Search Results (198)

Background/Objectives: The composition of the thrombus is not taken into account in the etiology determination of patients with acute ischemic stroke (AIS); however, it varies depending on the origin of the thrombus, as atherothrombotic thrombi contain more red blood cells and cardioembolic thrombi contain more fibrin and platelets. Radiomics has the potential to provide quantitative imaging data that may vary depending on the composition of thrombi. The aim of this study is to predict cardioembolic and atherothrombotic thrombi using radiomic features (RFs) from non-contrast computed tomography (NCCT) brain scans. Methods: A total of 845 RFs were extracted from each of the 41 patients included in the study. A predictive model was used to classify patients as either cardioembolic or atherothrombotic, and the results were compared with the TOAST criteria-based classification. Results: Ten RFs (one shape feature and nine texture features) were found to demonstrate a statistically significant correlation with cardioembolic or atherothrombotic origins. The predictive radiomics model achieved an area under the curve (AUC) of 0.842 and an accuracy of 0.902 (p < 0.001) in classifying stroke etiology. Conclusions: Radiomics based on NCCT can help to determine the etiology of AIS. Full article

Background/Objective: Atrial fibrillation (AF) is associated with more grave and fatal outcomes than the other stroke etiologies. Left ventricular diastolic dysfunction (LVDD) is prevalent in elderly people and is associated with AF risk. We investigated whether higher preadmission CHA₂DS₂-VASc score is related to LVDD severity and functional outcome among stroke patients with nonvalvular AF. Methods: A retrospective cross-sectional analysis of data on consecutive acute ischemic stroke patients with AF within a week of onset was conducted from March 2015 to February 2018. Patients were compared by median LVDD value (13.0). CHA₂DS₂-VASc was assessed by score, with three categories (low risk [a CHA₂DS₂-VASc score of 0–2], moderate risk [3,4], and high risk [≥5]), and its individual component. Functional outcome was measured with the modified Rankin Scale (mRS) at 3 months poststroke, and unfavorable outcome was defined as mRS ≥ 3. Results: A total of 256 patients (mean age, 73.3 ± 10.2; male, 51.6%) were included. In multivariable regression analysis, CHA₂DS₂-VASc was associated with LVDD (OR 1.70, 95% CI: 1.31–2.21 for score and 9.92, 2.99–32.88 for high risk ≥ 5 versus low risk 0–2). Increasing CHA₂DS₂-VASc score and high risk ≥ 5 versus low risk 0–2 was associated with mRS ≥ 3 (1.72, 1.27–2.33 and 6.48, 1.37–30.60, respectively). The C-statistic of the CHA₂DS₂-VASc score was 0.75 (0.70–0.80) for LVDD and 0.80 (0.75–0.85) for mRS ≥ 3. The sensitivity of the CHA₂DS₂-VASc score for mRS ≥ 3 was higher than for LVDD. Conclusions: Higher preadmission CHA₂DS₂-VASc score can be a cumulative determinant of short-term functional outcome more than LVDD severity among stroke patients with nonvalvular AF. Full article

Background/Objectives: Immature platelet fraction (IPF) and reticulated platelets (RPs) are biomarkers reflecting the youngest and most metabolically active platelets in circulation. RPs, a subset of immature platelets, contain residual RNA and have been associated with increased thrombotic potential. Elevated IPF levels indicate enhanced platelet production, commonly observed during elevated platelet turnover, such as in autoimmune reactions, consumption, and thrombotic events. This systematic review aims to evaluate the potential role of IPF and RPs in the context of cerebrovascular events, specifically ischemic and hemorrhagic stroke, as well as transient ischemic attacks (TIAs), and to assess their clinical utility in stroke monitoring and management. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science for studies published between 2000 and 2024, which focused on IPF and RPs in human subjects with cerebrovascular events. Results: Six studies met the inclusion criteria. Findings suggest that elevated levels of IPF and RP are associated with the acute and chronic phases of ischemic stroke and TIA and may reflect increased platelet turnover and thrombotic activity. Some evidence supports their role in predicting stroke severity, recurrence, and underlying etiology, although results are not yet consistent across all studies. Conclusions: IPF and RPs are emerging biomarkers with potential applications in acute ischemic stroke and risk stratification. While current evidence is promising, further research is needed to standardize measurement techniques and validate their routine use in clinical practice. Full article

Melatonin (MEL)is an endogenous hormone with antioxidant potential that plays an important role in maintaining redox homeostasis. MEL and its derivatives directly scavenge free oxygen and nitrogen radicals. Melatonin inhibits lipid peroxidation, stimulates antioxidant enzymes, and reduces metal toxicity. It stabilizes mitochondrial activity and suppresses inflammatory signaling. It takes part in neurogenesis, neuroprotection, and modulation of the cardiovascular system. It prevents many diseases of free radical etiology, i.e., neurodegenerative and circulatory system diseases and ischemic stroke. Supplementation with this antioxidant can slow down the aging process and provide protection against diseases of the central nervous system and support the body’s natural antioxidant system. This study uses current reports from the literature and meta-analyses of the antioxidant mechanisms of melatonin and its importance in neurodegenerative diseases. Full article

Objectives: This study aimed to investigate the relationship between the anticoagulation and risk factors in atrial fibrillation (ATRIA) score and initial stroke severity in patients with acute ischemic stroke of varying etiologies, including atrial fibrillation (AF), large-artery atherosclerosis, and undetermined origin. Methods: In this prospective observational study, 416 patients admitted with acute ischemic stroke between June 2022 and December 2024 were analyzed. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and patients were categorized into two groups: mild-to-moderate (NIHSS ≤ 15) and moderate-to-severe/severe (NIHSS > 15). Pre-admission ATRIA scores were calculated based on demographic and clinical parameters. Multivariable logistic regression was performed to assess the association between ATRIA scores and stroke severity. Results: Patients with more severe strokes had significantly higher ATRIA scores (median 8.5 vs. 5.0, p < 0.001). AF was more frequent in the severe group (44.8% vs. 31.3%, p = 0.037). In multivariable analysis, each one-point increase in the ATRIA score was independently associated with a 1.82-fold increase in the odds of severe stroke (OR 1.823, 95% CI 1.568–2.119, p < 0.001). High ATRIA scores (>6) were associated with an 11.7-fold increased risk of severe stroke (OR 11.692, 95% CI 5.636–24.255, p < 0.001), independent of stroke etiology, ejection fraction, and inflammatory markers. Conclusions: The ATRIA score is independently associated with initial stroke severity across diverse ischemic stroke etiologies. It may serve as a simple, practical tool for early risk stratification in the acute setting, regardless of AF status. Further studies are warranted to confirm its utility in guiding early management and prognosis. Full article

Ischemic stroke following percutaneous coronary intervention (PCI) is a rare complication, with an overall incidence of 0.56%. Most embolic strokes result from the dislodgement of atherosclerotic plaques, thrombi formed on catheter surfaces, procedural maneuvers, or, less commonly, air or metallic emboli originating from fractured guidewires. We present a unique case of stroke following PCI due to a previously unreported mechanism—arterial tunica media embolization associated with arterial access. A 57-year-old female presented with chest pain at rest and with exertion, accompanied by episodes of anxiety and fluctuating blood pressure, for which coronary angiography was performed, revealing 90–99% stenosis of the left anterior descending artery and necessitating PCI. During the procedure, the patient developed an eye deviation, aphasia, and left-sided hemiparesis. Cerebral angiography identified a M2 segment occlusion of the right middle cerebral artery (MCA) and a subocclusion of the right anterior cerebral artery (ACA). Thrombectomy was performed, retrieving two white, tubular emboli resembling fragments of a vessel wall, histologically confirmed to be arterial tunica media. While PCI is associated with a low complication rate, its increasing frequency necessitates awareness of emerging complications. This case underscores a previously undocumented potential embolic complication arising from the performance of PCI. Full article

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare disease with variable clinical manifestations. MELAS is most often caused by the human mitochondrial DNA (mtDNA) m.3243A>G variant. We describe cardiac magnetic resonance (CMR) imaging findings and clinical features of 22 subjects with the m.3243A>G mutation and endeavored to discover the role of CMR in MELAS cardiomyopathy diagnostics. The clinical symptoms, ECG findings, and laboratory tests were retrospectively collected from the electronic medical record. Ten subjects (46%) had cardiac symptoms, and eighteen subjects (82%) had some clinical symptoms or signs of MELAS. Seventeen subjects (77%) showed cardiac findings compatible with MELAS. An ECG showed a short PR interval in six subjects (27%). Two patients had a first-degree atrioventricular block. Repolarization changes in the ECG were observed in thirteen subjects (59%), whereas left ventricular hypertrophy voltage criteria were only observed in one subject. Patients with ECG abnormalities had a strong link between proBNP value and cardiac tissue composition (T1 relaxation, p < 0.02) and showed decreased CMR-based strain (p < 0.025). The CMR findings are heterogeneous in subjects with m.3243A>G. Cardiac MELAS may include left ventricular hypertrophy, which mimics sarcomericcardiomyopathy but maypredispose individuals to severe heart failure episodes triggered by acute critical situations. CMR may be used to clarify ECG findings. This study indicates that the genetic testing of MELAS should be considered in new cases of HCM or sudden heart failure phenotypes of unknown etiology. Full article

Moyamoya disease (MMD) is a cerebrovascular disease which can result in severe strokes. However, its etiology is still unknown. We analyzed gene expression datasets from 36 MMD patients and 24 controls to identify differentially expressed genes. Using weighted gene co-expression network analysis and databases such as KEGG, we identified hypoxia-immune-related genes. These genes were further refined through machine learning algorithms. The diagnostic value was confirmed using an external dataset, and a diagnostic nomogram was constructed. Additionally, gene set enrichment analysis was conducted, and a competitive endogenous RNA (ceRNA) network was built to predict potential therapeutic targets. Our study identified AKT1, CLDN3, ISG20, and TGFB2 as the key hypoxia-immune genes associated with MMD. These genes were implicated in epithelial–mesenchymal transition, angiogenesis, and cell adhesion, suggesting a role in MMD pathogenesis. Further, our study constructed the ceRNA network and predicted potential drug targets for MMD. We obtained the top 10 drugs in the interaction of the four key genes that might serve as potential targets for the treatment of MMD. In conclusion, this study comprehensively analyzes the role of hypoxia-immune genes in MMD, which is conducive to the development of new diagnostic and therapeutic approaches and the exploration of the potential pathogenesis of MMD. Full article

Background and Objectives: Peripheral facial paralysis (PFP) is a condition with diverse etiologies, requiring multidisciplinary management. This study aimed to describe the sociodemographic, clinical, and functional characteristics of patients with PFP treated at the Rehabilitation Service of the University Hospital of Burgos and to evaluate factors associated with the initial degree of impairment. Materials and Methods: A descriptive, cross-sectional study was conducted on 45 patients referred to the Rehabilitation Service from July 2018 to July 2023. Inclusion criteria included first-time rehabilitation visits for PFP during the study period with signed informed consent. Patients with prior PFP on the affected side or severe comorbidities, such as stroke, were excluded. Data were collected from medical records and initial evaluations. The Sunnybrook Facial Grading System (SFGS) was used to assess impairment. Results: Idiopathic paralysis was the most common etiology, with a predominance in men (60.9%) and middle-aged or older adults. Otorhinolaryngology was the leading referral service, though primary care referrals were underrepresented. Delays in initiating rehabilitation were identified, especially in complex cases like acoustic neurinoma. The ANOVA test revealed no significant differences in functional assessments based on age, sex, or etiology, likely due to the limited sample size. Conclusions: The study highlights the predominance of idiopathic etiology in PFP and the importance of otorhinolaryngology in referrals. Greater awareness in primary care and early identification are crucial. Future studies with larger samples are needed to evaluate predictors of impairment and optimize rehabilitation strategies. Full article

Background: Intracranial artery calcification detected on CT imaging is a recognized risk factor for ischemic cerebrovascular diseases, but the underlying etiology of this association remains unclear. Differences in objective morphometric characteristics of these calcifications may partially explain this association, yet these measurements are largely absent in the literature. We investigated intracranial artery calcification morphometry in patients with recent anterior ischemic stroke or TIA, assessing potential differences between calcifications in both intracranial carotid arteries (ICAs) located ipsilateral and contralateral to the cerebral ischemia. Methods: Among 100 patients (mean age 69.6 (SD 8.8) years) presenting to academic neurology departments, 3D reconstructions of both ICAs were based on clinical CT-angiography images. On these reconstructions, a luminal centerline and cross-sections perpendicular to this centerline were created, facilitating the assessment of calcification morphometry, spatial orientation and stenosis severity. Differences in calcification characteristics between ICAs were assessed using two-sided Wilcoxon signed-rank and χ² tests. Results: Among 200 arteries, a median of four (IQR 2–6) individual calcifications were counted, with a mean area of 1.8 (IQR 1.2–2.7) mm², a mean arc width of 43.5 (IQR 32.3–53.2) degrees, and median longitudinal extent of 15.4 (IQR 5.9–27.0) mm. Calcifications were most often present in the anatomical C4 section (56.0%), with predominantly posterosuperior orientation (38.5%) and 42.0% had a local stenosis severity > 70%. None of these aspects significantly differed between ICAs, and this remained after restricting analyses to patients with undetermined etiology. Conclusions: We found no differences in morphometrical or spatial aspects of calcifications between ICAs ipsilateral and contralateral to the cerebral ischemia. Full article

Background/Objectives: We describe a case of intravascular large B-cell lymphoma (IVLBCL) presenting with recurrent cerebral infarctions and review similar reported cases. Our aim is to explore potential early diagnostic markers and discuss their prognostic implications. Methods/Results: A 79-year-old man with a history of hypertension, hyperuricemia, and postoperative bladder cancer presented with five to six cerebral infarctions over an 11-month period, despite successive changes in antiplatelet and anticoagulant medications. Neurological examination revealed decreased pain sensation, bilateral hearing loss, and right thenar atrophy. Laboratory studies showed elevated inflammatory markers and soluble IL-2 receptor. CSF analysis revealed elevated protein, β2-microglobulin, IL-6, and IL-10 levels. A skin biopsy was performed to investigate suspected IVLBCL. Histopathological examination of the skin biopsy revealed large pleomorphic CD20-positive cells within the vasculature, confirming a diagnosis of IVLBCL. The patient was treated with chemotherapy, including dose-adjusted R-CHOP and high-dose methotrexate, and achieved complete remission. No recurrence of cerebral infarction was observed during a two-year follow-up period. Conclusions: This case highlights the importance of considering IVLBCL in patients with recurrent strokes of unknown etiology, especially when laboratory or imaging findings suggest systemic involvement. Early recognition and appropriate tissue diagnosis, such as skin biopsy, are essential for timely treatment and favorable prognosis. Full article

Oral anticoagulation (OAC) is essential for preventing ischemic stroke events in patients with atrial fibrillation (AF), and leads to a significant ischemic prophylaxis, when appropriately used. However, there is still a risk of experiencing stroke events, despite being under anticoagulation. Stroke despite OAC is an increasingly common diagnosis, and pathophysiologically, it can be associated with several etiologies, ranging from AF competing mechanisms to true anticoagulation failure. While the cardioembolic origin of stroke is the most frequently identified etiology, other factors also have to be considered, as there is a significance risk of coexistence. This highlights the need for thorough diagnostic testing, evaluating each stroke etiology independently, with the use of imaging, biomarker and blood tests. Treating such patients, however, is more complex, as there is still uncertainty regarding the selection of OAC post-stroke, with data showing a superiority of direct OAC (DOAC), compared to vitamin K antagonists, in recurrent ischemic stroke prevention and conflicting results regarding OAC switch. Finally, the additive value of cardiac interventions, such as left atrial appendage occlusion (LAAO), in secondary prevention of stroke, is being explored, as it could potentially lead to significant stroke risk reduction. This review, therefore, provides an updated summary of the pathophysiology, diagnostics and therapeutics of stroke under OAC, while also discussing the future direction on the Achilles heel of AF management. Full article

Background and purpose: Perforator stroke (PS) is a subtype of perinatal arterial ischemic stroke (PAIS), in which injuries occur in the territory of the perforator branches of the main cerebral arteries. This study aims to explore the incidence, timing, risk factors, and clinical presentation of PS in both preterm and full-term neonates. Material and methods: We retrospectively analyzed data about all the neonatal brain MRIs carried out in our hospital from March 2012 to March 2023. Criterium of inclusion was the radiologically confirmed diagnosis of perforator stroke involving one or more arterial districts. Results: A total of 1928 patients underwent brain MRIs during the period considered. PAIS was present in 50 patients, of which 19 had PS (38%). Among the patients with PS, nine were preterm babies (47%), and six suffered from perinatal asphyxia (31.5%). PS cUS diagnosis preceded MRI diagnosis in 88% of preterm babies. The mean age at cUS diagnosis was 20 ± 7 days. Preterm babies were often asymptomatic, whereas term babies showed neurological symptoms (mainly seizures). The outcome was favorable as long as PS was isolated. Conclusions: PS is surprisingly frequent among PAIS. It represents the most common form of PAIS in preterm babies and in babies suffering from birth asphyxia. Prenatal and perinatal factors suggesting a possible thromboembolic etiology leading to PAIS are rare in our population of preterm babies, in which the diagnosis was always preceded by negative cUS. These assumptions suggest a postnatal development of PS in premature babies more than a perinatal one. Full article

Background: Endothelial dysfunction and inflammation are associated with the progression of coronary artery disease (CAD) and the pathophysiology of acute coronary syndrome (ACS). We examined the prognostic role of endothelial function and pro-inflammatory cytokines in patients admitted with ACS. Methods: The study population consisted of 864 subjects. From 663 subjects who presented with chest pain, ACS was diagnosed in 460. We additionally recruited 201 consecutive patients with stable CAD. Endothelial function was assessed using flow-mediated dilatation (FMD). Tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were measured via ELISA. Subjects with ACS were followed up for major adverse cardiovascular events (MACE), defined as cardiovascular death, cardiac arrest, myocardial infarction, stroke, nonfatal stroke, other arterial thrombotic events, and hospitalization due to cardiovascular conditions. Results: There was a stepwise impairment in FMD, logTNF-α, and logIL-6 in patients with chest pain of non-epicardial CAD etiology compared to patients with stable CAD and those with ACS (p < 0.001 for all). Moreover, patients who presented with chest pain had increased odds of ACS in accordance with the increasing levels of TNF-α, IL-6, and impaired FMD (p < 0.05 for all). Interestingly, from all these markers, in patients with ACS, we found that only TNF-α levels above 5.19 pg/mL had a 2.5-times-increased risk of MACE compared to patients with TNF-α levels below 5.19 pg/mL, independently of other confounders. Conclusions: In the current study, we found that patients who presented with ACS had impaired endothelial function and increased levels of IL-6 and TNF-α. Full article

Acute ischemic stroke outcomes depend on various factors. We investigated whether the outcome-relevant factor (ORF) profiles differ between different vascular territories and different therapeutic strategies. In this retrospective study, we analyzed 410 comprehensive stroke center patients [median age of 70 years (IQR 57–80), 125 women (30%)] by analyzing five groups: all patients, patients with infratentorial infarctions only (n = 80), all patients with supratentorial infarctions (n = 330), patients with supratentorial infarctions without (n = 269), and with mechanical thrombectomy (n = 61). Outcomes were classified with the modified Rankin scale as ≤2 (good) or >2 (poor) after three months. The patient group with infratentorial strokes was compared to the group of patients with supratentorial strokes using the Kruskal–Wallis test or chi-squared statistics. Within each of the five stroke groups, univariate logistic regression analysis was used to identify the ORF of a poor outcome; if more than one ORF was identified, all identified factors were included in one multinomial logistic regression analysis model. Compared to the patients with supratentorial strokes, the patients with infratentorial stroke exhibited a less severe neurological deficit at entry and lower rates of ischemic heart disease, thrombolytic intervention, and cardio-embolism but a higher rate of large vessel disease. After multinomial logistic regression analysis, a poor outcome in the infratentorial group was associated with atrial fibrillation [odds ratio (OR) 13.73 (95% confidence interval 1.05–181.89), p = 0.04], estimated glomerular filtration rate [OR 0.96 (0.91–0.99)], p = 0.02], and marginally with diabetes mellitus [OR 7.69 (0.96–62.63), p = 0.05]. In all three supratentorial stroke groups, the neurological deficit as scored by the National Institute of Health Stroke Scale [OR 1.32 (1.22–1.44), p < 0.0001] was predominantly associated with a poor outcome, accompanied by age only in the group of all supratentorial strokes [OR 1.04 (1.01–1.08), p = 0.01]. In this cohort of mild to moderate stroke patients, the ORFs differed between the supra- and infratentorial stroke populations. Full article