Search Results (392)

Background and Clinical Significance: Intracerebral hemorrhage (ICH) is a very rare complication following endovascular closure of direct carotid-cavernous fistulas (CCFs). When reported, ICH typically appears within the first 48 h after CCF closure. We performed an extensive literature review, starting from the case of a 48-year-old patient presenting with an intracerebral hemorrhage after CCF closure. Case Presentation: A 48-year-old woman with arterial hypertension developed an intracerebral hemorrhage in the right frontal lobe 12 days after successful closure of a traumatic CCF. The patient exhibited acute neurological deterioration in a previously hypoperfused territory. A narrative review identifies the classical molecular theory of hemodynamic dysregulation, known as Normal Perfusion Pressure Breakthrough (NPPB), as the principal pathophysiological mechanism. Other mechanisms such as oxidative stress, microglial activation, blood–brain barrier disruption, metalloproteinase expression, and possible genetic alterations such as ICA1L variants are also implicated. Conclusions: This case underscores the importance of considering molecular mechanisms in the pathophysiology of delayed post-endovascular treatment of ICH, as well as the need for hemodynamic monitoring and follow-up in patients with vascular comorbidities. Full article

Introduction: Spontaneous intracerebral hemorrhage (sICH) is a devastating type of stroke. Blood pressure reduction is crucial in its management and is well mentioned in current guidelines; however, the role of blood pressure variability (BPV) in emergency departments (EDs) has not been well studied. This study aimed to identify predictors of lower systolic blood pressure (SBP) (≤160 mmHg) and BPV at ED discharge and course, respectively. Methods: This is a retrospective study of prospectively collected data at a quaternary care center of adult patients diagnosed and treated with sICH between 1 January 2017 and 31 December 2020. The primary outcome of interest was SBP at ED discharge; this was divided into two groups: a control group composed of patients discharged with an SBP ≤ 160 mmHg and a comparison group composed of patients discharged with an SBP > 160 mmHg. Secondary outcomes included measures of BPV, specifically successive variation (SBPSV), and standard deviation (SBPSD) during ED course. Machine learning algorithms were used to identify predictors of SBP at ED discharge: SBPSV and SBPSV. Results: This study evaluated 142 patients, of which 85 (60%) were discharged with SBP ≤ 160 mmHg. The mean SBP at ED discharge was 133 (±16.1) mmHg for the control group and 184 (±21.3) for the comparison group (difference −51; 95% CI −58 to −45; p < 0.001). The top five predictors for the primary outcome identified by machine learning included initial SBP at ED triage, serum sodium, clevidipine administration, serum glucose, and serum creatinine. Predictors for secondary outcome included mechanical ventilation, serum glucose, and initial SBP at ED triage. Conclusion: Initial SBP was the top predictor of achieving a goal SBP ≤160 mmHg at ED discharge in patients with sICH. Predictors of increased BPV included mechanical ventilation, elevated serum glucose, and high initial SBP in the ED. While further studies are necessary to confirm our observations, clinicians should consider these factors when they care for patients with sICH. Full article

Handcrafted radiomics use predefined formulas to extract quantitative features from medical images, whereas deep neural networks learn de novo features through iterative training. We compared these approaches for predicting 3-month outcomes and hematoma expansion from admission non-contrast head CT in acute intracerebral hemorrhage (ICH). Training and cross-validation were performed using a multicenter trial cohort (n = 866), with external validation on a single-center dataset (n = 645). We trained multiscale U-shaped segmentation models for hematoma segmentation and extracted (i) radiomics from the segmented lesions and (ii) two latent deep feature sets—from the segmentation encoder and a generative autoencoder trained on dilated lesion patches. Features were reduced with unsupervised Non-Negative Matrix Factorization (NMF) to 128 per set and used—alone or in combination—for six machine-learning classifiers to predict 3-month clinical outcomes and (>3, >6, >9 mL) hematoma expansion thresholds. The addition of latent deep features to radiomics numerically increased model prediction performance for 3-month outcomes and hematoma expansion using Random Forest, XGBoost, Extra Trees, or Elastic Net classifiers; however, the improved accuracy only reached statistical significance in predicting >3 mL hematoma expansion. Clinically, these consistent but modest increases in prediction performance may improve risk stratification at the individual level. Nevertheless, the latent deep features show potential for extracting additional clinically relevant information from admission head CT for prognostication in hemorrhagic stroke. Full article

Objectives: We aimed to determine temporal patterns of blood–brain barrier (BBB) dysfunction, edema formation and functional recovery in acute stroke. Materials and Methods: Patients of two observational studies on ischemic and hemorrhagic stroke between 2006 and 2019 were analyzed. Blood–brain barrier dysfunction was assessed using the cerebrospinal fluid-to-plasma albumin ratio. Edema formation was measured on all available imaging scans during hospital stay. Relative edema was defined as the ratio of edema volume to stroke volume. Multivariable regression models were applied to analyze associations and calculate predicted probabilities. Results: Overall, 138 stroke patients, 103 (74.6%) with ischemic stroke and 35 (25.4%) with hemorrhagic stroke, were analyzed. The predicted probability of substantial BBB dysfunction was approximately 46 (37–55) % among patients analyzed on 1 day after symptom onset and declined with increasing time, thereafter reaching 10 (3–29) % on day 30. The maximal extent of edema was lower in ischemic versus hemorrhagic stroke (relative edema: 1.5 [1.2–1.8] vs. 2.6 [1.9–4.5], p = 0.003) and occurred earlier after stroke onset (5.9 [4.6–8.5] days vs. 12.3 [9.7–16.4] days, p = 0.009). BBB dysfunction was associated with increased edema formation (adjusted relative edema: 4.0 [2.8–4.5] vs. 2.3 [1.8–3.0], p = 0.037) and lower chances of functional recovery (20/48 [41.7%] vs. 51/90 [56.7%], adjusted Odds Ratio: 0.37 [0.16–0.88], p = 0.025) in both ischemic and hemorrhagic stroke patients. Conclusions: BBB dysfunction frequently occurred in acute ischemic and hemorrhagic stroke and was associated with secondary injury and worse clinical outcomes. Future studies should evaluate BBB dysfunction as a potential therapeutic target using advanced imaging techniques early after stroke onset. Edema formation was aggravated and prolonged in hemorrhagic versus ischemic stroke. Full article

Extracellular vesicles (EVs) have emerged as potential therapeutic agents for neurological disorders. Their molecular cargo may reflect the clinical status of the donor and has been identified as a biomarker for the cellular damage and repair processes underlying intracerebral hemorrhage (ICH). It has been shown that EVs from patients with favorable outcomes carry a distinct proteomic signature, compared to those from poor outcome patients, which may promote recovery in preclinical models of ICH. We investigated whether intravenously administered EVs isolated from patients with poor outcomes after ICH provide any benefit in a preclinical ICH model. No significant differences were observed in lesion volume between the placebo and treatment groups at 24 h, 72 h, or 28 days post-ICH. Functional assessments using the Rogers and tapered beam walking tests revealed no improvement in motor performance in the treatment group at 24 h, 72 h, 7 d, 14 d and 28 d. Histological analysis at 28 days showed no significant differences in immunofluorescence markers of myelin preservation (MOG, Olig-2), astroglial activation (GFAP), or angiogenesis (VEGF) between groups. In conclusion, EVs derived from patients with poor outcomes after ICH failed to promote functional recovery or modulate markers of injury and repair in a rat model, suggesting few endogenous repair mechanisms. Full article

Pigeon paramyxovirus type 1 (PPMV-1) poses a significant threat to pigeon farming in China, and understanding its biological characteristics and pathogenicity is critical for vaccine development and disease control. In this study, we characterized a PPMV-1 QY strain, performed full-length genome sequencing, and constructed a phylogenetic tree based on the F gene. Then, the biological properties and the pathogenicity of the QY strain were assessed and evaluated in vitro and in vivo. The results showed that phylogenetic analysis classified the QY strain within subgenotype VI.2.1.1.2.2, the predominant circulating strain in China. The QY strain exhibited a 50% egg infectious dose (EID₅₀) of 10^−6.8/0.1 mL, mean death time (MDT) in chicken embryos of 68.7 ± 2.1 h, and intracerebral pathogenicity index (ICPI) in one-day-old chicks of 1.12, which indicate it is a moderately virulent strain. Animal experiments showed that the QY strain resulted in a mortality rate of 66.7% in healthy pigeons. Necropsy findings included cerebral congestion and swelling, hemorrhagic glandular stomach papillae, tracheal ring hemorrhages, and duodenal congestion and swelling. Histopathological analysis revealed extensive inflammatory infiltration in the lungs and liver, widespread intestinal erosion, and severe necrosis of splenic red pulp cells. In conclusion, the QY strain belongs to subgenotype VI.2.1.1.2.2 and exhibits moderate virulence, causing high mortality and severe pathological lesions in infected pigeons. These findings provide valuable insights into the pathogenicity of PPMV-1 and the specific mutations in the F protein can serve as potential attenuation targets in vaccine development against the emerging subgenotype VI.2.1.1.2.2. Full article

Background/Objectives: The amino acid cysteine (Cys) plays an important role in the neuronal injury process in stroke. Cys is present in blood plasma in various forms. The relationship between Cys and its forms and the severity of acute stroke has not been sufficiently studied. We investigated the levels of total Cys and two of its forms (reduced Cys and its disulfide (cystine, CysS)) in blood plasma and their influence on stroke severity in patients at admission. Methods: A total of 210 patients (39–59 years old) with ischemic stroke and intracerebral or subarachnoid hemorrhage were examined. The contents of the different forms of Cys were determined in the first 10–72 h. Stroke severity was estimated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRs). Results: CysS levels < 54 μM were associated with severe (NIHSS > 13) neurological deficit (ischemic stroke: RR = 5.58 and p = 0.0021; hemorrhagic stroke: RR = 3.56 and p = 0.0003). Smoking and high levels of total Cys and other thiols (glutathione and homocysteine) appear to be factors determining this relationship. Conclusions: Low CysS levels may serve as a potential biomarker of acute stroke severity. Full article

Insights into motor cortex remodeling may enable the development of more effective rehabilitation strategies during the acute phase. We aim to assess the affected and unaffected motor/premotor/somatosensory cortex resting state functional connectivity (RSFC) and reactivity with continuous wave functional near-infrared spectroscopy (cw-fNIRS) in patients with ICH compared to age, sex, and comorbidity-matched subjects. We enrolled patients with acute–subacute hemispheric ICH (n = 37; two were excluded due to artifacts) and grouped them according to the side (right and left) of the stroke. Matched participants or patients with recent transient ischemic attack were enrolled as control subjects for the study (n = 44; five were excluded due to artifacts). RSFC was assessed in both affected and unaffected hemispheres by group-level seed-based (primary motor cortex, priMC) correlation analysis. FT-associated relative oxyhemoglobin (ΔHbO) changes were analyzed in affected and unaffected hemispheres with generalized linear model regression. In left hemispheric ICH, the resting state coherence between the affected priMC and the affected premotor cortex (preMC) increased (β = 0.83, 95% CI = 0.19, 1.47, p = 0.01). In contrast, in right hemispheric ICH, the coherence between the unaffected priMC and the affected preMC decreased (β = −0.6, 95% CI = −1.12, −0.09, p = 0.02). In the left hemispheric ICH, the left-hand FT was associated with increased ΔHbO over the affected preMC (β = 0.01, 95% CI = 0.003, 0.02, p = 0.01). In contrast, in right hemispheric ICH, the left-hand FT was associated with increased ΔHbO over the unaffected preMC (β = 0.02, 95% CI = 0.006, 0.04, p = 0.01). Left hemispheric preMC may be involved in motor cortex reorganization in acute ICH in either hemisphere. Further studies may be required to assess longitudinal changes in motor cortex reorganization to inform acute motor rehabilitation. Full article

Background: Early hematoma expansion is a major determinant of poor outcomes after spontaneous intracerebral hemorrhage (ICH). Identifying reliable predictors of hematoma expansion may facilitate risk stratification and timely interventions. This study aimed to evaluate clinical, laboratory, and radiological factors associated with early hematoma expansion within 24 h. Methods: We retrospectively analyzed consecutive patients with spontaneous ICH admitted to a tertiary hospital in Korea between 2009 and 2021. Inclusion criteria were aged ≥ 18 years, primary spontaneous ICH, baseline non-contrast CT (NCCT), and follow-up CT within 24 h. Clinical, laboratory, and medication histories were collected, and NCCT/CT angiography (CTA) imaging markers (spot sign, blend sign, hypodensity, swirl sign, black hole sign, island sign, mean hematoma density) were evaluated. Early hematoma expansion was defined as an absolute volume increase ≥6 cm³ or a relative increase ≥33% on follow-up CT. Multivariate logistic regression identified independent predictors. Results: Among 899 screened patients, 581 met inclusion criteria (mean age 61.6 years; 59.7% male). Seventy-eight patients (13.4%) experienced early hematoma expansion. Independent predictors included CTA spot sign (adjusted OR 9.001, 95% CI 4.414–18.354), blend sign (OR 3.054, 95% CI 1.349–6.910), mean hematoma density <60 HU (OR 2.432, 95% CI 1.271–4.655), male sex (OR 2.902, 95% CI 1.419–5.935), and statin use (OR 2.990, 95% CI 1.149–7.782). Prior antiplatelet therapy was associated with a reduced risk of hematoma expansion (OR 0.118, 95% CI 0.014–0.981). Conclusions: Early hematoma expansion occurred in 13.4% of patients and was predicted by a combination of CTA and NCCT markers, as well as clinical and pharmacological factors. Spot sign remained the strongest predictor, while NCCT features such as blend sign and low hematoma density also provided practical prognostic value. These findings underscore the multifactorial pathophysiology of ICH expansion and highlight the importance of integrating imaging, clinical, and therapeutic variables into prediction models to improve early risk stratification and guide targeted interventions. Full article

Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, disproportionately affecting older adults and is associated with high rates of mortality, functional dependence, and long-term cognitive decline. Aging profoundly alters the structure and function of the cerebral vasculature, predisposing the brain to both covert hemorrhage and the development of cerebral microbleeds (CMBs), small, often subclinical lesions that share common pathophysiological mechanisms with ICH. These mechanisms include endothelial dysfunction, impaired cerebral autoregulation, blood–brain barrier breakdown, vascular senescence, and chronic inflammation. Systemic factors such as age-related insulin-like growth factor 1 (IGF-1) deficiency further exacerbate microvascular vulnerability. CMBs and ICH represent distinct yet interconnected manifestations along a continuum of hemorrhagic small vessel disease, with growing recognition of their contribution to vascular cognitive impairment and dementia (VCID). Despite their increasing burden, older adults remain underrepresented in clinical trials, and few therapeutic approaches specifically target aging-related mechanisms. This review synthesizes current knowledge on the cellular, molecular, and systemic drivers of ICH and CMBs in aging, highlights diagnostic and therapeutic challenges, and outlines opportunities for age-sensitive prevention and individualized care strategies. Full article

Background and Clinical Significance: Moyamoya disease (MMD) is a progressive intracranial vasculopathy characterized by stenosis or occlusion of the terminal internal carotid arteries and the development of fragile collateral networks. It predisposes patients to ischemic and hemorrhagic strokes. Although both direct and indirect revascularization procedures are recommended to restore cerebral blood flow, recurrent cerebrovascular events may still occur, and delayed hemorrhage following revascularization is particularly uncommon. Case Description: We report the case of a 42-year-old woman who presented with seizure, syncope, and aphasia. Cranial computed tomography (CT) revealed a large left temporal–insular intraparenchymal hematoma with a midline shift. Computed tomography angiography (CTA) demonstrated bilateral internal carotid artery narrowing and collateral vessel proliferation, without aneurysm. Her history indicated a hemorrhagic stroke 15 years earlier, at which time MMD was diagnosed by magnetic resonance angiography (MRA) and managed with multiple burr hole surgeries. She remained free of cerebrovascular events until the current presentation. The patient underwent emergent hematoma evacuation, followed by intensive care management. Postoperatively, she demonstrated neurological improvement, though with residual motor aphasia and right-sided weakness, and was discharged for rehabilitation. Conclusions: This case underscores the rare occurrence of delayed intracerebral hemorrhage 15 years after indirect revascularization in MMD. Although revascularization surgery remains the standard therapeutic approach, this report highlights the importance of sustained long-term surveillance, strict risk factor management, and careful postoperative follow-up. The key point is that late hemorrhagic complications, though uncommon, must be considered in the long-term care of MMD patients following revascularization. Full article

Contrast-induced encephalopathy (CIE) is a rare complication after percutaneous coronary intervention (PCI) that mimics intracranial hemorrhage (ICH). Its computed tomography (CT) findings (cortical contrast enhancement, sulci effacement) overlap with cerebrovascular conditions (e.g., cerebral infarction, subarachnoid hemorrhage). Dual-energy CT (DECT) differentiates blood/calcification from iodinated contrast medium (CM) extravasation via material decomposition, contributing to the accurate diagnosis of CIE. We report a CIE case highlighting DECT’s value. A 74-year-old woman underwent PCI. 50 min post-PCI, she had moderate headache (Numeric Rating Scale 4), dizziness, non-projectile vomiting (no seizures); vital signs were stable, no focal deficits, mannitol ineffective. Non-contrast CT demonstrated a left parietal 75 Hounsfield unit (HU) high-attenuation lesion, indistinguishable from acute intracerebral hemorrhage. Conventional non-contrast CT revealed a high-attenuation lesion (75 HU) in the left parietal lobe—indistinguishable from ICH. DECT clarified the diagnosis: virtual non-contrast maps showed CM extravasation, iodine concentration maps confirmed focal CM accumulation, and effective atomic number maps improved lesion visualization. The patient’s headache resolved within 5 h; follow-up non-contrast CT at 24 h showed complete disappearance of the lesion. She resumed clopidogrel, discharged day 3 without sequelae. This case underscores DECT’s role in distinguishing CIE (transient CM, normal neuro exam) from ICH (persistent hemorrhage), guiding safe post-PCI antiplatelet therapy. Full article

A 56-year-old man, accompanied by city hall staff, visited our neurorehabilitation clinic. Despite hyperuricemia being diagnosed several years ago, he refused treatment. He had no history of hypertension and antihypertensive drug use. He developed painful joint tophi around the age of 51, which were managed with over-the-counter painkillers. At age 54, a knee tophus was removed, histologically confirming gouty tophi. Subsequently, he lost his chef’s job, and his lifestyle deteriorated. Gouty tophi were observed in the right ear, knuckles, elbows, and ankles, with some ulceration. Blood tests showed anemia and hyperuricemia (10.1 mg/dL: reference 3.6–7.0 mg/dL). Chest–abdominal CT demonstrated calcification of the aorta. Brain MRI revealed an old putaminal hemorrhage and numerous microbleeds. Dementia (Clinical Dementia Rating: 1) was diagnosed based on neuropsychological testing. Public services and social assistance were arranged for him. This case is hypothesis-generating. In settings with adequate healthcare access, the presentation of severe, uncontrolled gouty tophi with poor engagement should prompt a selective, stepwise evaluation—beginning with cognitive screening and proceeding to neurologic assessment if indicated; routine preventive brain imaging is not recommended. The presence of lobar and deep microbleeds should be interpreted within the context of standardized diagnostic criteria and lesion distribution patterns to inform differential diagnosis. Full article

Background: While sleep duration’s association with stroke is established, the combined influence of sleep onset time and duration on stroke subtypes remains inadequately explored. Since circadian biology links sleep onset timing to vascular risk via mechanisms operating independently of sleep duration, we quantified their joint contributions to the risk of stroke. Methods: In this population-based cross-sectional study, from 31 December 2021 to 31 March 2022, we recruited 8168 ischemic stroke cases, 3172 intracerebral hemorrhage cases, and 13,458 control participants across 152 survey centers in 28 counties in Hunan Province, China. Standardized computer-assisted interviews collected sleep parameters. Conjoint analysis identified protective sleep profiles. Results: Short sleep duration (<6 h) was consistently associated with elevated ischemic risk across all sleep onset times (p < 0.05 in all cases, i.e., sleep before 10 p.m. [odds ratio (95%CI): 1.886(1.606, 2.214)], 10–11 p.m. [1.740(1.336, 2.265)], 11 p.m.–12 a.m. [2.335(1.190, 4.581)], and after 12 a.m. [2.834(1.193, 6.728)]). A sleep duration of 6–8 h with a sleep onset time between 10 p.m. and 12 a.m. was associated with the lowest ischemic risk (p < 0.001 in all cases). Conversely, prolonged sleep (>8 h) with an early sleep onset time (<10 p.m.) increased ischemic risk (OR 1.194, 95% CI 1.090–1.308, p < 0.001), whereas a late sleep onset time (11 p.m.–12 a.m.) in long sleepers was protective (OR 0.580, 95% CI 0.352–0.956, p < 0.001). Similar trends were observed for ICH, though the effect sizes were attenuated. Conclusion: Sleep duration and onset time interact to influence stroke risk. Optimal cerebrovascular protection requires ≥6 h of sleep, ideally initiated between 10 p.m. and 11 p.m. These findings highlight sleep optimization as a potential modifiable target for high-risk populations. Full article

Background/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for 174 patients with spontaneous ICH. The patients were classified according to treatment (Group A, without surgery; Group B, hematoma evacuation with residual hematoma volume ≥10 mL; Group C, hematoma evacuation with residual hematoma volume <10 mL). Kaplan–Meier analysis was used to evaluate infectious complications following ICH, while multivariate logistic regression analysis was used to identify risk factors for infectious complications. Results: Groups A, B, and C included 88 (50.6%), 25 (14.4%), and 61 (35.0%) patients, respectively. A total of 68 patients (39.0%) experienced 88 infectious complications, most frequently pneumonia and urinary tract infections. Group C had a significantly lower frequency of infectious complications compared with Groups A and B (p = 0.016). The independent risk factors for infectious complications included age, higher National Institutes of Health Stroke Scale score at admission, motor weakness, intraventricular hemorrhage, Group A, and Group B. Patients with infections had longer hospital stays. The frequencies of poor clinical outcomes at one and six months in patients with infection were lower than those in patients without infection (both p < 0.01). Conclusions: Surgical hematoma evacuation can reduce the risk of post-hemorrhagic stroke infections. Moreover, residual hematoma after surgical evacuation was associated with the risk of cytotoxic effects and subsequent infectious complications. Full article