Search Results (934)

Background: Cerebrovascular diseases have complex pathogenesis and pose a serious threat to human health; thus, novel diagnostic and therapeutic strategies are needed. Small extracellular vesicles (sEVs), commonly referred to as exosomes, are 30–150 nm lipid-bilayer vesicles that shield long noncoding RNAs (lncRNAs) from degradation. Because exosomal lncRNAs are more stable than free lncRNAs in blood and cerebrospinal fluid and can cross the blood–brain barrier, they are promising as biomarkers and therapeutic vectors. This review summarizes the roles and mechanisms of exosomal lncRNAs in cerebrovascular diseases. Methods: This narrative review is based on the experimental literature and focuses on the biological functions and regulatory mechanisms of exosomal lncRNAs in cerebrovascular disorders. Results: As competing endogenous RNAs (ceRNAs), they sequester microRNAs (miRNAs), thereby derepressing downstream target-gene expression and modulating neuronal injury (oxidative stress, apoptosis, neuroinflammation) through the nuclear factor kappa-B (NF-κB) and phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathways. They show altered profiles in acute stroke (ischemic/hemorrhagic) correlated with neurological deficits, and are relevant to the early diagnosis of chronic diseases (atherosclerosis, aneurysm) and vascular dementia. Conclusions: Exosomal lncRNAs demonstrate promising translational potential in preclinical studies because they combine exosome delivery capabilities with lncRNA regulatory functions, although clinical validation remains limited. Full article

Background/Objectives: The apelin/APJ system has demonstrated neuroprotective effects in experimental studies by regulating key pathogenic mechanisms of ischemic stroke, including oxidative stress, apoptosis, cerebral edema, and inflammation. This study aimed to investigate the role of serum apelin levels measured within the first 24 h in predicting 28-day and long-term mortality in patients with ischemic cerebrovascular disease. Methods: This prospective cohort study included 44 patients hospitalized with a diagnosis of acute ischemic stroke due to large artery atherosclerosis. Serum apelin levels were measured using the ELISA method from blood samples obtained within the first 24 h after symptom onset. Patients were prospectively followed for 28-day and long-term mortality. Results: During the follow-up period, 32.6% of the patients died. The median serum apelin level was significantly higher in the deceased group compared to the survivors [105.0 pg/mL vs. 55.8 pg/mL]. In ROC analysis, the area under the curve (AUC) for apelin in predicting mortality was 0.727 (95% CI: 0.550–0.903). The optimal cut-off value was determined as ≥70.47 pg/mL (sensitivity: 85.71%, specificity: 62.07%). In Kaplan–Meier analysis, the 28-day mortality rate was 52.2% in the high-apelin group (≥70.47 pg/mL), whereas it was 10.0% in the low-apelin group (<70.47 pg/mL) (p = 0.004). In multivariate Cox regression analysis, an apelin level <70.47 pg/mL was identified as an independent prognostic factor (HR: 0.16; 95% CI: 0.03–0.94). The cumulative survival rates at days 28, 56, and 180 were 56.1%, 46.7%, and 11.7%, respectively, in the high-apelin group, while these rates were 100%, 100%, and 81.8%, respectively, in the low-apelin group. The mean NIHSS score was significantly higher in the high-apelin group, and a strong, positive, and highly significant correlation was found between serum apelin level and NIHSS score (r = 0.703, p < 0.001). Conclusions: High serum apelin levels measured within the first 24 h in acute ischemic stroke are associated with increased 28-day and long-term mortality. The association of high endogenous apelin levels with poor prognosis in the clinical setting suggests that apelin is mobilized as a stress response during ischemia, and that elevated circulating levels may actually reflect the severity of the ischemic insult. Full article

Background: Stroke survivors often present vascular risk factors (VRFs) that are increasingly recognized as contributing to neurodegenerative diseases such as Parkinson’s disease (PD). We examined the influence of VRFs on the risk of PD in stroke survivors. Methods: Using the Korean National Health Insurance Service database, we identified 284,799 individuals with new-onset stroke and followed them for the occurrence of PD. The diagnosis of PD was confirmed using the International Classification of Diseases (ICD-10) code G20 and the rare disease registration code (V124). Results: Cox proportional hazard analyses revealed that smoking (former: Hazard ratio [HR] = 0.80; current: HR = 0.66) and alcohol consumption (moderate: HR = 0.83; heavy: HR = 0.74) were associated with a lower risk of PD. Conversely, diabetes mellitus, especially with a duration ≥ 5 years, was associated with increased PD risk (HR = 1.38). Conclusions: These findings suggest that several VRFs are associated with subsequent PD risk in stroke survivors. Further studies are warranted to determine whether modification of these risk factors influences the development of PD. Full article

Objectives: To determine the prevalence of visual deficits among inpatients with acquired brain injury, to examine the agreement between objective screenings and patient-reported visual deficits, and to investigate patient characteristics associated with visual deficits. Methods: This cross-sectional study included data on screened and patient-reported visual deficits in patients with acquired brain injury admitted for inpatient rehabilitation. The screenings were conducted by occupational therapists. Visual acuity and visual field were assessed in 2014–2023, and complemented by assessment of ocular motility and patient-reported deficits in 2021–2023. Predictive values were calculated for the agreement between screening results and patient-reported symptoms. Logistic regression models were applied to investigate the association between clinical characteristics and visual deficits. Results: 2814 patients were screened, 65% were men, the median age was 64 years, and the most common diagnosis was stroke (66%). In screened patients 32% had reduced visual acuity, 18% had ocular motility deficits, and 15% had visual field deficits. Of 975 patients providing self-reports, 38% reported vision problems. A total of 28% of patients who did not report visual deficits, had visual deficits in the objective screening. Lower functional level was associated with greater odds of having any visual deficits. Traumatic and anoxic brain injuries were associated with lower odds of visual field deficits compared with stroke. Conclusions: The high proportion of patients with visual deficits underlines that these are common consequences following acquired brain injury. Objective screening and patient-reported deficits offer overlapping yet distinct insights into visual deficits. Knowledge of clinical characteristics associated with visual deficits may help recognize high-risk subgroups. Full article

Background: Sex-based differences in complications after venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock are not well defined. We compared 30-day coded acute kidney injury and other short-term outcomes between female and male patients receiving ECMO. Methods: We performed a retrospective multicenter cohort study using the TriNetX U.S. Collaborative Network from 2012 through 2025. Adults with cardiogenic shock supported with VA-ECMO were identified. Patients with a diagnosis-coded AKI (ICD-10-CM N17) recorded on or before the index ECMO procedure were excluded, and female and male cohorts were then matched 1:1 by propensity score on 23 characteristics. The primary endpoint was diagnosis-coded AKI between day 1 and day 30 after ECMO initiation. Secondary endpoints were all-cause mortality, newly diagnosis-coded sepsis, and newly diagnosis-coded ischemic stroke. Results: Among 11,229 adults meeting cohort criteria, 3773 were women, and 7456 were men. After exclusion of 8272 patients with previously coded AKI, 1152 women and 1805 men were eligible, and 1100 patients were matched in each group. Diagnosis-coded AKI occurred in 222 women (20.2%) and 276 men (25.1%) (risk ratio, 0.80; 95% confidence interval [CI], 0.69–0.94; hazard ratio [HR], 0.78; 95% CI, 0.65–0.93; p = 0.005). All-cause mortality was identical between groups (29.5% vs. 29.5%; risk ratio, 1.00; 95% CI, 0.88–1.14). Newly coded sepsis (5.1% vs. 6.3%) and newly coded ischemic stroke (4.0% vs. 3.2%) did not differ significantly. In an unadjusted Aalen–Johansen analysis performed in the unmatched eligible cohorts, the 30-day cumulative incidence of coded AKI was 21.6% among women and 27.8% among men. Conclusions: In this propensity-matched federated electronic health record cohort of adults with cardiogenic shock receiving VA-ECMO and without previously coded AKI, recorded female sex was associated with a lower 30-day risk of diagnosis-coded AKI. Mortality, newly coded sepsis, and newly coded ischemic stroke were similar. These findings are hypothesis-generating and support further investigation of sex-associated differences in datasets with granular renal and ECMO-specific variables. Full article

Severe aortic stenosis represents a growing burden of disease globally with a high risk of death if untreated. There are sex differences in the pathophysiological disease process affecting the aortic valve, patients’ clinical presentation, progression of valve disease, ventricular adaptation, timing of symptom onset, delays in diagnosis, and treatment strategies. Female patients are more likely than male patients to have preserved left ventricular function with concentric left ventricular hypertrophy and smaller left ventricular cavity sizes, which consequently produce low stroke volumes and more paradoxical low flow low gradient severe aortic stenosis. These differences can lead to diagnostic uncertainty resulting in delays to treatment and associated morbidity and mortality. The higher mortality rate reported in women in observational cohorts is multifactorial. It is influenced by delayed diagnosis, lower referral rates, older age at intervention and frailty; rather than female sex alone. There exist variations in the treatment and management of aortic stenosis with women being underdiagnosed and conservatively managed compared to men. A better understanding of the differences in pathophysiology, ventricular adaptation and haemodynamic effects between the sexes are key to improving diagnostic accuracy and referral for timely intervention. Women may require a more tailored approach to their lifetime management of aortic stenosis due to their smaller anatomy and greater comorbidity burden at presentation. This narrative review explores the epidemiology, pathophysiology, presentation, diagnosis and management of aortic stenosis in female patients. Full article

Objective: The aim of this study was to evaluate the efficacy and safety of endovascular and hybrid treatment approaches in patients with aortic arch aneurysms. Materials and Methods. This retrospective study included 68 male and female patients with a confirmed diagnosis of either an aortic arch aneurysm or a descending thoracic aortic aneurysm with a short proximal landing zone (<1.5 cm) who underwent either hybrid or endovascular treatment at the Department of Vascular Surgery between January 2017 and December 2024. Study outcomes included a composite measure of technical success, a composite measure of in-hospital clinical success, and a composite measure of long-term treatment outcomes, including stroke, myocardial infarction, and aortic-related mortality. Results. All 68 patients were divided into two groups: Group I comprised patients who underwent endovascular treatment, whereas Group II included patients who underwent hybrid surgical treatment. The groups were comparable with regard to demographic and anatomical characteristics, clinical presentation, and comorbidities. The composite technical success rate (defined as successful target stent-graft deployment without conversion to open surgery and absence of type I or type III endoleaks) was comparable between the groups at the intraoperative stage (p = 1.000). The composite measure of in-hospital clinical success was achieved in 33 patients (94%) in Group I and 22 patients (67%) in Group II and was significantly higher in the endovascular group (adjusted p = 0.005). This difference was primarily attributable to a higher incidence of complications in the hybrid treatment group, including stroke (9%) and peripheral nerve injury (9%), associated with the open surgical component of the procedure. The mean follow-up duration was shorter in Group I (19.3 ± 10.4 months) than in Group II (63.9 ± 29.5 months), reflecting the fact that most patients in Group I underwent treatment during the later years of the study period. Although a difference in the composite long-term outcome measure was observed before adjustment (p = 0.031), this finding did not remain statistically significant after correction for multiple testing (adjusted p = 1.000). Conclusions. In this preliminary single-centre study, endovascular and hybrid approaches showed comparable technical efficacy in the early postoperative period. However, hybrid surgical treatment was associated with a less favourable safety profile during the early postoperative period, as reflected by the significantly lower in-hospital composite clinical success rate and longer hospital stay than in the endovascular group. These findings remained robust after correction for multiple testing. Long-term results should be interpreted with caution and require confirmation in larger prospective studies with longer and balanced follow-up periods. Full article

Atrial cardiomyopathy (ACM) is defined as any complex of structural, architectural, functional, electrophysiological, and molecular changes affecting the atria that may result in clinically significant health consequences. ACM can be caused by a variety of factors, including age-related changes, valvular or vascular disease, genetic diseases, congestive heart failure, metabolic diseases, cardiovascular disease (CVD) risk factors such as arterial hypertension (AH) or obesity, obstructive sleep apnea, and other infectious or noninfectious diseases predisposing to chronic inflammation. The diagnosis of ACM relies on several modalities, including electrocardiography, echocardiography, cardiac magnetic resonance imaging (MRI), computed tomography (CT), electroanatomical mapping (EAM), genetic studies, and biomarkers, which can detect and characterize structural, mechanical, and electrical atrial dysfunction. These changes often include structural atrial remodeling (fibrosis), abnormal structure of the atrial wall and its components, and contractile and electrical dysfunctions. When assessing aspects of ACM, structural changes in the atria such as left atrium (LA) size and fibrosis; LA architectural changes such as the expression of remodeling; changes in LA mechanics such as echocardiographic stress indices; changes in reservoir function and changes in contraction; biological factors determining changes in biomarkers; possible genetic predispositions and higher expression of certain genes encoding certain proteins; and arrhythmogenic factors associated with a higher risk of atrial fibrillation (AF) and stroke and a worse short- and long-term prognosis are very important. When considering the challenges of diagnosing ACM, it should be noted that without standardized diagnostics, most ACM diagnostic situations remain primarily research tools rather than practical clinical diagnostic methods. This review critically evaluates the evidence and translational gaps in the diagnosis of ACM, synthesizing the emerging role of advanced diagnostics and their clinical and prognostic implications as a key future tool for individual risk stratification. Full article

Neonatal thromboembolic (TE) disease is an increasingly recognized clinical entity, driven by the physiological uniqueness of developmental hemostasis, improved survival of preterm infants, and the widespread use of invasive supportive technologies. Most neonatal thrombotic events are associated with central venous and arterial catheterization which are considered the most significant modifiable risk factors. The clinical spectrum encompasses catheter-related thrombosis, perinatal stroke and site-specific entities such as renal vein and portal vein thrombosis. Each condition presents distinct challenges such as neurological complications, chronic organ dysfunction and portal hypertension. Diagnosis relies primarily on Doppler ultrasonography, though its sensitivity is limited in deep-vessel scenarios, often requiring advanced modalities like magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). Therapeutic interventions remain controversial due to a lack of high-quality evidence, with current guidelines largely based on observational data. Ultimately, managing neonatal TE requires a nuanced, individualized approach that balances the risk of thrombus extension against the inherent hemorrhagic vulnerability of the neonate. This review aims to provide a comprehensive and up-to-date overview of neonatal TE, emphasizing major clinical entities and diagnostic strategies. It highlights current evidence gaps and outlines future directions, including the need for standardized management protocols and high-quality prospective research. Full article

Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Coordinated care delivered through protocol-driven multidisciplinary teams enables rapid diagnosis and treatment, both of which are essential for improving clinical outcomes. Objective: Our objective was to analyze care strategies in the emergency management of acute ischemic stroke, focusing on treatment times and influencing factors, interventions implemented in emergency settings and their impact on clinical outcomes, and the contribution of healthcare professionals to optimizing stroke care. Methods: A systematic review was conducted in accordance with the PRISMA 2020 Statement. Current evidence published between 2021 and 2026 was retrieved from five databases: PubMed, Web of Science, Scopus, Cochrane Library, and SciELO. Eligibility criteria were applied, and methodological quality and risk of bias were assessed using validated appraisal tools. Results: Fourteen studies involving a total of 6384 patients were included. Factors such as healthcare system reorganization, multidisciplinary teamwork, early protocol activation, and the use of stroke-specific triage scales significantly influenced treatment times. Coordinated and protocolized care pathways, together with evidence-based clinical interventions, were consistently associated with higher thrombolysis rates and shorter treatment times, while improvements in neurological and functional recovery were reported in several, but not all, studies. The integration of specialized stroke professionals and structured emergency care processes contributed to reducing treatment delays and improving patient outcomes. Conclusions: Critical treatment times in acute ischemic stroke are influenced by multiple factors, and targeted organizational and clinical strategies can accelerate diagnosis and treatment. Although improvements in clinical outcomes were not consistently demonstrated across all included studies, the available evidence consistently supports protocol-driven multidisciplinary emergency care as an effective strategy for reducing treatment delays and optimizing acute ischemic stroke management. Full article

Background/Objectives: Stroke is a major cause of long-term disability worldwide. Wearable devices have shown potential in supporting rehabilitation, yet evidence on their safety, feasibility, and adherence remains fragmented. This scoping review aimed to evaluate the safety, feasibility, and adherence of wearable devices in stroke rehabilitation. Methods: A systematic search of PubMed, EMBASE, Web of Science, and CINAHL Complete was conducted in January 2026. Studies involving participants with a confirmed diagnosis of stroke were included regardless of study design. Studies were eligible if wearable devices were used as part of rehabilitation interventions and reported outcomes related to safety, feasibility, or adherence. Adverse events were categorized according to severity, while feasibility was assessed using indicators such as recruitment rate, dropout rate, and adherence rate. Results: A total of 38 studies involving 1121 participants were included in this review. Available evidence generally suggested a favorable safety profile for wearable device-assisted rehabilitation, with most reported adverse events being mild and primarily consisting of skin irritation, pressure-related discomfort, muscle fatigue, localized pain, and transient discomfort. Recruitment rates ranged from 5.8% to 100%, indicating substantial variability in implementation feasibility across studies. Only four studies reported adherence-related outcomes, and considerable variation existed in the definitions and assessment methods used. Most included studies reported intervention completion, attendance, or dropout outcomes rather than directly evaluating adherence. Conclusions: Current evidence suggests that wearable devices are generally safe and potentially feasible for stroke rehabilitation. However, substantial heterogeneity across studies, inconsistent adverse event reporting, and limited adherence data restrict the strength of current conclusions. Adherence remains an important evidence gap, as it was infrequently reported and inconsistently defined. Future research should establish standardized reporting criteria for safety, feasibility, and adherence outcomes and evaluate wearable device interventions in larger and more diverse populations with longer follow-up periods. Full article

Unilateral spatial neglect (USN) is a neuropsychological syndrome characterized by a reduced awareness of, and attention toward, stimuli located in the contralesional space. The left side of the space is most frequently affected, due to the higher incidence of the disorder following right-hemisphere lesions, particularly within the territory of the right middle cerebral artery and, less commonly, the right anterior cerebral artery. Although USN can also occur following left-hemisphere damage, it is typically less severe and tends to resolve more quickly. USN is a common consequence of acquired brain injury, especially of vascular origin, and significantly impairs a patient’s functional abilities and quality of life. Its high incidence in the acute phase after stroke, together with its potential persistence into the chronic stage, makes early diagnosis and timely rehabilitation essential. In this narrative review, we provide an overview of current assessment tools and rehabilitation approaches for post-stroke USN, with a focus also on recent advances and emerging therapeutic strategies. To illustrate diagnostic and therapeutic decision making, a representative case of a patient admitted to a Stroke Unit is reported, illustrating the application of assessment methods in a real-world setting. The aim of this review is to offer clinicians practical tools and evidence-based strategies to support a more effective and individualized management of patients affected by this complex and disabling condition. Full article

Cerebral strokes have been a global problem for many decades. Interest in saliva as a diagnostic material has grown substantially. The ease of collection, minimal invasiveness and low storage costs make saliva particularly well suited for diagnostic and therapeutic applications. Research shows that markers detected in blood can also be found in saliva, opening up the possibility of using this biofluid for clinical purposes. The aim of this paper is to review current knowledge on salivary biomarkers in stroke patients. Among the markers detected in the saliva of stroke patients are indicators of antioxidant capacity (e.g., reduced glutathione and uric acid), oxidative (e.g., malondialdehyde, advanced oxidation protein products) and nitrosative stress (e.g., peroxynitrite), inflammation (pro- and anti-inflammatory cytokines) and others. The levels of many salivary biomarkers correlate with the severity of disease, organ complications and may serve as valuable tools for the differential stroke diagnosis. The collective findings of these studies underscore the potential clinical applications of salivary biomarkers in stroke. However, considerable obstacles such as methodological heterogeneity, limited differential diagnostic studies, small cohorts, and insufficient standardization of saliva collection and oral health assessment impede their clinical implementation. Establishing standardized saliva collection protocols and reference values for key parameters is crucial. Identifying biomarkers in saliva lays the groundwork for developing innovative tools to analyze and accurately assess stroke patients. Full article

Background: Magnetic resonance imaging (MRI) has a central role in acute ischemic stroke (AIS) and transient ischemic attack (TIA) diagnosis; however, conventional high-field MRI remains limited by infrastructure requirements, patient transport, and restricted accessibility. Low-field and portable MRI systems have emerged as potential solutions for point-of-care neuroimaging in emergency, intensive care, and resource-limited settings. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception through May 2026. Studies evaluating low-field or portable MRI systems (≤0.55 T) in adults with AIS, TIA, sub-acute ischemic stroke, or suspected stroke were included. Diagnostic accuracy, feasibility, safety, workflow, and clinical utility outcomes were extracted. Risk of bias was assessed using QUADAS-2. Results: Eleven studies encompassing portable and low-field MRI platforms ranging from 0.064 T to 0.55 T were included. Portable MRI demonstrated feasibility in bedside ICU and emergency department settings without major device-related adverse events. Diagnostic performance varied by field strength, lesion size, and imaging protocol. Conclusions: Low-field and portable MRI show promising diagnostic potential for AIS and TIA, particularly when conventional MRI is unavailable, delayed, or impractical. However, current evidence is limited by small, predominantly single-center studies with substantial risk of bias, and further prospective multicenter validation is required before these technologies can be incorporated into routine clinical decision-making. Full article

Ischemic stroke remains a leading cause of death and disability. Accurate segmentation of affected areas on brain CT scans plays a crucial role in timely diagnosis and treatment decisions. This study examines an ensemble approach to ischemic stroke foci segmentation on non-contrast CT scans using three 3D U-Net models. CT scans of 50 patients with confirmed acute ischemic stroke (provided by the International Tomography Center, SB RAS) were used as input data. Experiments demonstrated that the 3D U-Net ensemble outperforms each of the individual models in segmentation quality, achieving a Dice coefficient of 0.7008. Analysis of the results demonstrates more accurate delineation of pathological areas and a reduction in segmentation errors. The proposed approach can find application in automated diagnosis of stroke and other diseases requiring accurate segmentation of medical images. Full article