Search Results (1,977)

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

Technologies for home movement rehabilitation after stroke are rapidly expanding. However, for consumers, the number and nature of available products are unclear, and the information provided by device manufacturers varies widely. To understand this landscape, we conducted a mixed-methods, descriptive study in which we used the U.S. Food and Drug Administration (FDA) database to identify interactive devices for stroke rehabilitation suitable for home use. We then surveyed 13 individuals with stroke to determine what information they most wanted about home-based rehabilitation devices and contacted manufacturers to obtain those details. Thirteen FDA codes were associated with stroke rehabilitation devices, encompassing 57 devices produced by 40 companies. Nearly half were categorized under two codes: QKC (interactive rehabilitation exercise devices) and GZI (neuromuscular stimulators). Among devices for which information was available, 71% were listed after 2015, and 23% cost under $1000. The top information priorities for individuals with stroke were required usage to achieve therapeutic benefit, expected benefit, ease of use, and motivational features. Despite repeated outreach, only 45% of companies responded to our queries; among those that did, details were vague and variable. These results confirm that a large and growing number of FDA-listed devices are now available for home-based post-stroke motor rehabilitation. We further identify a need to establish industry standards for reporting ease of use, motivational effectiveness, and dose–response characteristics to help the intended consumers select appropriate technologies. The curated dataset generated in this study is provided as a resource for future work and may support the development of accurate Artificial Intelligence-based interfaces for identifying and comparing rehabilitation devices. Full article

This study proposes a non-invasive, simplified muscle force estimation model (NSMFEM) designed for elderly individuals and stroke patients under slow walking conditions. The model estimates lower limb muscle forces dynamically using only kinematic parameters—with real-time muscle fiber length as the key variable—thus avoiding the limitations of traditional surface electromyography (sEMG)-based approaches such as environmental interference, signal noise, and difficulty in obtaining deep muscle sEMG. A personalized Digital Twin Musculoskeletal Model (DTMSM) was constructed by scaling a reference kinematic model and calibrating muscle origin/insertion markers based on individual anthropometry. Muscle architecture indices were derived from a multiple regression model with publicly available anatomical data. Twelve elderly subjects (eight healthy ESND and four post-stroke ESP) were evaluated at varying walking speeds. Results at slow speeds (X-slow and slow) show strong Pearson correlations between NSMFEM predictions and reference data for the majority of nine representative lower limb muscles (e.g., TFL, Iliacus, Pectineus, Tib_Ant, Soleus); passive forces of TFL, Iliacus, and Vas_Int also correlate strongly. As speed rises, correlations for some muscles (e.g., Vas_Int, Tib_Post) decline, reflecting the growing influence of segmental acceleration and muscle activation—factors omitted in the model. For stroke patient gait (ESP), Spearman analysis indicates maintained strong correlations for affected side muscles Glut_Max1, TFL, Pectineus, and Soleus, supporting the model’s utility in stroke rehabilitation assessment. Overall, NSMFEM offers a practical, sEMG free method for non-invasive dynamic muscle force estimation in slow walking elderly and post-stroke populations, aiding functional assessment and personalized rehabilitation planning. Future efforts will aim to incorporate muscle activation corrections to extend the model to faster walking speeds. Full article

Continuous monitoring of pathological motor features is vital for post-stroke rehabilitation but remains challenged by power reliance and low sensitivity of wearable sensors. Here, we develop a high-sensitivity, self-powered breathable nanogenerator (BN-TENG) utilizing fish-scale-derived biological hydroxyapatite/carbon (Bio-HAp/C) fillers within electrospun polyvinylidene fluoride (PVDF) nanofibers. The Bio-HAp/C enhances electron-trapping capability, while a high-resilience ethylene-vinyl acetate (EVA) spacer optimizes contact-separation dynamics. The BN-TENG achieves a superior sensitivity of 16.28 V·N⁻¹ and remarkable stability over 10,000 cycles. By implementing a multi-node sensing strategy, the sensor successfully captures complex hemiplegic patterns, including compensatory shoulder hiking, distal muscle spasticity, and postural asymmetry. By resolving subtle micro-vibrations missed by traditional electronics, this work provides a sustainable, autonomous interface for characterizing pathological motor features and assessing rehabilitation progress in hemiplegic patients. Full article

Background and Clinical Significance: Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction, but postoperative secondary injury mechanisms and functional outcome remain difficult to evaluate using intracranial pressure (ICP) alone. The pressure reactivity index (PRx), calculated as the moving correlation coefficient between ICP and mean arterial pressure (MAP), provides a measure of cerebral autoregulation. The utility of PRx monitoring in ischemic stroke, especially following DHC, remains uncertain. Case Presentation: We describe two patients presenting with acute ischemic stroke in the MCA territory who underwent DHC followed by postoperative ICP and PRx monitoring. Case 1 is a 40-year-old female with a left proximal MCA occlusion initially treated with endovascular thrombectomy (EVT) who required emergent DHC due to re-occlusion. Postoperatively, ICPs remained controlled, and PRx values were favorable (<0.2), indicating preserved cerebral autoregulation. She later showed moderate neurological improvement. Case 2 was a 68-year-old female with a left proximal MCA occlusion treated with EVT who developed worsening cerebral edema and midline shift, necessitating emergent DHC. Despite adequate ICP control, PRx values remained markedly elevated (0.45 to 0.73), consistent with impaired cerebral autoregulation, and her neurologic state remained poor at discharge. Conclusions: These contrasting cases suggest that PRx may provide physiologic information not reflected by ICP metrics alone post-DHC. PRx monitoring may provide complementary physiologic insight into postoperative autoregulatory status following DHC. Further investigation is warranted to define its role in individualized post-DHC management and prognostication in malignant ischemic stroke. Full article

Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF. Full article

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major contributor to ischemic stroke, heart failure, hospitalization, and mortality. AF-related strokes account for approximately 20–30% of all ischemic strokes and are typically associated with more severe neurological deficits and poorer long-term outcomes. As the prevalence of AF continues to rise with population aging, optimizing both stroke prevention and post-stroke management has become increasingly important. This narrative review summarizes current evidence on AF in the context of ischemic stroke, with particular emphasis on anticoagulation, acute stroke management, and early neurorehabilitation. Special attention is given to the unique challenges of AF-associated stroke, including hemodynamic instability, recurrent embolic risk, bleeding risk during anticoagulation, and the need for individualized rehabilitation strategies. We also discuss interdisciplinary care models, including the Hemodynamic Gating Matrix and the Heart–Brain Team approach, as potential frameworks for integrating cardiovascular and neurological management during recovery. AF-related stroke requires coordinated care across cardiology, neurology, and rehabilitation medicine. A physiology-guided and interdisciplinary approach may improve functional recovery while maintaining cardiovascular safety in this high-risk population. Full article

Post-stroke upper limb pain is prevalent and challenging to manage once established. Early use of botulinum toxin can reduce spasticity and contracture development and has potential to prevent or reduce pain. A secondary analysis of the EUBoSS study was undertaken to report pain prevalence in people post-stroke with severe upper limb impairment and spasticity in a hyper/acute setting, identify if botulinum toxin Type-A (BoNTA) could prevent pain developing and reduce pain if already present and evaluate differences in analgesic use between BoNTA and placebo groups. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Ninety-three participants (48F:45M) were randomised at a median of 11 days post-stroke (IQR 8–19) and included in the intention-to-treat analysis. Pain prevalence increased from 29.0% (95% CI [20.1–37.9%]) to 63.4% (95% CI [54.0–72.9%]) at six months. BoNTA treatment may prevent the development of pain at six months (OR = 0.42, 95% CI [0.18 to 1.01]) but not at three months (OR = 0.57, 95% CI [0.25 to 1.32]). The odds ratio for being on at least one analgesic at six months in the BoNTA group was 0.35 ([95% 0.14 to 0.87]). This secondary analysis suggests that early treatment of spasticity with BoNTA may potentially help prevent post-stroke upper limb pain and reduce analgesic use but appears less effective once pain is established. Further prospective studies are required to verify the hypotheses generated from this secondary analysis. Full article

Rehabilitation is a critical component in the recovery of patients with either complete or partial loss of motor movements. Repeated and slow limb movements are usually advised by practitioners. Advanced robotic systems can help to configure monotonous movements and accelerate the recovery process as an alternative to therapist-assisted motions, especially during the later phase of recovery. In this work, robotic-assisted human limb movements are engineered and augmented with a novel electromyography (EMG) signal to characterize the movements. The proposed lower- and upper-limb assistive system is designed on a wheelchair platform and is IoT-enabled. The proposed assistive system is designed for patients affected with hemiplegia, paraplegia and tetraplegia. Existing state-of-the-art (SOTA) systems are typically focused on either the upper or lower limbs, with limited degrees of freedom (DoF). The IoT framework for remote access enables the possibility of home-based rehabilitation. A prototype was successfully developed and experiments to characterize various muscle movements using the proposed system were performed. Full article

Cardiac surgery carries substantial risk of early postoperative complications including postoperative atrial fibrillation (POAF, 30–50%), periprocedural myocardial infarction (PMI), acute kidney injury (AKI, 3.8–54.4%), bleeding (3–5%), stroke, and cognitive dysfunction. This narrative review synthesizes 30+ studies on circulating microRNAs (miRNAs) as perioperative biomarkers, identifying strongest evidence for cardiac-enriched miR-499 (AUC 0.93, sensitivity 85.7%, specificity 93.3%) and miR-133a (peaks 1–3 h post-declamping) in PMI diagnosis -outperforming troponins’ 6h kinetics. POAF prediction favors preoperative miR-483-5p (AUC 0.78), while AKI, bleeding (miR-223), and neurological injury show emerging but less validated candidates (miR-21, miR-210-3p). We critically analyze limitations across studies and outline clinical translation barriers (3–6 h assay times, heparin inhibition, lacking standardization) with solutions for point-of-care implementation. Full article

Background: Huafeng Dan (HFD) is a traditional famous medicine from Guizhou Province, commonly used for the treatment of stroke-induced hemiplegia and epilepsy. Yaomu is a key component and serves as the sovereign herb in the formula. Most of the components of Yaomu are toxic Chinese herbal medicines. Traditional fermentation processing methods are required to reduce its toxicity. Purpose: Current studies have not yet systematically analyzed the chemical constituents before and after fermentation. Meanwhile, there is a lack of safety evaluation before and after the fermentation of Yaomu, which can provide a basis for safe clinical medication. Method: Chemical constituents of Yaomu before and after processing were analyzed using UHPLC-Q/TOF-MS to compare compositional changes induced by fermentation. To further screen potential toxic components, representative compounds were selected from these differential compounds based on statistical indicators (such as VIP value), low cost and easy availability, as well as criteria from the literature, and the content changes before and after fermentation were investigated. In vitro toxicity was evaluated using a microfluidic liver organ-on-a-chip model to assess the toxic effects of Yaomu extracts before and after fermentation. Results: Studies have shown that in both positive and negative ionization modes, a total of 361 compounds were annotated in unfermented Yaomu. After fermentation, a total of 350 compounds were annotated. Multivariate statistical analysis revealed significant differences in the chemical composition of Yaomu before and after fermentation. Quantitative analysis demonstrated that the levels of diester-type diterpenoid alkaloids were significantly reduced after fermentation, accompanied by concurrent decreases in lysophosphatidylcholine (LPC) species, compared with unfermented Yaomu. In contrast, the concentrations of amino alcohol-type diterpenoid alkaloids were significantly increased. The microfluidic liver organ-on-a-chip results demonstrated that the post-fermentation extract caused significantly attenuated impairment of hepatocellular function and viability. The in vitro toxicity findings showed good concordance. Full article

Background: Cerebrovascular accidents (stroke) remain a leading global cause of death and disability, with its burden increasingly overlapping the rising prevalence of obstructive sleep apnea (OSA) and diabetes mellitus (DM). These highly prevalent cardiometabolic conditions frequently coexist and may jointly amplify cerebrovascular risk through shared and interacting pathophysiologic pathways. This narrative review synthesizes current evidence on the independent and combined contributions of OSA and DM to cerebrovascular complications, with emphasis on mechanisms, stroke outcomes and implications for screening and integrated management. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library to identify English-language articles published between January 2000 and December 2024. Search terms combined OSA or sleep-disordered breathing with stroke or cerebrovascular disease and DM or hyperglycemia. Secondary searches targeted mechanistic domains including intermittent hypoxia, insulin resistance, metabolic syndrome, atrial fibrillation, hypercoagulability, and bariatric surgery. Priority was given to systematic reviews and meta-analyses, randomized controlled trials, and large prospective cohort studies, with smaller studies included when mechanistically informative. Findings were synthesized thematically across OSA-related mechanisms, DM-related mechanisms, bidirectional interactions, combined risk through metabolic syndrome, stroke outcomes, and clinical management considerations. Results: OSA is associated with increased cerebrovascular risk through intermittent hypoxemia-related oxidative stress and inflammation, sympathetic activation with blood pressure surges and sustained hypertension, endothelial dysfunction and atherosclerosis, impaired cerebral autoregulation, arrhythmogenesis, particularly atrial fibrillation and prothrombotic changes. DM increases stroke risk via accelerated atherosclerosis, cerebral small vessel disease, endothelial injury, hypercoagulability, glycemic variability, and cardioembolic mechanisms. Evidence indicates that coexisting OSA and DM are common and associated with greater vascular injury markers, higher rates of cerebrovascular events, and poorer post-stroke recovery. Conclusions: OSA and DM contribute to cerebrovascular complications through convergent mechanisms centered on metabolic syndrome, obesity, inflammation, vascular dysfunction, and thrombosis. These findings support proactive screening and coordinated management strategies to reduce cerebrovascular risk and improve outcomes. 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

Background/Objectives: Stroke is a leading cause of long-term disability, resulting in motor and functional impairments that compromise independence and quality of life. Telerehabilitation offers a promising solution by providing remote, continuous, and accessible post-stroke therapy. This systematic review examined the effects of telerehabilitation on functional capacity, mobility, balance, and quality of life in stroke survivors. Methods: A systematic search was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251169784). Searches in PubMed, Cochrane Library, PEDro, Web of Science, Scopus and CINAHL ultimately identified randomized controlled and quasi-experimental trials from the last decade involving adult stroke patients receiving exercise-based telerehabilitation. Methodological quality was assessed using Joanna Briggs Institute tools and Cochrane risk of bias evaluation. Twenty-one studies with a total of 1067 participants were included, featuring supervised tele-sessions, autonomous exercises, caregiver-assisted training, and hybrid approaches. Results: Results demonstrated significant improvements in functional capacity, motor performance, balance, and quality of life, comparable to conventional rehabilitation. Additional benefits included enhanced self-efficacy, treatment adherence, and caregiver satisfaction. Overall risk of bias was low, though participant blinding was unfeasible. Conclusions: Telerehabilitation may represent a strategy for post-stroke recovery, with studies suggesting outcomes comparable to conventional face-to-face rehabilitation while enhancing accessibility and psychosocial well-being. However, further well-designed, standardized trials with longer follow-up periods are required to confirm its clinical effectiveness. Full article

COVID-19 not only affects the respiratory system but also increases the risk of cerebrovascular complications, including ischemic stroke. Experimental and clinical data suggest that cytokine dysregulation and polymorphisms of thrombophilia-related genes (MTHFR, MTR, and MTRR) may jointly promote hypercoagulation, endothelial dysfunction, and thromboinflammation, thereby contributing to post-COVID ischemic stroke. This study included 160 patients treated at Zangiota Infectious Diseases Hospitals (2021–2023): 60 patients with ischemic stroke in the acute or post-COVID period (experiment group), 50 COVID-19 patients without ischemic stroke (comparison group), and 50 ischemic stroke patients without COVID-19 (control group). Clinical–neurological and immunological parameters were assessed, and polymorphisms in thrombophilia/folate cycle genes (MTHFR C677T, MTR, and MTRR) were genotyped by PCR/real-time PCR. Statistical analysis included χ² tests, t-tests, logistic regression with odds ratios (OR) and 95% confidence intervals (CI); Hardy–Weinberg equilibrium was verified. A strong association was identified between the MTHFR C677T polymorphism and ischemic stroke on the background of COVID-19 (OR = 5.4; 95% CI: 2.1–13.8; p < 0.001). The TNF-α rs1800629 polymorphism was also significantly associated with COVID-19-related cerebrovascular events (OR = 3.27; 95% CI: 1.4–7.6; p = 0.006). Carriage of two or more minor alleles produced a synergistic effect, markedly increasing the risk of post-COVID ischemic stroke (OR = 5.59; 95% CI: 2.3–13.6; p < 0.001). These polymorphisms were linked to hyperhomocysteinemia, endothelial dysfunction, and mechanisms contributing to multifactorial arterial ischemic events. The combined assessment of thrombophilia and folate cycle-related genotypes and clinical indicators may provide a potential framework for improved risk stratification. Polymorphisms in MTHFR may appear to represent important genetic determinants of ischemic stroke following COVID-19, particularly in the context of arterial ischemic mechanisms. Full article