Search Results (328)

Background and Clinical Significance: Overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in children is a rare but life-threatening metabolic emergency. The coexistence of hyperosmolality and ketoacidosis increases neurologic vulnerability and complicates fluid and insulin management. Early identification and osmolality-guided therapy are essential to prevent cerebral edema and other complications. This case describes a 5-year-old boy with new-onset type 1 diabetes mellitus (T1D) presenting with DKA/HHS overlap two weeks after influenza vaccination—an unusual temporal association without proven causality. Case Presentation: A previously healthy 5-year-old presented with progressive polyuria, polydipsia, nocturnal enuresis, fatigue, and drowsiness. Two weeks earlier, he had received the influenza vaccine. Examination revealed moderate dehydration without Kussmaul respiration or altered consciousness. Laboratory evaluation showed glucose 45.9 mmol/L (826 mg/dL; reference 3.9–7.8 mmol/L), venous pH 7.29 (reference 7.35–7.45), bicarbonate 12 mmol/L (reference 22–26 mmol/L), moderate ketonuria, and measured serum osmolality 344 mOsm/kg (reference 275–295 mOsm/kg), fulfilling diagnostic criteria for DKA/HHS overlap. After an initial 20 mL/kg 0.9% NaCl bolus, fluids were adjusted to maintenance plus approximately 10% deficit using 0.45–0.75% NaCl according to sodium/osmolality trajectory. Intravenous insulin (approximately 0.03–0.05 IU/kg/h) was initiated once blood glucose no longer decreased adequately with fluids alone and had stabilized near 22.4 mmol/L (≈400 mg/dL). Dextrose was added when glucose reached 13.9 mmol/L (250 mg/dL) to avoid rapid osmolar shifts. Hourly neurological and biochemical monitoring ensured a glucose decline of 2.8–4.2 mmol/L/h (50–75 mg/dL/h) and osmolality decrease ≤3 mOsm/kg/h. The patient recovered fully without cerebral edema or neurologic sequelae. IA-2 antibody positivity with low C-peptide and markedly elevated HbA1c confirmed new-onset T1D. Conclusions: This case highlights the diagnostic and therapeutic challenges of pediatric DKA/HHS overlap. Osmolality-based management, conservative insulin initiation, and vigilant monitoring are crucial for preventing complications. The temporal proximity to influenza vaccination remains incidental. Full article

Background/Objectives: To analyze the parent-perceived quality of life (QoL) in children with cerebral palsy (CP) and to study the relationship between sociodemographic and clinical factors and this perception, under the perspective of the International Classification of Functioning, Disability and Health (ICF). Methods: A cross-sectional study was conducted with 95 participants (ages 5–19 years) with CP. Participants’ parents were asked about sociodemographic and clinical characteristics and compiled Cerebral Palsy Quality of Life (CP-QoL) and Pediatric Disability Inventory-Computer Adaptive Test (PEDI-CAT). Participants were assessed and classified into the following functional domains: gross motor function (GMFM-88, GMFCS), manual ability (MACS), eating and drinking abilities (EDACS), and communication function (CFCS). Correlations between CP-QoL domains and variables were investigated using Spearman’s correlation coefficient and multivariate predictive models were used to investigate the variables predicting CP-QoL scores for each domain. Results: A total of 95 children with a mean age of 12.4 ± 3.5 years (range 5–19 years) were included. Participants demonstrated moderate-high GMFM-88 level (228.8 ± 44.7) and high functional performance across PEDI-CAT domains: Activity (57.2 ± 5.1), Mobility (63.1 ± 5.6), and Social/Cognitive (70.2 ± 4.3). Parent-perceived QoL was significantly higher when children did not require AFOs, botulinum toxin, or recent hospitalizations, and lower among children who attended physical therapy >2 h/week. Moderate correlations were consistently found between the ‘Feelings about Functioning’ domain and functional variables, being positive for GMFM-88 and all PEDI-CAT domains, and negative for GMFCS, MACS, EDACS and CFCS. That domain of CP-QoL was best explained by the regression model (R² = 0.619, p < 0.001), with the combination of three variables: GMFM-88, PEDI-CAT Activity and PEDI-CAT Social/Cognitive. Among them, PEDI-CAT Activity was the strongest predictor (β = 0.1436). Conclusions: In children with CP, to enhance family well-being, interventions should prioritize social participation and carefully balance the intensity and frequency of therapy against family burden and daily life demands, as QoL is primarily driven by manual ability and functional performance. Full article

Background: Periodontitis has been associated with systemic diseases such as cerebrovascular events. Emerging research highlights the potential role of the microbiome in intracranial aneurysm formation and rupture. Aims: We aimed to explore the associations among periodontal pathogens and the outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: A total of 43 aSAH patients were enrolled. Clinical probing depth measurement and microbiological culture were performed for all participants. The markers of systemic immune response (IL-6, hsCRP) and brain injury (NSE, S100B) were measured between 24 and 48 h after admission. Development of delayed cerebral ischemia (DCI) as the primary and clinical outcome, based on modified Rankin Scale as secondary endpoints, comprised the chosen metrics. Results: A significant association was observed between patients with periodontal pocket depth PPD ≥ 5 mm (n = 28) and DCI, which developed in 19 patients (p = 0.007). In the subgroup of patients with PPD ≥ 5 mm significant associations were found between certain periodontal pathogens and DCI. Higher hsCRP (p = 0.05), IL-6 (p = 0.037) levels were observed in cases with periodontal pathogens, independent of the depth of the pocket, suggesting systemic inflammation. Conclusions: Elevated hsCRP and IL-6 levels, periodontal pocket depth ≥ 5 mm, and red-complex periodontal pathogens are associated with an increased risk of DCI after aSAH, suggesting a role for periodontal disease–related systemic inflammation in DCI risk stratification. Full article

The reduced scattering coefficient (μ_s′), measured using time-resolved near-infrared spectroscopy (TR-NIRS) has been linked to brain water diffusion assessed by diffusion tensor imaging, suggesting its potential as a bedside marker of cerebral microstructure. However, the physiological determinants of μ_s′ and its early postnatal changes remain unclear. This study examined clinical associations with cerebral μ_s′ in healthy term newborn infants during the first 2 postnatal days. Eighteen newborn infants underwent TR-NIRS at 6 and 36 h postnatally. Associations between μ_s′ and 14 clinical variables were analysed using generalised estimating equations. Median μ_s′ was 7.395 cm⁻¹ (IQR: 6.140–8.159) at 6 h and 7.112 cm⁻¹ (IQR: 6.473–7.410) at 36 h, with no significant difference (p = 0.327). Male sex was associated with higher μ_s′ (regression coefficient = 0.895, p = 0.007), whereas caesarean delivery (regression coefficient = −0.969, p = 0.012) was associated with lower μ_s′. A significant interaction between caesarean delivery and postnatal age indicated that the negative effect diminished between 6 and 36 h after birth (difference = 0.057, p = 0.016). These findings suggest delivery mode transiently influences brain scattering, whereas the effect of sex remains stable, supporting further investigation of TR-NIRS as an acute-phase cerebral marker. Full article

Despite advances in post-cardiac arrest care, mortality and poor neurological outcomes remain common after out-of-hospital cardiac arrest (OHCA). Calcium imbalance is characteristic of post-cardiac arrest syndrome, but its prognostic role is unclear. We retrospectively analyzed 421 OHCA patients treated with targeted temperature management (TTM) (2011–2023). pH-adjusted ionized calcium levels were measured at 0, 12, 24, 48, and 72 h after return of spontaneous circulation (ROSC). Associations with 30-day neurological outcomes and mortality were assessed using multivariable logistic regression with two-stage maximum likelihood estimation. Higher baseline-adjusted ionized calcium levels were significantly associated with better neurological outcomes (Cerebral Performance Category 1–2) and lower 30-day mortality, regardless of calcium infusion or clinical covariates. Each 0.01-unit increase corresponded to 17% lower odds of unfavorable neurological outcome (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.76–0.90) and 10% lower mortality (OR, 0.90; 95% CI, 0.84–0.96). Incorporating longitudinal calcium measurements improved predictive accuracy, raising the area under the curve for neurological outcomes from 0.843 to 0.919. Early post-ROSC ionized calcium levels were independently associated with neurological outcomes and mortality in patients with OHCA treated with TTM. Serial ionized calcium monitoring may serve as a prognostic marker, warranting prospective evaluation of therapeutic implications. Full article

Background: COPD patients may be prone to cerebral small vessel disease resulting in perivascular white matter lesions and consequent cognitive decline. The pathophysiological background of these observations is not completely understood. It is hypothesized that COPD may involve systemic vascular dysfunction extending to the brain. The present study aimed to assess whether acetazolamide-induced cerebral vasoreactivity and cerebrovascular reserve capacity are impaired in patients with COPD. Methods: A total of 17 patients with COPD and 20 healthy control subjects underwent transcranial Doppler monitoring before and after IV administration of 15 mg/kgBW acetazolamide for 20 min. Cerebrovascular reactivity (CVR) was defined as a percent increase in blood flow velocity in the middle cerebral artery (MBFV) after acetazolamide. Cerebrovascular reserve capacity (CVRC) was defined as the maximal percent change in MBFV during the entire registration. Results: Administration of acetazolamide resulted in a slight decrease in pH and a mild increase in PaCO₂ (both p < 0.001) in COPD patients. Absolute MBFV values were consequently higher, and pulsatility indices were lower in control subjects compared to those measured in patients with COPD. The CVR at different time points after acetazolamide and CVRC did not show any difference between COPD patients and control subjects. Conclusions: In the present study, in normocapnic mild and normocapnic moderate COPD patients, cerebrovascular reactivity is not impaired, indicating that in mild stages, cerebral arteriolar function is preserved. Further studies, using patient selection based on different severity stages of the disease, may show whether alteration of the cerebral arteriolar function is responsible for the white matter lesions and cognitive decline observed in severe COPD patients. Full article

Introduction: Cerebral palsy (CP) affects motor function development, requiring intensive rehabilitation. Virtual reality (VR) interventions show promise for improving motor learning through immersive, engaging experiences. This systematic review and meta-analysis evaluated VR effectiveness for motor function improvement in children with CP. Methods: Following PRISMA 2020 guidelines, we searched six electronic databases from inception to 15 June 2025. Included studies compared VR interventions versus control conditions in children with CP (ages 4–18 years), measuring motor function outcomes. Sixteen studies (n = 397 participants) met the inclusion criteria for qualitative synthesis. Random-effects models, subgroup analyses, and meta-regression were performed. Evidence certainty was evaluated using GRADE methodology. Results: Five randomized controlled trials with complete extractable data (N = 190 participants, 40 effect sizes) were included in the primary quantitative meta-analysis. The primary meta-analysis demonstrated moderate overall effects favoring VR interventions (standardized mean difference [SMD] = 0.41, 95% CI [0.16, 0.66], p = 0.001; I² = 74%); however, GRADE quality was rated LOW due to risk of bias and imprecision. Technology type critically moderated outcomes: robotic exoskeleton systems showed large effects (SMD = 1.00, p = 0.002), commercial gaming platforms showed small-to-moderate effects (SMD = 0.38, p = 0.013), while custom VR systems showed no significant benefit (SMD = 0.01, p = 0.905; Q = 29.00, p < 0.001). Age emerged as the strongest moderator: children (<6 years) demonstrated significant benefits (SMD = 0.98, p < 0.001), whereas school-age children (6–12 years) showed no effect (SMD = −0.01, p = 0.903; meta-regression slope = −0.236 per year, p < 0.001). Dose–response was non-linear, with optimal benefits at 30–40 intervention hours and diminishing returns beyond 50 h. VR proved superior to standard care (SMD = 0.83) but not to active intensive therapies (SMD = 0.09). The safety profile was favorable (1.3% adverse event rate, no serious events). No publication bias was detected. Conclusions: VR interventions demonstrated moderate, technology-dependent motor function improvements in children with CP, with benefits concentrated in young children using robotic systems. Evidence certainty is low, requiring further high-quality trials. Implementation should prioritize robotic VR for children with 30–40 h protocols. Full article

Stroke is the leading cause of death and long-term disability worldwide, with ischemic stroke accounting for nearly 87% of all cases. Vascular occlusion, a key pathological event in ischemic stroke, has been reliably reproduced in preclinical studies using permanent ischemic stroke models. This study demonstrated the neuroprotective effect of NXC736, a functional antagonist of sphingosine-1-phosphate receptor 4 (S1P₄, currently in phase II clinical trials for alopecia areata), against acute injury in mice with permanent middle cerebral artery occlusion (pMCAO). pMCAO-challenged mice received oral NXC736 1 h after occlusion. NXC736 demonstrated substantial therapeutic activity against permanent ischemic stroke by attenuating pMCAO-induced acute brain infarction, neurological deficits, and apoptosis. Additionally, NXC736 reduced blood–brain barrier disruption and edema in the injured brain. Moreover, NXC736 reduced microglial activation and proliferation, oxidative stress, and suppressed pro-inflammatory cytokine expression, suggesting that the efficacy of NXC736 in permanent ischemic stroke is associated with the suppression of neuroinflammatory responses. Mechanistically, we found that NXC736-mediated neuroprotective effects were dependent on the inactivation of NF-κB and MAPKs, including ERK1/2, JNK, and p38. Collectively, our findings indicate that NXC736 is an effective neuroprotective drug for permanent ischemic brain stroke, highlighting S1P₄ as a promising therapeutic target for ischemic stroke. Full article

Introduction: Blood gas analysis is utilized to assess parameters of oxygenation and ventilation, including acid–base status [pH value, base excess (BE) or base deficit (BD), and bicarbonate (HCO₃)], to evaluate systemic metabolism status. Acid–base imbalances can have complex effects on the organism, potentially impacting oxygen delivery to tissue. Cerebral oximetry is a non-invasive monitoring technique using near-infrared spectroscopy (NIRS) for the continuous measurement of cerebral tissue oxygenation. The relationship between the acid–base status and cerebral tissue oxygenation in neonates remains unclear. This systematic qualitative review aims to analyze current knowledge of the potential correlations between different acid–base status parameters and cerebral tissue oxygenation measured via NIRS in neonates. Methods: A systematic search of PubMed and Ovid Embase was performed, focusing on cerebral oxygenation, neonates, and acid–base status. Risk of bias was assessed using the ‘‘Risk of Bias for Non-randomized Studies of Exposures’’ (ROBINS-E) instrument. Results: Fifty studies that measured parameters of the acid–base status and cerebral tissue oxygenation in the neonatal period were identified. Seven studies demonstrated a correlation between pH and cerebral tissue oxygenation, while eleven studies found no such correlation. Five studies demonstrated a correlation between the BE/BD and cerebral tissue oxygenation, while six studies found no such correlation. Three studies demonstrated a correlation between HCO₃ and cerebral tissue oxygenation, while five studies found no such correlation. Discussion: Associations between acid–base status parameters and cerebral tissue oxygenation remain controversial. However, studies with the lowest risk of bias mainly demonstrated no significant correlation between any of the acid–base status parameters and cerebral tissue oxygenation. Full article

Introduction: We aimed to clarify the influence of the thrombus composition on ischemic stroke endovascular thrombectomy (EVT) efficiency by utilizing various staining methods for patients that presented with occlusions of the middle cerebral artery (MCA). Methods: Between September 2017 and May 2021, we analyzed thrombi retrieved during endovascular thrombectomy EVT in patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion. Patients with reperfusion failure, intracranial atherosclerotic occlusions, and inadequate staining were excluded. The thrombus composition was stratified using three staining techniques—Hematoxylin and Eosin (H&E), Martius Scarlet Blue (MSB) staining, and immunohistochemistry (IHC) for red blood cells (RBCs), white blood cells (WBCs), fibrin (Fibrin II), and platelets (CD41). Associations between EVT efficiency outcomes and the thrombus composition were evaluated. Results: During the study period, thrombus was available for analysis in 159 patients. A total of 59 patients were included in the main analysis. Increases in the trichotomized RBS tertiles were associated with decreases in the components of various platelet/other components but not for fibrin. A modified first pass effect (mFPE) of the modified Thrombolysis in Cerebral Infarction perfusion scale (mTICI) 2b or higher was associated with larger thrombus surface area (16.0 ± 11.6 vs. 47.4 ± 62.3 mm², p = 0.005), a higher MSB fibrin content (29.8 ± 10.7 vs. 21.3 ± 10.9%, p = 0.002), and IHC fibrin (28.5 ± 14.5 vs. 20.1 ± 11.4%, p = 0.008). There was a marginal association between the mTICI 2b mFPE and lower MSB platelet/other components (27.6 ± 20.9 vs. 34.4 ± 14.9%, p = 0.078). The discrepancy between MSB platelet/others and IHC platelets was greater in the mFPE (-) group, suggesting that components other than platelets may contribute to EVT resistance. A mFPE of mTICI 2c or higher was associated with greater thrombus surface area (17.8 ± 11.9 vs. 37.7 ± 55.0 mm², p = 0.015) and MSB fibrin (32.1 ± 10.3 vs. 22.8 ± 11.0%, p = 0.002). There was a marginal reverse association between the mTICI 2c mFPE and MSB RBCs (33.4 ± 20.2% vs. 41.5 ± 17.3%, p = 0.062). There was no significant association between final near-complete reperfusion and the thrombus composition. Conclusions: In patients presenting with occlusions of the MCA, a higher thrombus fibrin content is associated with better EVT efficiency. Both a higher MSB platelet/other components and RBC content may have a negative influence on EVT efficiency. These results may help identify preprocedural biomarkers beyond the conventional assessment of RBCs, WBCs, and fibrin compositions, which could guide decision-making during mechanical thrombectomy. Full article

Background: Long-term management of cerebral venous thrombosis (CVT) with rivaroxaban is still under evaluation. The primary objective was to compare the contemporary evidence of the safety and efficacy of rivaroxaban versus warfarin in the long-term (≥ 6 months) treatment of CVT. Methods: We searched electronic databases up to 30 April 2025 for randomised control trials (RCTs) and observational studies in CVT management. We utilised the Mantel–Haenszel (M-H) method with a fixed-effects model to calculate risk differences (RDs) between rivaroxaban and warfarin arms. The ROB 2.0 and ROBINS-I tools were used to observe the risk of bias among included studies. Results: A total of 12 studies were identified (4 RCTs and 8 observational cohorts), evaluating 1174 patients treated with rivaroxaban (n = 262) or warfarin (n = 912). The rate of recurrence of venous thrombosis was 4% lower among rivaroxaban- compared to warfarin-treated patients (1.5% vs. 4.0%; RD = −0.04; p = 0.04). However, non-recanalisation events were identical among rivaroxaban and warfarin arms (16.4% vs. 16.5%; RD = −0.01, p = 0.68). Additionally, long-term all-cause mortality (p = 0.39), clinically relevant bleeding events (p = 0.18), new intracranial haemorrhage (p = 0.79), and good clinical outcome (p = 0.92) events were similar between rivaroxaban and warfarin arms. While RCTs and observational cohorts have methodological concerns and potential bias, we validated our results by excluding studies with serious or critical risks of bias to ensure the robustness of our findings. Conclusions: Compared to warfarin, rivaroxaban offers lower recurrence rates with similar efficacy and safety profiles along with improved clinical convenience. Full article

Background: Non-communicable diseases represent a major global health challenge. Among these, diabetic ketoacidosis (DKA), an acute complication of type 1 diabetes mellitus in children and adolescents, significantly contributes to worldwide morbidity and mortality. Effective management of DKA relies on adequate insulin therapy, but variability in dosing, administration, and frequency leads to increased risk of complications and delayed DKA resolution. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the insulin dose and route of administration regimens for managing pediatric DKA. Methods: This review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024568747). A comprehensive search of PubMed, CINAHL, Cochrane Library, and Scopus identified studies examining insulin regimens in pediatric DKA. Eligible studies were assessed for risk of bias using the Cochrane’s Risk of Bias (RoB-2) tool, and data were pooled using Review Manager for meta-analysis. Outcomes included morbidity (cerebral injury, hypoglycemia, hypokalemia), mortality, hospital stay, and adverse events. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. This review was commissioned by the WHO for the development of consolidated guidelines on common childhood illnesses. Results: Twelve RCTs, involving 530 participants, were included. A lower insulin dose (0.05 U/kg/h) was associated with a significantly reduced risk of hypoglycemia (RR = 0.39, 95% CI: 0.18–0.88, p = 0.02) and hypokalemia (RR = 0.54, 95% CI: 0.33,0.89, p = 0.01) compared to 0.1 U/kg/h. There were no significant differences in mortality and length of hospital stay between the dosing regimens. Additionally, no significant differences were observed in the incidence of cerebral injury and other adverse events. Conclusions: Findings suggest that lower insulin doses may reduce the risks of hypoglycemia and hypokalemia in children with mild-to-moderate DKA without increasing the risk of mortality, cerebral injury, or length of hospital stay. Further studies are needed to provide an evidence-based core outcome set and refine insulin dosing strategies across the full spectrum of disease severity. Full article

This study uses a pointwise statistical approach to analyze Near-Infrared Spectroscopy (NIRS) signals in preterm infants with and without Patent Ductus Arteriosus (PDA). The analysis focuses on three signals: blood oxygenation (SpO₂), cerebral oxygenation (rSO₂-1), and renal oxygenation (rSO₂-2), across three newborn groups: without PDA (no-PDA), with hemodynamically insignificant PDA (PDA), and with hemodynamically significant PDA (hsPDA). While NIRS is widely used in medicine, its research, featuring statistical analysis, has been limited. Smoothed signals were tested using pointwise ANOVA and Tukey HSD to detect significant group differences. Results showed distinct patterns in rSO₂-1 and rSO₂-2, with the hsPDA group standing out in rSO₂-1 and the no-PDA group in rSO₂-2, demonstrating the value of this method in biomedical signal analysis. Pointwise ANOVA shows more time periods with significant differences compared to the SpO₂ signal. The time period with the most significant differences is between 2 and 6 h, with additional peaks of p-values below 0.05 occurring before 2 h. These findings demonstrate the value of FDA in improving statistical analysis of biomedical NIRS signals and support its use in future research. Full article

Background/Objectives: To evaluate whether incorporating both diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in pituitary MRI examinations improves differential diagnosis by providing additional diagnostic value. Methods: A retrospective analysis was performed on 88 patients with histologically confirmed sellar or parasellar tumors who underwent 1.5T MRI with DWI and dynamic susceptibility contrast PWI (DSC-PWI) between October 2007 and April 2023. DWI parameters included minimum apparent diffusion coefficient (ADCmin) and relative ADCmin (rADCmin). PWI parameters included mean and maximum relative cerebral blood volume (rCBV, rCBVmax) and relative peak height (rPH, rPHmax), normalized to white matter. Tumor regions of interest were manually segmented, excluding calcified or hemorrhagic areas. Group comparisons and ROC analyses assessed diagnostic performance of individual and combined parameters. Results: Significant differences in diffusion and perfusion metrics were observed among the five tumor types. The combined analysis of DWI and PWI improved diagnostic accuracy in selected comparisons. The greatest benefit occurred in distinguishing meningiomas from solid non-functional pituitary adenomas (pituitary neuroendocrine tumors-PitNET), where the combination of ADCmin and rPHmax yielded an AUC of 0.818, sensitivity of 88%, and specificity of 76%, exceeding the performance of either parameter alone. In other comparisons, including meningiomas versus invasive PitNETs and adamantinomatous craniopharyngiomas, combined analysis did not substantially improve accuracy when single parameters, particularly rCBVmax (AUC = 0.995), already demonstrated excellent performance. Conclusions: Integration of DWI and PWI into pituitary MRI protocols enhances diagnostic performance in selected tumor groups. The additive value is context-dependent, supporting the tailored application of these sequences in the evaluation of sellar and parasellar tumors. Full article

Background: Aneurysmal subarachnoid hemorrhage (SAH) is over twice as common in females compared to males, who may also experience more severe hemorrhages and worse outcomes. Differences in SAH severity, susceptibility to delayed cerebral ischemia (DCI), and treatment responsiveness may underlie this disparity. This study evaluated sex-based differences in DCI timing, severity, treatment responsiveness, and outcomes after SAH. Methods: We analyzed 650 consecutive SAH patients admitted to RWTH Aachen University Hospital (2006–2021). SAH severity was assessed via the (World Federation of Neurological Surgeons) WFNS and modified Fisher scales. DCI-related infarction was defined as new infarcts on CT not present initially or within 48 h post-aneurysm occlusion. Endovascular rescue therapy (ERT) was used for treatment-resistant DCI. Outcomes were assessed at discharge and 12 months using the modified Rankin Scale (mRS). Generalized linear mixed-effects models adjusted for confounders. Results: Of 650 patients, 455 (70%) were female. DCI rates did not differ significantly between sexes (41.5% female vs. 36.4% male; p = 0.361). DCI-related infarction occurred in 19.4% of patients, with no sex-based differences in infarct volume (median 115 mL; p = 0.670) or location. ERT use was similar in females (22.4%) and males (23.9%; p = 0.825). Lower age, poor-grade SAH, and higher mFisher scores were associated with DCI and poor outcomes, but sex was not an independent predictor. Conclusions: Female sex was not associated with more severe SAH, a higher incidence of DCI, or more severe DCI manifestations. Although small effect sizes may become statistically significant in larger cohorts, our findings indicate that such effects are unlikely to be driven by differences in DCI timing, infarct size, or treatment responsiveness. Full article