Search Results (274)

Background/Objectives: Cognitive impairment is highly prevalent in atrial fibrillation (AF) and frequently occurs in the absence of overt stroke, implicating non-embolic mechanisms. We hypothesized that atrial remodeling and impaired cerebral hemodynamics are associated with mild cognitive impairment (MCI) in permanent AF. Methods: In this cross-sectional study, 252 stroke-free patients with permanent AF receiving direct oral anticoagulants (DOACs) underwent transthoracic echocardiography and transcranial Doppler (TCD) assessment of middle cerebral artery flow. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were analyzed. Multivariable logistic regression identified factors independently associated with MCI, and receiver operating characteristic (ROC) curves evaluated discriminative performance. Results: MCI was present in 40% of patients (101/252). AF-MCI patients were older and showed greater left atrial remodeling, reflected by increased left atrial diameter and left atrial volume index (LAVI) (both p ≤ 0.001), without differences in left ventricular systolic function. TCD demonstrated reduced EDV and increased RI in the MCI group (all p ≤ 0.01), whereas PSV showed minimal differences. In multivariable analysis, age, LAVI, and average RI were independently associated with MCI. Age showed excellent discrimination (AUC 0.858), whereas maximum RI demonstrated moderate discrimination (AUC 0.645; p < 0.001 for comparison). Conclusions: In stroke-censored permanent atrial fibrillation, cognitive impairment was associated with atrial remodeling and impaired diastolic cerebral perfusion, consistent with a potential contribution of chronic hypoperfusion and increased microvascular resistance. Combined echocardiographic and cerebral hemodynamic assessment may help characterize hemodynamic patterns associated with cognitive impairment in AF. Full article

Background/Objectives: Early neurological deterioration (END) is a frequent and clinically relevant complication in patients with a single small subcortical infarction (SSI), including lacunar infarction and branch atheromatous disease (BAD). Despite initially mild symptoms, END occurs in approximately 20–25% of cases and is strongly associated with poor functional outcomes. However, definitions, mechanisms, predictors, and therapeutic strategies remain heterogeneous. This review aims to synthesize current evidence regarding the incidence, pathophysiology, predictors, and management of END in SSI. Methods: We performed a narrative review of published studies addressing END in patients with lacunar stroke or SSI. We analyzed data on END definitions and incidence, imaging and clinical predictors, proposed pathophysiological mechanisms, and preventive and rescue therapeutic strategies. Results: END definitions vary across studies, most commonly defined as a ≥2-point increase in the National Institutes of Health Stroke Scale within 48–72 h. Hemodynamic compromise due to proximal perforator pathology, particularly in BAD, appears central to END development. Advanced imaging studies demonstrate perfusion abnormalities beyond the infarct core, supporting the concept of a “lacunar penumbra.” Lesion topology, proximal infarct patterns, parent artery plaques, larger infarct size, and vertical extension are consistent imaging predictors. Clinical factors such as diabetes mellitus, higher baseline severity, systemic inflammation, and increased arterial stiffness further modulate risk. Preventive strategies, including early dual antiplatelet therapy and intensified antithrombotic regimens, show promising signals, while induced hypertension may benefit selected patients as a rescue therapy. However, evidence remains largely observational or derived from subgroup analyses. Conclusions: END in SSI is a multifactorial and potentially modifiable process driven by interactions between proximal vascular pathology, hemodynamic failure, and tissue vulnerability. Standardized definitions, MRI-based phenotyping, and mechanism-driven trials are needed to optimize risk stratification and develop targeted preventive and rescue strategies. Full article

Background: We synthesized evidence from randomized clinical trials (RCTs) published between 2019 and 2025 on repetitive transcranial magnetic stimulation (rTMS) in post-stroke cognitive impairment (PSCI) and compared different stimulation parameters, cortical targets, and combinations with rehabilitation interventions. Methods: A systematic review according to PRISMA guidelines examined the RCTs applying rTMS in adults with PSCI compared with control or sham groups. The primary outcome was improvement in cognitive function and functional outcomes measured with standardized scales. Results: Fifteen studies, involving a total of 732 patients, were included. The most frequently investigated were high-frequency (≥10 Hz) stimulation protocols of the left dorsolateral prefrontal cortex, with treatment cycles ranging from 2 to 6 weeks. Overall, rTMS was generally safe and well tolerated, with rare and mild adverse events. Several studies reported improvements in cognitive performance following rTMS, although effects were variable across trials and need caution in light of heterogeneity in stimulation protocols, sample sizes, outcome measures, and methodological quality. In most cases, rTMS or intermittent theta burst stimulation combined with structured cognitive training yielded greater cognitive and functional gains than stimulation or rehabilitation alone. This suggests a positive interaction between rTMS and cognitive training, although current evidence does not yet allow definitive conclusions. Conclusions: rTMS appears to be a promising strategy for post-stroke cognitive rehabilitation, particularly for attention and executive functioning. However, heterogeneity in stimulation protocols and outcome measures, along with limited sample sizes and short follow-up, reduces the certainty and comparability of current evidence. The widespread reliance on global screening tools may further underestimate domain-specific effects. Future multicentre trials with standardized protocols and more sensitive cognitive assessments are needed to clarify efficacy and guide further clinical application of rTMS in PSCI. Full article

Objective: This review is to systematically evaluate the clinical effectiveness and safety of acupuncture therapy for patients with post-stroke neurogenic bladder (PSNB). Methods: We included randomized controlled trials (RCTs) evaluating any type of acupuncture treatment for PSNB. Data extraction and quality assessment using Cochrane Risk of Bias 2.0 were performed. Meta-analysis was conducted for total effective rate (TER) and urodynamic parameters. Results: Ten RCTs involving 727 participants were included. Meta-analysis showed that acupuncture was associated with a reduction in residual urine volume (RUV), and increases in maximum cystometric capacity (MCC), and maximal urinary flow rate (Qmax). Acupuncture also showed a higher TER compared to control groups (RR = 1.23, 95% CI [1.15, 1.33], p < 0.001). However, wide 95% prediction intervals for urodynamic parameters indicated substantial uncertainty for future clinical applications. Adverse events were mild and infrequent, but only partly reported in two studies among included trials. Conclusions: Acupuncture as an adjunctive therapy suggests potential trends for improving clinical efficacy and urodynamic parameters in PSNB patients. However, no definitive conclusions can be drawn regarding its clinical efficacy or safety due to the very low certainty of evidence, high methodological heterogeneity, and limited reporting of adverse events. Therefore, these results must be interpreted with extreme caution. Further high-quality, large-scale randomized controlled trials with standardized protocols are essential to establish robust evidence regarding its clinical effectiveness and safety. Protocol registration: PROSPERO CRD42025643092. Full article

Background and Objectives: During the past 25 years, a significant body of research has been conducted reporting on the salutary effects of the Mediterranean diet and extra-virgin olive oil, one of its main components. The initial studies were epidemiological observations on populations with very low mortality rates due to significant reductions in myocardial infarction fatalities. Population-based studies demonstrated that the Mediterranean diet with olive oil consumption is associated with a lower prevalence of cardiovascular and cerebrovascular disease, obesity, arthritis, and cancer. Materials and Methods: In this narrative review, we present recent studies on the effects of extra-virgin olive oil and the Mediterranean diet—compared with various other diets—on several vascular risk factors, including hypertension, hyperlipidemia, type 2 diabetes mellitus, and obesity, as well as their impact on cognitive decline and dementia. Results: This diet has been shown to improve cognitive function in patients with mild cognitive impairment, Alzheimer’s disease, vascular cognitive impairment, and vascular dementia. The main mechanisms responsible for cognitive improvement include control of arterial hypertension by reducing systolic and diastolic blood pressure, lowering triglycerides and low-density lipoprotein cholesterol and increasing high-density lipoprotein cholesterol, along with improvement in fasting glucose, insulin levels, and hemoglobin A1c in subjects with type 2 diabetes mellitus, as well as lowering body mass index and obesity. Conclusions: The Mediterranean diet and olive oil induce—along with prevention of cardiovascular disease and stroke—a significant improvement of vascular risk factors, slowing the progression of both vascular dementia and Alzheimer’s disease. There is a need for additional placebo-controlled clinical trials to confirm the supportive nutritional role of extra-virgin olive oil in age-associated cognitive decline in the elderly. Full article

Therapist shortages make home-based rehabilitation an essential component of post-stroke care, yet patients often exhibit reduced adherence when functional gains are difficult to quantify and interpret. This study presents a cloud-enabled assessment framework centered on a dynamic reaching task for upper-limb rehabilitation in individuals with mild stroke. The proposed system combines wearable sensing and Internet of Things (IoT) connectivity to stream kinematic data to the cloud for near real-time analysis, and integrates a force-feedback rehabilitation robot to deliver motion guidance during training. The pipeline proceeds in three stages. First, smoothness-related kinematic descriptors are extracted and fed into a deep multi-class classifier to discriminate the affected side (left, right, or healthy). Second, movement quality is modeled using a Gaussian Mixture Model (GMM) trained on IoT-acquired trajectories to quantify performance via probabilistic similarity. Third, a calibrated scoring function transforms GMM log-likelihood into a normalized 0–1 quality index, producing visual reports that support interpretable feedback for patients and therapists. The framework is validated using motion data collected from stroke patients at Taipei Veterans General Hospital. Experimental results demonstrate that the neural network multi-classifier achieved an F1-score of 0.95. Incorporating robot-derived interaction signals further improved classification performance by approximately 5%. For movement quality assessment, the derived scores showed a significant positive correlation (Pearson correlation = 0.632, p = 0.02) with therapist-defined gold reference standards for right-affected patients. Additionally, integrating robot force-feedback signals and AIoT-enabled dynamic streams improved score accuracy by 8% and score responsiveness by 10%. These quantitative outcomes substantiate the efficacy of combining IoT-driven sensing and robot-assisted training for objective, interpretable, and remotely deployable motor assessment. Full article

The neuroinvasive and neurotropic character of coronaviruses is a likely reason for neurological complications which may occur during acute COVID illness and sometimes persist or newly emerge in the post-acute phase. Terminology and temporal classification remain heterogeneous. A retrospective case series was conducted in a single center (Department of Neurology, Bielański Hospital, Warsaw, Poland). Medical records from March 2020 to December 2023 were screened. Inclusion criteria: (1) confirmed SARS-CoV-2 infection (polymerase chain reaction or antigen test and radiological findings), (2) new neurological syndrome within acute, post-acute, or post-COVID interval, and (3) diagnostic documentation. Exclusion criteria: alternative established etiology fully explaining the neurological condition. Six cases were selected for detailed analysis due to diagnostic completeness as well as etiological and temporal diversity. Cases included: (1) persistent neurocognitive and sensory symptoms (post-COVID), (2) acute ischemic stroke with internal carotid artery dissection during severe COVID-19, (3) cytotoxic lesion of the corpus callosum (CLOCC) during acute COVID-19, (4) Guillain–Barré syndrome (post-acute), (5) longitudinally extensive transverse myelitis (post-acute), and (6) delayed autoimmune cerebral vasculitis (post-COVID). Neurological presentations ranged from mild persistent symptoms to fatal outcome. Neurological complications span inflammatory, vascular, and autoimmune mechanisms across distinct temporal phases of SARS-CoV-2 infection. Precise temporal classification and systematic diagnostic protocols are essential. Prospective longitudinal studies integrating biomarkers and standardized neuroimaging are required. Full article

Background and Objectives: Stroke is a leading cause of long-term disability in older adults, who often face persistent motor, cognitive, and functional challenges. Conventional stroke rehabilitation programs often involve highly repetitive motor tasks, which may reduce patient motivation and contribute to suboptimal adherence over time. Virtual reality (VR) offers an engaging alternative; however, much of the existing research has focused on specialized rehabilitation-oriented VR systems rather than off-the-shelf commercial platforms. This study evaluated older stroke survivors’ acceptance, tolerability, and lived experiences of a short VR-based rehabilitation session using a commercial game on a commercial wearable VR system. Methods: A single-session convergent mixed-methods design was employed. Thirteen community-dwelling older stroke survivors (mean age 79.2 ± 7.1 years; 9 males, 4 female) completed a 15 min VR session using a commercial wearable VR system. The Technology Acceptance Model (TAM) questionnaire and Simulator Sickness Questionnaire (SSQ) assessed acceptance and tolerability, while semi-structured interviews explored lived experiences. Qualitative data were thematically analyzed. Results: Participants reported high acceptance across all TAM domains (overall M = 4.35 ± 0.79, scale 1–5). Enjoyment/intention to use was rated highest (M = 4.77 ± 0.42), while perceived usefulness was lowest (M = 4.15 ± 0.77). VR was well tolerated: the SSQ total score was 17.38 ± 1.73, with most symptoms rated at the mild level only. Exploratory Spearman correlations revealed a significant positive association between age and SSQ total score (r_h = +0.568, p = 0.043). Thematic analysis identified five themes: (1) usability and accessibility; (2) therapeutic value; (3) engagement and motivation; (4) social and clinical support; and (5) physical and cognitive demands. Conclusions: A commercial wearable VR system was found to be acceptable, safe, and engaging for older stroke survivors. With supervision and therapeutic framing, it may serve as a motivating adjunct to conventional rehabilitation. Full article

Approximately 795,000 people experience new or recurrent strokes in the United States each year; between 10 to 20% of these are spontaneous intracerebral hemorrhages (ICH). Uncontrolled hypertension is not only the most common cause of ICH but also a major risk factor for hematoma expansion. Resistant hypertension, defined as persistently elevated blood pressure despite the use of three or more antihypertensives of different classes, is common in patients with ICH. A long-acting calcium channel blocker, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), and a thiazide diuretic are generally considered the mainstay for the treatment of resistant hypertension. However, due to the risk of hyponatremia and worsening cerebral edema, thiazide diuretics should be avoided during the first few weeks of ICH. Recent evidence supports the use of a mineralocorticoid receptor antagonist. While resistant hypertension may be idiopathic, a workup of secondary causes should be pursued. Adequate and timely control of elevated blood pressure remains one of the main cornerstones of treatment in patients with ICH. Previous studies have revealed that resistant hypertension in patients with ICH is associated with longer ICU stays, a higher risk of recurrent stroke, and can contribute to renal, cardiac, and neurologic complications. This emphasizes the need for early initiation of oral antihypertensives and adequate blood pressure control at hospital discharge. Landmark studies have shown that early lowering of SBP to 130–150 mm Hg with smooth, sustained BP control is safe and may improve functional outcomes in patients with mild to moderate ICH. After initiating oral antihypertensives with a calcium channel blocker, an ACEi or ARB beta-blocker, and a mineralocorticoid receptor antagonist to maximally tolerated doses, the next line of antihypertensive treatment should be tailored to the patient’s co-morbidities, and may include a beta-blocker, central alpha agonist, hydralazine, and minoxidil. In this review, we discuss the epidemiology of resistant hypertension in ICH and its molecular basis, diagnostic workup, and acute and long-term treatment. We present novel mechanisms implicated in hypertensive ICH, including ferroptosis, neuroinflammation, the CNS–gut microbiome axis, and novel therapeutics. We also propose a simple algorithm for the optimal pharmacological management of resistant hypertension in ICH. Full article

Background: Moyamoya disease (MMD) is a rare, progressive cerebrovascular arteriopathy characterized by stenosis and occlusion of the distal internal carotid arteries with the development of compensatory collateral networks. In children, MMD is a major cause of ischemic stroke; however, neurological morbidity frequently extends beyond cerebrovascular events to include epilepsy, headache, cognitive impairment, and psychiatric manifestations. Data regarding the long-term evolution of these complications in Caucasian pediatric patients remains limited. Case Report: We present the longitudinal case of a Caucasian female diagnosed with advanced MMD after an ischemic stroke at the age of 7 years, followed by indirect surgical revascularization (encephalo-duro-arterio-synangiosis) and chronic antiplatelet therapy. Four years later, she developed recurrent focal aware sensory–motor seizures associated with chronic post-ischemic cortical injury. Despite stable vascular imaging and absence of recurrent infarction, the patient experienced persistent neurological sequelae, including residual spastic hemiparesis, episodic tension-type headaches, and evolving neuropsychological complications. Cognitive assessment initially suggested mild neurocognitive impairment, with subsequent improvement during adolescence. In late follow-up, prominent anxiety symptoms emerged, and psychiatric evaluation confirmed panic disorder requiring psychological and pharmacological support. The patient remained neurologically stable into adulthood under continued multidisciplinary care. This case illustrates the broad spectrum of neurological and psychiatric complications that may accompany pediatric MMD, even in the absence of new ischemic events. The accompanying literature review emphasizes that epilepsy, headache, cognitive dysfunction, and psychiatric disorders represent clinically significant components of the long-term disease burden in children with MMD. Conclusions: Pediatric moyamoya disease should be regarded not only as a cause of childhood stroke, but also as a chronic condition with long-term epileptic, cognitive, and psychiatric sequelae that may evolve independently of recurrent ischemic injury. By providing longitudinal follow-up from childhood into adulthood in a Caucasian patient, this report underscores the importance of integrating neuropsychological and psychiatric surveillance into standard care pathways, alongside vascular and surgical management, to better address the full spectrum of morbidity and improve quality of life. Full article

Port areas are core hubs for national logistics and high-risk security zones that require constant vehicle access control. However, ensuring the reliability of automatic license plate recognition (ALPR) systems in port environments is severely challenged by complex image degradations, such as dense haze, low light, and motion blur. In this study, we propose a stage-wise degradation-aware restoration network (SDR-Net), which effectively addresses harsh port conditions by sequentially restoring photometric and structural degradations. Particularly, SDR-Net first secures visual cues lost to haze and low light through a photometric restoration module involving a dark-channel-prior-based dehazing and adaptive brightness adjustment. Next, a structural restoration module based on a generative adversarial network featuring edge-guided structural feature blocks and edge-aware refinement blocks is employed to precisely reconstruct character strokes and outlines damaged by motion blur, stably restoring license plate legibility even under complex degradation conditions. Experiments across various intensities of complex degradation demonstrate that SDR-Net maintains high character recognition accuracies of over 97.35% under mild motion blur and low-concentration haze conditions, indicating its superiority over state-of-the-art models. Notably, the performance gap between SDR-Net and comparison models widened as the degradation intensity increased, and SDR-Net achieved the highest multiscale structural similarity index scores across all intervals. Full article

Cannabidiol (CBD) is one of the most studied compounds of Cannabis sativa and has attracted significant interest due to its therapeutic and beneficial properties, which have been confirmed in numerous preclinical and clinical studies over the last few years. A great advantage of CBD over the other widely known Cannabis sativa ingredient, Δ-9-tetrahydrocannabinol (THC), is that CBD does not exert intoxicating and psychoactive effects, making it an attractive candidate for therapeutic applications in neurological disorders. CBD has been shown to exert antioxidant, analgesic, anti-inflammatory, and neuroprotective effects, with therapeutic potential for various neurological conditions. To date, the only drug that consists solely of highly purified CBD is Epidiolex, which is used in the management of severe forms of epilepsy such as Dravet syndrome and Lennox–Gastaut syndrome. Another legal medication containing CBD (albeit with the addition of THC) is Sativex, used to alleviate spasticity in multiple sclerosis. Besides epilepsy, preclinical data suggest that CBD alone may be potentially beneficial in treating chronic pain, multiple sclerosis, Alzheimer’s and Parkinson’s diseases, or stroke. The safety profile of CBD is generally considered favorable, as the most commonly reported adverse effects are mild (e.g., somnolence, diarrhea). However, much attention should be paid as CBD-driven drug–drug interactions have been reported. This review article aims to assess the outcomes of preclinical and clinical research on CBD’s effects in various neurological conditions while also addressing potential risks and concerns related to its use. Full article

Paravalvular leak (PVL) remains a clinically important complication after surgical or transcatheter valve implantation, presenting predominantly with heart failure (HF) and/or high-shear hemolysis. While redo surgery can be definitive, contemporary candidates frequently carry prohibitive operative risk, positioning transcatheter PVL closure as a key therapeutic alternative. However, available outcome data are largely derived from observational series and registries with heterogeneity in PVL mechanisms, prosthesis types, imaging protocols, and endpoint definitions. Standardized frameworks—such as those proposed by the PVL Academic Research Consortium—support harmonized PVL grading and clinically meaningful composite endpoints that integrate imaging/hemodynamic results with patient-centered outcomes. Across datasets, the most consistent determinant of benefit is residual PVL severity: procedural efficacy is most commonly defined as achieving ≤ mild residual regurgitation without prosthetic leaflet interference, device embolization, or major complications. This review provides a step-by-step, phenotype-driven approach to transcatheter PVL closure, emphasizing multimodality imaging (TEE and cardiac CT, with adjunct CMR and PET when appropriate), access and support planning tailored to valve position, and morphology-matched device selection—often requiring modular multi-device strategies for elongated crescentic channels, particularly in hemolysis-predominant presentations. We also synthesize evidence on complications and bailout management, with a focus on preventable high-severity events (leaflet impingement, embolization, stroke/air, vascular injury, tamponade) and standardized pre-release safety checks. Collectively, contemporary practice supports high implant success in experienced programs, with clinical improvement tightly coupled to procedural endpoint quality and careful Heart Team selection. Full article

Background. Virtual reality (VR) is emerging as a non-pharmacological tool to support rehabilitation and self-management. Evidence of its effectiveness, however, remains fragmented. This umbrella review synthesized systematic reviews and meta-analyses on VR interventions in chronic conditions. Methods. Following the Joanna Briggs Institute Manual for Evidence Synthesis, comprehensive searches were conducted in MEDLINE, CINAHL, Cochrane Database, Web of Science, and Scopus. Eligible studies were systematic reviews and meta-analyses assessing VR interventions. Two reviewers independently performed screening, quality appraisal, and data extraction. Results. Seventeen reviews, including 229 primary studies, were analyzed. Stroke and chronic obstructive pulmonary disease were most frequently investigated. VR tools ranged from web- and smartphone-based systems to wearable devices and interactive games. Significant improvements were reported in respiratory outcomes, functional mobility, balance, and psychological symptoms. Cognitive effects were mixed. Reported adverse events, mainly cybersickness and dizziness, were mild. Conclusions. VR may improve physical, respiratory, psychological, and selected cognitive outcomes in chronic conditions. Despite study heterogeneity, evidence supports its integration into chronic care. Future work should standardize protocols, assess long-term effects, broaden target populations, and address equity and ethical issues to fully realize VR’s potential as a person-centered tool. Full article

Cold-inducible RNA-binding protein (CIRP) is a critical molecule in the central nervous system (CNS) with functions that depend on its subcellular localization, exhibiting biphasic regulatory roles in both physiological and pathological processes. Under physiological conditions, intracellular cold-inducible RNA-binding protein (iCIRP) contributes to the maintenance of circadian rhythms by regulating the stability of core clock gene mRNAs and exerts neuroprotective effects during mild hypothermia by preserving the blood–brain barrier and inhibiting apoptosis. Pathologically, extracellular cold-inducible RNA-binding protein (eCIRP) functions as a damage-associated molecular pattern (DAMP) that drives neuroinflammation and brain injury. In ischemic stroke (IS), eCIRP promotes neutrophil extracellular trap (NET) formation and increases microglial activity via the Toll-like receptor 4 (TLR4) pathway. In cerebral ischemia–reperfusion (I/R) injury, eCIRP activates oxidative stress and the NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome through the TLR4 axis, exacerbating mitochondrial damage. In intracerebral hemorrhage (ICH), eCIRP further amplifies inflammation via the interleukin-6 receptor (IL-6R)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. In traumatic brain injury (TBI), eCIRP activates the endoplasmic reticulum stress pathway, intensifying apoptosis. In Alzheimer’s disease (AD), eCIRP regulates tau phosphorylation and β-amyloid (Aβ) metabolism and may mediate the link between alcohol exposure and AD pathology. Preclinical studies indicate that serum eCIRP levels correlate with IS and ICH severity, highlighting its potential as a biomarker. This systematic review elucidates the mechanisms of CIRP in CNS diseases, providing insights for understanding and preventing conditions such as IS, cerebral I/R injury, ICH, TBI, and AD. Full article