Search Results (43)

Background and Clinical Significance: Trousseau’s syndrome, characterized by recurrent thromboembolic events and non-bacterial thrombotic endocarditis, represents a severe paraneoplastic condition associated with poor prognosis in cancer patients. Due to the growing life expectancy of cancer patients, Trousseau’s syndrome is becoming more frequent. Consequently, risk of thrombosis and bleeding assessment, as well as early diagnosis and opportune therapy will gain importance. Case Presentation: We describe a case of a 63-year-old Caucasian male presenting with ischemic stroke. During management, he developed a mitral valve marantic endocarditis, and finally the diagnosis of pulmonary adenocarcinoma was performed. The case description is followed by a brief review of the relevant literature on the condition. Discussion and Conclusions: This case highlights the complexity of diagnosing and managing Trousseau’s syndrome. Early recognition, appropriate anticoagulation strategies, and the need for multidisciplinary management are crucial to improve the outcomes and the quality of life for cancer patients. Full article

Background and Objectives: Ongoing efforts to develop early diagnostic tools for Acute Ischemic Stroke (AIS) point out the advantages of accessible biomarkers such as Immature Platelet Fraction (IPF). This is particularly important for emergency department (EDs), especially those that are overcrowded and have limited resources. The present study aimed to evaluate the diagnostic, prognostic, and therapeutic significance of IPF in patients with AIS presenting to the ED. Materials and Methods: This prospective case–control study was conducted in an ED. Participants aged 18-years and older who presented with complaints of numbness, weakness, diplopia or visual disturbances, speech or comprehension impairment, confusion, imbalance, impaired coordination and gait, or dizziness were included in the study. The diagnostic value of IPF in AIS and its relationship with short-term prognosis (STP) were investigated. Additional variables potentially associated with parameters such as infarct localization, number of lesions, affected hemisphere, main artery status, carotid status and treatment method were also analyzed. Results: The median age of the study participants was 67 years (Q1 = 54, Q3 = 76), with 48.9% (n = 88) being female and 51.1% (n = 92) male. Receiver operating characteristic curve analysis demonstrated that IPF was statistically significantly superior to other complete blood count parameters in the diagnostic evaluation of AIS. The diagnostic cutoff value of IPF for AIS was calculated as 2.45. An increase of 1 unit in IPF was found to raise the likelihood of AIS by 2.599 times. The Ratio of Red Cell Distribution Width (RDW) to IPF and NEU to IPF, mean corpuscular volume, and infarct volume were found to be significant predictors in STP assessment. Conclusions: Although not definitive alone, IPF may aid early stroke recognition, support treatment monitoring, and inform targeted therapies. The use of IPF, a biomarker that can be rapidly obtained, in the diagnosis of AIS is expected to yield beneficial outcomes in patient management, particularly in emergency departments and other clinical settings. Full article

Timely identification and accurate delineation of ultra-early ischemic stroke lesions in non-contrast computed tomography (CT) scans of the human brain are of paramount importance for prompt medical intervention and improved patient outcomes. In this study, we propose a deep learning-driven methodology specifically designed for segmenting ultra-early ischemic regions, with a particular emphasis on both the ischemic core and the surrounding penumbra during the initial stages of stroke progression. We introduce a lightweight preprocessing model based on convolutional filtering techniques, which enhances image clarity while preserving the structural integrity of medical scans, a critical factor when detecting subtle signs of ultra-early ischemic strokes. Unlike conventional preprocessing methods that directly modify the image and may introduce artifacts or distortions, our approach ensures the absence of neural network-induced artifacts, which is especially crucial for accurate diagnosis and segmentation of ultra-early ischemic lesions. The model employs predefined differentiable filters with trainable parameters, allowing for artifact-free and precision-enhanced image refinement tailored to the challenges of ultra-early stroke detection. In addition, we incorporated into the combined preprocessing pipeline a newly proposed trainable linear combination of pretrained image filters, a concept first introduced in this study. For model training and evaluation, we utilize a publicly available dataset of acute ischemic stroke cases, focusing on the subset relevant to ultra-early stroke manifestations, which contains annotated non-contrast CT brain scans from 112 patients. The proposed model demonstrates high segmentation accuracy for ultra-early ischemic regions, surpassing existing methodologies across key performance metrics. The results have been rigorously validated on test subsets from the dataset, confirming the effectiveness of our approach in supporting the early-stage diagnosis and treatment planning for ultra-early ischemic strokes. Full article

Ischemic stroke is now widely recognized as a disease with a strong inflammatory profile. Cerebral vascular damage is both preceded and followed by a chain of molecular events involving immune cells and inflammatory markers, irrespective of the etiology of the ischemic injury. Over time, an increasingly comprehensive understanding of these markers has led to a better insight into the mechanisms behind the vascular event and recovery following ischemic stroke. However, to date, there are still no available circulating or tissue biomarkers for early diagnosis or prognostic stratification, making ischemic stroke diagnosis contingent on clinical and instrumental investigations. However, neurological and internal medicine research is progressing in identifying markers that could potentially take on this role. This manuscript, therefore, aims to review the most recent and innovative results of medical advances, summarising the current state of the art and future perspectives. If ischaemic stroke is an inflammatory disease, it is also true that it is not just a singular condition, but a group of entities with their own neuroinflammatory features. Thus, given that, in ischemic cerebral vascular damage, “time is brain,” tracking increasingly accurate markers in the diagnosis of ischemic stroke is a valuable tool that will potentially enable earlier recognition of this disease and, hopefully, make it less disabling and more widely treated. Full article

Background/Objectives: Blood vessel tortuosity can complicate endovascular procedures such as endovascular thrombectomy in acute ischemic stroke. This study aimed to assess the morphometric characteristics of carotid arteries and investigate the association between the tortuosity of the carotid arteries and the technical aspects of endovascular thrombectomy, patient demographics and clinical characteristics, and treatment outcome. Methods: This retrospective study included 84 patients with ischemic stroke treated by endovascular thrombectomy at the newly established thrombectomy-capable stroke center. The following data were collected from prethrombectomy computed tomography angiography: aortic arch type, type of carotid artery tortuosity, and tortuosity index (TI). The technical aspects of the procedure, as well as patient demographics, were collected from the radiological information system. Results: Time from arterial puncture to the first pass was significantly shorter in patients with a nontortuous carotid artery compared to a tortuous one (p = 0.006). There were no significant differences in the number of passes, total duration of the procedure, and the difference in National Institutes of Health Stroke Scale (NIHSS) score before and after the procedure regarding the form of tortuosity. Patients with hypertension had significantly higher tortuosity index values compared to those without hypertension (p = 0.008), and patients with a nontortuous carotid tree were significantly younger compared to those with all forms of tortuosity (p = 0.003). Conclusions: The majority of patients had tortuous carotid arteries, which were associated with older age and hypertension. A high index of tortuosity was associated with a longer time from arterial puncture to the first pass, but not to the treatment outcome. Preprocedural recognition of carotid artery tortuosity may aid in endovascular thrombectomy procedural planning. Full article

Background/Objectives: Stroke is a major cause of disability worldwide, with ischemic stroke being the most common type. This study investigated face perception in patients with lacunar strokes, specifically examining the ability to distinguish and recognize familiar and unfamiliar faces. Methods: We tested 52 patients with lacunar stroke (mean age = 65.97 ± 9.96) and 28 age-matched healthy controls (HC) (mean age = 66.24 ± 10.15). The participants received three face perception tasks: Name that Celebrity, Identity Sorting Task, and Face & Object Solitaire, and were also given the MMSE and mRS clinical assessments. Results: For the Name that Celebrity task, the stroke group had a lower efficiency score than the control group (i.e., they needed 2–3 extra slides of cues to recognize famous persons). For the Face Identity Sorting task, both groups were more accurate when sorting familiar faces; however, the stroke group performed significantly worse than the healthy group when sorting unfamiliar faces. For the Face/Object Solitaire task, the control group performed better than the stroke group on the face solitaire, but there were no differences in the object solitaire condition. Conclusions: Our findings suggest that despite having a normal mean MMSE score (HC: 28.22, Stroke: 27.96), patients with lacunar stroke had difficulties recognizing famous faces and discriminating among unfamiliar faces. This may reveal an overlooked deficit in face perception, highlighting the importance of future interventions that specifically focus on face recognition skills to enhance patients’ daily social interactions and the overall effectiveness of post-stroke rehabilitation programs. Full article

Background/Objectives: Tick-borne diseases (TBDs) are increasingly recognized as causes of both systemic and neurologic illness. While their impact on vascular health is established, their role in cerebrovascular disease remains underexplored. This review aims to synthesize clinical evidence linking TBDs with cerebrovascular events, focusing on mechanisms of injury, pathogen-specific associations, and treatment outcomes. Methods: A narrative review was conducted using Boolean keyword searches across PubMed, Scopus, EMBASE, and Web of Science. Relevant literature on ischemic and hemorrhagic stroke, cerebral vasculitis, and stroke mimics associated with TBDs was examined. The review included case reports, observational studies, and mechanistic research. Pathogen-specific data and disease characteristics were extracted and summarized. Results: Several tick-borne pathogens were associated with cerebrovascular complications. Borrelia burgdorferi was most commonly implicated and typically presented with large-vessel vasculitis. Rickettsia, Ehrlichia, and Anaplasma species caused endothelial injury through immune-mediated inflammation. Powassan virus and Crimean–Congo hemorrhagic fever virus exhibited central nervous system involvement and hemorrhagic potential. Babesia species contributed to vascular injury through thrombocytopenia and embolic complications. Neuroimaging frequently demonstrated multifocal stenoses and vessel wall inflammation. Antimicrobial treatment, particularly with doxycycline or ceftriaxone, was often effective, especially when administered early. Supportive care for stroke symptoms varied by presentation and underlying pathogen. Conclusions: Cerebrovascular disease caused by tick-borne pathogens is an underrecognized but potentially reversible condition. Despite diverse etiologies, most pathogens share a final common pathway of endothelial dysfunction. Early recognition and targeted antimicrobial therapy, combined with supportive stroke care, are essential to improving patient outcomes. Full article

Microwave imaging systems show potential as replacements for commonly used stroke diagnostic systems. We developed and tested a 10-port microwave system on a liquid head phantom with ischemic and hemorrhagic strokes of varying sizes and positions. This system allows for visualization of changes in dielectric parameters using the TSVD Born approximation, enabling recognition of stroke position and size from the resulting images. The SVM algorithm effectively distinguishes between ischemic and hemorrhagic strokes, achieving 98% accuracy on experimental data, with 99% accuracy in ischemic scenarios and 97% in hemorrhagic scenarios. Using the TSVD Born algorithm, it was possible to precisely image changes in the absolute permittivity of different stroke locations; however, changes in stroke size were more apparent in the variations of absolute permittivity than in the reconstructed stroke size within the antenna plane. Outside this plane, changes in the S-parameters decreased depending on the distance and size of the stroke, making detection and classification more difficult. One ring of antennas around the head proved insufficient, prompting us to focus on developing a system with antennas positioned around the entire head. Full article

Background and Clinical Significance: The pathogenesis of ischemic lesions in tubercular meningoencephalitis remains unclear, as do the best therapeutic strategies during the acute phase and for secondary prevention. Case Presentation: We report on an atypical case of tubercular meningoencephalitis with a concomitant ischemic stroke. The infectious origin of the ischemic lesion was hypothesized due to a discrepancy between clinical and radiological findings. The patient underwent neuroimaging, blood tests, and a lumbar puncture to diagnose tubercular meningoencephalitis. She subsequently started on antitubercular therapy. Despite the initiation of treatment, her neurological condition worsened. A computed tomography revealed hydrocephalus, leading to the placement of an external ventricular shunt. This intervention resulted in a reduction in ventricular size and an overall improvement in her clinical condition. To reduce the risk of death, secondary prophylaxis with cardioaspirin was added to her treatment regimen. Conclusions: This report highlights the diagnostic and therapeutic challenges encountered in managing patients with tubercular meningitis presenting with concomitant ischemic stroke. By elucidating the complexities of this clinical scenario, we emphasize the importance of early recognition, comprehensive evaluation, and multidisciplinary management to optimize patient outcomes. Full article

As acute ischemic stroke (AIS) is still a significant cause of morbidity globally, new methods of rapid diagnostics are continually being researched and improved. Still, the only definite way to diagnose AIS is radiological imaging. Lately, serum biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have shown their usefulness in AIS as potential complementary tools in early recognition. We aimed to investigate if GFAP and UCH-L1 can correlate with comprehensive diagnostic information provided by computed tomography (CT) and several clinical parameters in AIS severity assessment and subsequently with clinical outcomes. Fifty-two patients with AIS and a potential for mechanical thrombectomy (MT) were included in our study. Thirty-seven patients underwent MT. Results showed no correlation of biomarkers with any analyzed CT parameter (thrombus length, volume, and density, clot burden score, collateral score, AIS core and penumbra volume, differences in perfusion between healthy and affected brain tissue). In addition, none of the clinical parameters, such as sex, symptom onset time, or the National Institutes of Health Stroke Scale, correlated with biomarkers. However, lower biomarker levels corresponded with a good clinical outcome, and higher levels to a poor outcome following hospital discharge, irrespective of the performed MT (p = 0.005 for GFAP, p = 0.001 for UCH-L1). In patients with successful MT, there were also differences between patients with a good clinical outcome compared with patients with a poor clinical outcome (p = 0.007 for GFAP, p = 0.004 for UCH-L1). In conclusion, these biomarkers cannot replace imaging modalities but can provide complementary diagnostic information in the setting of AIS. Full article

Introduction: Pediatric ischemic stroke (IS) is a rare but severe neurological emergency, with an incidence of 2–13 per 100,000. Most cases occur in the prenatal period or early infancy. Integrating artificial intelligence (AI) into clinical practice may enhance the early recognition of stroke. This pilot study aimed to identify immunoenzymatic markers as early predictors of pediatric IS, supporting machine learning applications. Materials and Methods: A prospective study (2017–2019) in Moldova included 53 children with IS and 53 healthy controls. The serum levels of vascular endothelial growth factor (VEGF), ciliary neurotrophic factor (CNTF), the S100B protein, CD105 (endoglin), antiphospholipid antibodies (APAs), and interleukin-6 (IL-6) were measured using ELISA during the acute phase. Results: Endoglin levels were significantly lower in IS patients (2.06 ± 0.012 ng/mL) vs. controls (2.51 ± 0.071 ng/mL) (p < 0.001). S100B levels were elevated (0.524 ± 0.0850 ng/mL vs. 0.120 ± 0.0038 ng/mL, p < 0.01). VEGF levels were significantly increased (613.41 ± 39.299 pg/mL vs. 185.50 ± 12.039 pg/mL, p < 0.001), correlating with the infarct size and disease severity. CNTF levels were also higher (7.84 ± 0.322 pg/mL vs. 5.29 ± 0.067 pg/mL, p < 0.001). APA levels were elevated (1.37 ± 0.046 U/mL vs. 0.92 ± 0.021 U/mL, p < 0.001). IL-6 levels were 10 times higher in IS patients (22.02 ± 2.143 pg/mL vs. 2.38 ± 0.302 pg/mL, p < 0.001), correlating with the infarct size (p < 0.004) and neurological prognosis at six months (p < 0.01). Conclusions: IL-6, VEGF, CNTF, S100B, CD105, and APAs are key markers in pediatric IS, reflecting neuroinflammation, vascular disruption, and the long-term prognosis. Their integration into AI-driven diagnostic models may improve early stroke detection and pediatric monitoring. Full article

Stroke affects over 12 million people annually, leading to high mortality, long-term disability, and substantial healthcare costs. Although East Asian herbal medicines are widely used for stroke treatment, the pathways of operation they use remain poorly understood. Our study investigates the neuroprotective properties of Astragalus mongholicus (AM) in acute ischemic stroke using photothrombotic (PTB) and transient middle cerebral artery occlusion (tMCAO) mouse models, as well as an in vitro oxygen-glucose deprivation (OGD) model. Post-OGD treatment with AM improved cell viability in mouse neuroblastoma cells, likely by reducing reactive oxygen species (ROS). Mice received short-term (0–2 days) or long-term (0–27 days) AM treatment post-stroke. Infarct size was assessed using a 2,3,5-triphenyl tetrazolium chloride (TTC) staining procedure alongside magnetic resonance imaging (MRI). Neuroprotective metabolites including inositol (Ins), glycerophosphocholine+phosphocholine (GPc+ PCh), N-acetylaspartate+N-acetylaspartylglutamate (NAA+NAAG), creatine + phosphocreatine (Cr+PCr), and glutamine+glutamate (Glx) were analyzed via magnetic resonance spectroscopy (MRS). Gliosis was assessed using GFAP and Iba-1 immunohistochemical markers, while neurological deficits were quantified with modified neurological severity scores (mNSS). Motor and cognitive functions were assessed using cylinder, rotarod, and novel object recognition (NOR) tests. AM treatment significantly reduced ischemic damage and improved neurological outcomes in both acute and chronic stages of PTB and tMCAO models. Additionally, AM increased neuroprotective metabolites levels, reduced gliosis, and decreased oxidative stress, as evidenced by reduced inducible nitric oxide synthase (iNOS). These findings highlight the antioxidant properties of AM and its strong therapeutic potential for promoting recovery after ischemic stroke by alleviating neurological deficits, reducing gliosis, and mitigating oxidative stress. Full article

Ischemic stroke, caused by blocked cerebral blood flow, requires prompt intervention to prevent severe motor and cognitive impairments. Despite extensive drug development efforts, the failure rate of clinical trials remains high, highlighting the need for novel therapeutic approaches. This study investigated the therapeutic potential of a natural herbal extract mixture of Astragalus mongholicus Bunge (AM) and Scutellaria baicalensis Georgi (SB), traditionally used in Eastern Asian herbal medicine (EAHM) for ischemic stroke treatment. Using transient middle cerebral artery occlusion (tMCAO) and photothrombotic (PTB) mouse models, oral administration of the AM-SB mixture was evaluated during both acute and chronic phases. Results showed that AM-SB significantly reduced infarction volume, inflammation (IL-1β, TNF-α), and pyroptosis-related markers (NLRP3, GSDMD, ASC, Caspase-1), while decreasing gliosis and improving cerebral metabolites. Behavioral assessments revealed that early and sustained AM-SB intervention enhanced motor and cognitive functions, as measured by mNSS, Rotarod, Novel Object Recognition, and Passive Avoidance tests. These findings suggest that AM-SB extract is a promising alternative therapy for ischemic stroke management. Full article

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute ischemic stroke patients undergoing ECMO support. The incidence rate of ISs is estimated to be between 1 and 8%, while the mortality rate ranges from 44 to 76%, depending on several factors, including ECMO type, duration of support and patient characteristics. Several mechanisms leading to ISs during ECMO have been identified, with thromboembolic events and cerebral hypoperfusion being the most common causes. However, considering that most of the ECMO patients are severely ill or under sedation, stroke symptoms are often underdiagnosed. Multimodal monitoring and daily clinical assessment could be useful preventive techniques. Early recognition of neurological deficits is of paramount importance for prompt therapeutic interventions. All ECMO patients with suspected strokes should immediately receive brain computed tomography (CT) and CT angiography (CTA) for the identification of large vessel occlusion (LVO) and assessment of collateral blood flow. CT perfusion (CTP) can further assist in the detection of viable tissue (penumbra), especially in cases of strokes of unknown onset. Catheter angiography is required to confirm LVO detected on CTA. Intravenous thrombolytic therapy is usually contraindicated in ECMO as most patients are on active anticoagulation treatment. Therefore, mechanical thrombectomy is the preferred treatment option in cases where there is evidence of LVO. The choice of the arterial vascular access used to perform mechanical thrombectomy should be discussed between interventional radiologists and an ECMO team. Anticoagulation management during the acute phase of IS should be individualized after the thromboembolic risk has been carefully balanced against hemorrhagic risk. A multidisciplinary approach is essential for the optimal management of ISs in patients treated with ECMO. Full article

Cognitive impairments are frequently reported after ischemic strokes. Novel and effective treatments are required. This study aimed to develop a functional ingredient obtained from marine algae and to determine the effect of the extract on antioxidative stress, as well as neuroprotective effects, in a rat model of MCAO-induced ischemic stroke. Among the selected marine algal extracts, Sargassum polycystum displayed the highest total phenolic content and antioxidative potential, and was subsequently used to evaluate cognitive function in rat models of ischemic stroke. The S. polycystum extract, administered at doses of 100, 300, and 500 mg/kg BW, significantly improved cognitive function by enhancing cognitive performance in the Morris water maze and novel object recognition tests. Biochemical changes revealed that providing S. polycystum increased the activities of SOD, CAT, and GSH-Px by 52.48%, 50.77%, and 66.20%, respectively, and decreased the concentrations of MDA by 51.58% and S100B by 36.64% compared to the vehicle group. These findings suggest that S. polycystum extract may mitigate cognitive impairment in ischemic stroke by reducing oxidative stress and inhibiting S100B expression, thus highlighting its potential as a functional ingredient for drugs and nutraceuticals aimed at neuroprotection. Full article