabilities rather than clinically validated benefits. They may support more standardised workflows and multidisciplinary coordination; however, no TeleKap-specific ICH registry, consecutive cohort, or comparative study has demonstrated shorter treatment times, more appropriate transfers, improved resource utilisation, or better clinical outcomes. Published evidence of telestroke effectiveness relates predominantly to AIS and cannot be extrapolated directly to ICH. Conclusions: TeleKap represents a national implementation of established telemedicine principles within the Slovenian healthcare system, but its clinical effectiveness, cost-effectiveness, and transferability remain to be established. Further development should prioritise registry-based quality monitoring, standardised protocols, and interoperability, with locally validated AI-supported imaging considered as a subsequent step. Full article

Background/Objectives: Obesity and diabetes mellitus coexist, but the association of obesity with invasive management and in-hospital outcomes in acute myocardial infarction (AMI) complicated by cardiogenic shock is uncertain. We evaluated these associations among adults with diabetes mellitus. Methods: We performed a retrospective discharge-level analysis of the National Inpatient Sample for 2016–2021. Obesity was identified from ICD-10-CM codes. Survey-design logistic regression accounted for weights, strata, hospital clusters, and prespecified covariates. Results: The cohort comprised 19,399 discharges, representing 96,995 hospitalizations; 24.1% had obesity. Angiography and coronary artery bypass grafting (CABG) were more frequent with obesity, whereas percutaneous coronary intervention (PCI) was less frequent. After adjustment, obesity was associated with higher odds of angiography (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.03–1.21) and CABG (aOR 1.49, 95% CI 1.35–1.63), lower odds of PCI (aOR 0.90, 95% CI 0.84–0.97), and similar odds of circulatory support (aOR 1.00, 95% CI 0.93–1.07). Adjusted odds were lower for major adverse cardiovascular and cerebrovascular events (aOR 0.88, 95% CI 0.82–0.95), in-hospital mortality (aOR 0.90, 95% CI 0.83–0.98), acute ischemic stroke (aOR 0.78, 95% CI 0.64–0.95), and major bleeding (aOR 0.86, 95% CI 0.76–0.98). Procedure adjustment attenuated mortality and major bleeding. Conclusions: Obesity was associated with a different invasive-management pattern and lower adjusted odds of several short-term outcomes, consistent with an apparent in-hospital obesity paradox in this high-risk population. Full article

Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Coordinated care delivered through protocol-driven multidisciplinary teams enables rapid diagnosis and treatment, both of which are essential for improving clinical outcomes. Objective: Our objective was to analyze care strategies in the emergency management of acute ischemic stroke, focusing on treatment times and influencing factors, interventions implemented in emergency settings and their impact on clinical outcomes, and the contribution of healthcare professionals to optimizing stroke care. Methods: A systematic review was conducted in accordance with the PRISMA 2020 Statement. Current evidence published between 2021 and 2026 was retrieved from five databases: PubMed, Web of Science, Scopus, Cochrane Library, and SciELO. Eligibility criteria were applied, and methodological quality and risk of bias were assessed using validated appraisal tools. Results: Fourteen studies involving a total of 6384 patients were included. Factors such as healthcare system reorganization, multidisciplinary teamwork, early protocol activation, and the use of stroke-specific triage scales significantly influenced treatment times. Coordinated and protocolized care pathways, together with evidence-based clinical interventions, were consistently associated with higher thrombolysis rates and shorter treatment times, while improvements in neurological and functional recovery were reported in several, but not all, studies. The integration of specialized stroke professionals and structured emergency care processes contributed to reducing treatment delays and improving patient outcomes. Conclusions: Critical treatment times in acute ischemic stroke are influenced by multiple factors, and targeted organizational and clinical strategies can accelerate diagnosis and treatment. Although improvements in clinical outcomes were not consistently demonstrated across all included studies, the available evidence consistently supports protocol-driven multidisciplinary emergency care as an effective strategy for reducing treatment delays and optimizing acute ischemic stroke management. Full article

Unilateral spatial neglect (USN) is a neuropsychological syndrome characterized by a reduced awareness of, and attention toward, stimuli located in the contralesional space. The left side of the space is most frequently affected, due to the higher incidence of the disorder following right-hemisphere lesions, particularly within the territory of the right middle cerebral artery and, less commonly, the right anterior cerebral artery. Although USN can also occur following left-hemisphere damage, it is typically less severe and tends to resolve more quickly. USN is a common consequence of acquired brain injury, especially of vascular origin, and significantly impairs a patient’s functional abilities and quality of life. Its high incidence in the acute phase after stroke, together with its potential persistence into the chronic stage, makes early diagnosis and timely rehabilitation essential. In this narrative review, we provide an overview of current assessment tools and rehabilitation approaches for post-stroke USN, with a focus also on recent advances and emerging therapeutic strategies. To illustrate diagnostic and therapeutic decision making, a representative case of a patient admitted to a Stroke Unit is reported, illustrating the application of assessment methods in a real-world setting. The aim of this review is to offer clinicians practical tools and evidence-based strategies to support a more effective and individualized management of patients affected by this complex and disabling condition. Full article

The aim of this article is to provide a literature review of current approaches and recommendations for medical rehabilitation in stroke patients, with the goal of achieving the best possible outcomes for their condition and improving their quality of life. Materials and Methods: A narrative review was conducted of articles published in the databases available to us (PubMed, ScienceDirect, Google Scholar, PEDro, ResearchGate) that contain information regarding therapeutic management of stroke and, in particular, interventions aimed at motor recovery and improving quality of life. Included in this literature review were: scientific articles, guidelines on stroke and motor rehabilitation, clinical studies, longitudinal clinical studies, controlled clinical studies, systematic reviews, and meta-analyses published before April 2026, covering a ten-year period. Results: Data showing a trend toward higher patient survival rates following acute stroke were identified. For this reason, existing non-pharmacological approaches to motor recovery should be optimized. The rehabilitation process must begin as early as possible. Motor recovery depends on the establishment of motor control and the neuroplastic processes occurring in brain tissue. Rehabilitation is conducted by a rehabilitation team with the patient’s active participation, while monitoring motor rehabilitation potential. Conclusions: Rehabilitation is an essential component of post-stroke treatment. When timely and adequate medical rehabilitation is provided to stroke patients, there is a significant improvement in their overall condition and motor functions, as well as in their independence, self-care, and quality of life. Full article

Background/Objectives: Intraoperative hypotension (IOHs) affects up to 87% of patients under general anesthesia and is consistently associated with acute kidney injury, myocardial damage, stroke, and mortality. The intermittent unavailability of ephedrine across healthcare systems underscores the need for evidence-based alternatives. This review critically evaluates pharmacological options for IOH when ephedrine is unavailable, focusing on receptor pharmacodynamics, population-specific evidence, and clinical consequences of inadequately managed hypotension. Methods: A narrative, evidence-based review was conducted examining mechanisms of action, dosing strategies, adverse effect profiles, and clinical applicability of key vasoactive agents: ephedrine, phenylephrine, norepinephrine, and epinephrine. Population-specific evidence across obstetric, pediatric, and elderly cohorts was synthesized from randomized controlled trials, meta-analyses, and observational studies. The clinical impact of IOH on neurological, cardiovascular, and renal outcomes was reviewed. Results: Each vasopressor exhibits a distinct receptor-selectivity profile that determines its hemodynamic effect and optimal clinical context. Norepinephrine’s favorable α1/β1 balance tends to preserve cardiac output better than pure α1-agonists and has emerged as a promising alternative in obstetric and elderly populations, although the optimal agent ultimately depends on the underlying mechanism of hypotension and individual patient characteristics. Epinephrine provides combined vasopressor and inotropic support for hypotension with myocardial depression. IOH is associated with a greater than twofold increase in postoperative AKI and significantly elevated risks of myocardial infarction and stroke, with outcomes driven by cumulative hypotensive exposure rather than isolated pressure nadirs. Conclusions: Effective management of IOH requires individualized vasopressor selection guided by underlying pathophysiology, cardiovascular profile, and surgical context. A physiology-based strategy—rather than protocol-driven drug substitution—enables anesthesiologists to achieve precise hemodynamic control and preserve end-organ perfusion even when ephedrine is unavailable. Full article

Background: Intermediate-high and high-risk pulmonary embolism (PE) are associated with substantial mortality despite anticoagulation. While reperfusion therapies may improve outcomes, real-world evidence comparing treatment strategies and identifying predictors of mid-term mortality remains limited. We aimed to evaluate predictors of 90-day mortality and the impact of reperfusion therapy in patients with intermediate-high and high-risk PE managed within a multidisciplinary Pulmonary Embolism Response Team (PERT). Methods: This retrospective cohort study included 114 consecutive patients with intermediate-high or high-risk acute PE admitted to a tertiary referral center between October 2023 and December 2024. Risk stratification was performed according to ESC guidelines, and simplified Pulmonary Embolism Severity Index (sPESI) scores were calculated. Treatment strategies included anticoagulation alone or reperfusion therapy (systemic thrombolysis or catheter-directed therapy). The primary endpoint was all-cause 90-day mortality. Multivariate logistic regression was performed to identify independent predictors of mortality. Results: The mean age was 68 ± 16 years, and 88% had at least one comorbidity. Reperfusion therapy was administered to 27% of patients. Mortality rates were 1% at 24 h, 6% at 7 days, 17% at 30 days, and 25% at 90 days. In multivariate analysis, hemoglobin ≤ 11.7 g/dL (OR 5.06, 95% CI 1.58–16.17, p = 0.006), sPESI > 2 (OR 4.86, 95% CI 1.49–15.84, p = 0.009), prior stroke (OR 11.59, 95% CI 2.08–64.51, p = 0.005), and high 30-day mortality risk classification (OR 14.14, 95% CI 1.19–167.89, p = 0.036) were independent predictors of mortality. Reperfusion therapy was independently associated with a significant reduction in 90-day mortality (OR 0.05, 95% CI 0.003–0.65, p = 0.022). The regression model demonstrated good explanatory power (Nagelkerke R² = 0.487). Conclusions: In this real-world cohort of intermediate-high and high-risk PE, reperfusion therapy was independently associated with lower 90-day mortality and low bleeding risk. In addition to established predictors, sPESI retained strong prognostic value beyond its traditional 30-day timeframe. These findings support risk-adapted reperfusion strategies guided by multidisciplinary teams and reinforce the role of integrated clinical risk assessment in optimizing outcomes. Full article

Background: As many as two-thirds of acutely dizzy patients presenting to the emergency department report intermittent symptoms only, consistent with a transient acute vestibular syndrome (single episode lasting < 24 h) or an episodic vestibular syndrome (recurrent episodes, each lasting < 24 h). A broad differential diagnosis, presentation outside the episode(s), and difficulties in describing the symptoms make the diagnostic workup of transient vestibular symptoms (TVS) challenging. Methods: This critical review provides an overview on the management of TVS, focusing on structured history-taking and bedside testing, but also reviewing the role of neuroimaging and eye movement recordings. Results: Asking about timing and triggers helps clarify the temporal evolution of symptoms (transient vs. persistent) and the circumstances of occurrence (spontaneous vs. triggered). Such structured history-taking narrows down the differential diagnosis and ensures appropriate bedside tests. On clinical examination, identifying focal neurologic signs, (subtle) ocular motor findings, and gait imbalance is essential. While positional testing should be applied in all patients with TVS, HINTS+ has not been validated in those patients without nystagmus or with transient (already resolved) symptoms. For neuroimaging, MRI with diffusion-weighted imaging is preferred, but early false-negative findings in up to 20% (to even 50% for small brainstem strokes) of cases must be considered. Quantitative eye movement recordings may be especially valuable in rural areas, supporting telemedicine consults. Conclusions: Special emphasis should be put on distinguishing vertebrobasilar transient ischemic attack from vestibular migraine and cardiac arrhythmia. In the case of triggered TVS, immediate and sustained response to liberation maneuvers strongly supports benign paroxysmal positional vertigo over vestibular migraine or structural central positional nystagmus. Treatment strategies in TVS strongly depend on the underlying cause, ranging from hyperacute stroke treatment to migraine prophylaxis to liberation maneuvers. Full article

Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease primarily affecting upper and lower motor neurons. Although cerebrovascular disease (CVD) and ALS have traditionally been studied as distinct entities, a growing body of evidence indicates meaningful epidemiological, pathophysiological, and clinical overlap between the two conditions. This narrative review synthesizes current evidence on the coexistence of ALS and cerebrovascular disease, examines shared mechanistic pathways, addresses diagnostic challenges, including stroke mimicry, considers clinical management implications, and identifies priorities for future research. A search of PubMed, Scopus, Web of Science, and EMBASE was conducted through February 2026 using the terms “amyotrophic lateral sclerosis,” “motor neuron disease,” “cerebrovascular disease,” “stroke,” “ischemic stroke,” “blood-brain barrier,” “neuroinflammation,” and “neurovascular coupling,” alone and in combination. Peer-reviewed original research, systematic reviews, meta-analyses, population-based studies, registry analyses, and expert consensus statements were included. Studies were assessed for methodological quality and relevance to the review objectives. This review is reported as a narrative synthesis. Population-based data demonstrate a bidirectional relationship between ALS and cerebrovascular events. ALS patients face an approximately 2.6-fold elevated risk of ischemic stroke, and prior cerebrovascular injury modestly increases subsequent ALS risk. Shared pathophysiological mechanisms include neuroinflammation with microglial M1/M2 polarization imbalance, pro-inflammatory cytokine cascades mediated via NF-κB signaling, oxidative stress and SOD1 pathway dysregulation, glutamate excitotoxicity, blood–brain barrier (BBB) dysfunction, and impaired neurovascular coupling. Diagnostic confusion arises because upper motor neuron–predominant ALS can closely mimic acute ischemic stroke. Concurrent cerebrovascular disease appears to accelerate functional decline and reduce survival in ALS. Resource-limited settings face compounded challenges from diagnostic misclassification, restricted EMG access, and limited specialist availability. The ALS–cerebrovascular overlap is clinically relevant, biologically plausible, and systematically understudied. Integrated multidisciplinary management, prospective longitudinal cohort studies, and linked registry analyses are urgently needed to clarify causal relationships, characterize shared disease mechanisms, and improve patient outcomes. Full article

Stroke is a major cause of acquired epilepsy in adults, particularly in older individuals. However, seizures after stroke should not be regarded as a single clinical entity. Acute symptomatic seizures (ASyS) occur within the first seven days after stroke and are considered provoked events, whereas remote symptomatic seizures carry a higher recurrence risk and may fulfill the practical definition of post-stroke epilepsy (PSE). This narrative review provides a clinically oriented synthesis of current evidence on definitions, epidemiology, pathophysiology, risk factors, predictive scores, EEG and biomarker-based risk stratification, seizure prevention, and antiseizure medication (ASM) management. Current evidence does not support routine primary antiseizure medication prophylaxis for all stroke patients. In contrast, documented clinical or electrographic seizures require appropriate treatment, and established PSE often requires long-term individualized therapy. Predictive tools may help guide surveillance, EEG indication, counseling, and follow-up, but should not be used as automatic triggers for prophylactic treatment. ASM choice should account for seizure type, age, comorbidities, cognitive and psychiatric vulnerability, drug interactions, and secondary vascular prevention. Future research should focus on validated biomarkers and preventive strategies capable of modifying epileptogenesis after stroke. Full article

Stroke remains a leading cause of death and long-term disability worldwide, making prevention strategies a global health priority. Emerging technologies—including artificial intelligence (AI), wearable devices, digital health applications, and drone-assisted emergency systems—are increasingly being explored to improve stroke prevention and early management. In primary prevention, machine learning models can identify individuals at high risk of stroke using clinical and behavioral data with high reported predictive accuracy, although most models are derived from retrospective, single-center datasets and still require prospective external validation. Digital devices and wearable technologies enable continuous monitoring of cardiovascular risk factors and support behavioral interventions aimed at reducing vascular risk. In secondary prevention, AI-based tools are being developed to predict stroke recurrence, identify modifiable risk factors, and detect patients at risk of poor medication adherence. In the acute setting, AI-assisted neuroimaging platforms are already integrated into clinical and telestroke workflows, supporting rapid triage and treatment decisions. In parallel, drone-based emergency systems may contribute to improved outcomes by reducing prehospital delays and facilitating telemedicine-based triage in remote or resource-limited settings, although current evidence is derived largely from out-of-hospital cardiac arrest pathways rather than stroke-specific trials. Although advanced neurotechnological systems capable of real-time neurophysiological monitoring and closed-loop neuromodulation exist in other neurological disorders, their role in stroke prevention remains largely theoretical. Overall, these technologies offer promising opportunities to reshape the continuum of stroke prevention and care, but further validation, integration into clinical workflows, and evidence of real-world effectiveness are required before widespread implementation. Full article

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population. Full article

Background/Objectives: The optimal anesthetic strategy during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains debated. Although randomized trials suggest broadly comparable outcomes between general anesthesia (GA) and conscious sedation (CS), real-world data may be influenced by baseline severity, airway management, and postprocedural complications. We evaluated associations between anesthetic strategy, functional outcomes, mortality, and infectious and hemorrhagic complications after MT. Methods: This retrospective observational study included 257 consecutive adults with AIS treated with MT at a single comprehensive stroke center. Patients were managed under CS or GA according to clinical and procedural considerations. Outcomes, mortality, infectious and hemorrhagic complications were compared between groups. Multivariable logistic regression assessed associations with 90-day functional independence and mortality, adjusting for baseline and procedural factors. In an exploratory GA subgroup analysis, outcomes were compared according to extubation timing, defined as early (≤6 h) or delayed (>6 h). Results: Of 257 patients, 155 (60.3%) underwent MT under CS and 102 (39.7%) under GA. GA-treated patients had higher baseline NIHSS scores and worse unadjusted functional outcomes throughout follow-up. After adjustment, GA remained associated with higher 90-day mortality (OR 4.39, 95% CI 1.50–12.84; p = 0.007) and lower odds of 90-day functional independence (OR 0.29, 95% CI 0.10–0.82; p = 0.020). Pneumonia was more frequent with GA (49.0% vs. 26.5%; p < 0.001), although attenuated in adjusted analyses. Delayed extubation was associated with worse outcomes, higher pneumonia rates, and more frequent symptomatic intracranial hemorrhage. Conclusions: GA was associated with worse functional outcomes and higher mortality after MT, but residual confounding and differences in baseline stroke severity likely contributed to these associations. Pneumonia and hemorrhagic complications may identify patients at increased risk of poor outcome, especially when extubation is delayed. Findings require prospective confirmation. Full article