Search Results (504)

Background and Objectives: The prevalence of heart failure and atrial fibrillation is increasing because of population aging. There are important sex-related differences in the epidemiology, pathophysiology, treatment, and prognosis of patients with both heart failure and atrial fibrillation. While the overall lifetime risk of both diseases is similar between women and men, women tend to be older when diagnosed and to have more comorbidities. Materials and Methods: A narrative review was conducted by analyzing studies published across databases such as PubMed, SCOPUS, Web of Science, and Google Scholar. The review focused on research about sex-related differences in patients with heart failure and atrial fibrillation, emphasizing the peculiarities in women regarding drug treatment and prognosis after cardiac device implantation. Results: Current evidence highlights the sex-related differences in patients with both heart failure and atrial fibrillation regarding pathophysiology, clinical manifestations, and echocardiographic findings. There are also data regarding possible sex-related differences in mortality and therapy, as women tend to have longer hospital stays, but there are fewer reevaluations after discharge. Conclusions: Women with both atrial fibrillation and heart failure are at increased risk of stroke and other adverse outcomes that negatively affect their quality of life. Females with atrial fibrillation and heart failure tend to be treated less with rhythm control strategies and ablation, which may have a great impact on symptom burden in women compared to men. Full article

Diffusion-weighted imaging (DWI) has been increasingly utilized in the emergent evaluation of acute ischemic stroke (AIS) patients. DWI enhances sensitivity and specificity and enables the use of delayed reperfusion treatments in selected cases. However, DWI is not devoid of limitations. DWI-negative AIS is not uncommon in clinical practice and is reported in up to 1 of 4 AIS patients. We reviewed the relevant literature and searched the PubMed and Google Scholar databases for studies reporting on DWI-negative AIS prevalence during the 2021–2025 time period. Additionally, we included cases from our practice to highlight key points. DWI-negative AIS prevalence was 16% in one meta-analysis and ranged from 6.9% to 23.2% in identified studies that met our inclusion criteria. The biological, pathophysiological, technical, epidemiological and clinical factors that contribute to DWI-negative stroke are presented in detail. Overall, the application of diffusion imaging modalities for stroke is not bereft of blind spots despite enhanced sensitivity. Over-reliance on advanced neuroimaging and unfamiliarity with its limitations predispose DWI to errors in AIS assessment. Awareness of the predisposing factors, treatment effect, and prognosis guides appropriate decision-making, promoting good outcomes. Prospective appropriately designed trials should address the lingering questions identified, such as the association between time of imaging and DWI negativity. Full article

Background: Endothelial dysfunction plays a critical role in ischemic stroke. The Endothelial Activation and Stress Index (EASIX), calculated from creatinine, lactate dehydrogenase (LDH), and platelet levels, reflects endothelial injury. This study aimed to investigate the relationship between EASIX and 90-day mortality in patients with posterior circulation ischemic stroke (PCIS) treated with mechanical thrombectomy. Methods: Fifty-eight patients with acute ischemic stroke who underwent mechanical thrombectomy (MT) or MT combined with intravenous thrombolysis (intravenous tissue plasminogen activator (tPA)) for posterior circulation ischemic stroke (PCIS) were included. EASIX was calculated using 24 h laboratory values of creatinine, LDH, and platelets. Its association with 90-day mortality, length of hospital stay, intubation, and parenchymal hemorrhage was analyzed. Results: In patients receiving reperfusion therapy, the Endothelial Activation and Stress Index (EASIX) showed modest ability to predict 90-day mortality (AUC = 0.583, 95% CI 0.428–0.739, p = 0.295). Higher EASIX values were linked to a 6.58-fold increase in mortality risk. Patients with elevated EASIX were generally older, had more frequent hyperlipidemia, had higher 24 h National Institutes of Health Stroke Scale (NIHSS) scores, had greater need for intubation, and had higher in-hospital mortality. Conclusions: EASIX is a simple, inexpensive, and non-invasive marker that may reflect endothelial dysfunction and help predict mortality in PCIS patients undergoing reperfusion therapy. Higher EASIX values are associated with poorer prognosis. Early identification of high-risk patients may support secondary prevention strategies. Full article

Patients with multiple traumas, particularly those with traumatic brain injury (TBI), are among the most challenging cases in intensive care medicine. Although early orotracheal intubation and invasive mechanical ventilation (IMV) are essential for airway protection and neurological treatment, they significantly increase the risk of lower respiratory tract infection (LRTI), including ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). These complications are particularly prevalent among neurocritical patients due to the distinctive interaction between the brain, lungs and immune system. This narrative review examines the current evidence on the mechanisms underlying the brain–lung–immune axis; the diagnostic challenges in identifying respiratory infections in mechanically ventilated TBI patients; and optimal approaches to empirical or quasi-targeted antimicrobial therapy based on diagnostic algorithms and rapid molecular techniques. Severe TBI induces neurogenic inflammation, autonomic dysregulation, and immunosuppression, thereby increasing susceptibility to pulmonary infections. The ‘triple hit hypothesis’ best explains this cascade: sympathetic hyperactivity (first hit), iatrogenic ventilatory injury (second hit), and intestinal dysbiosis with systemic immune dysregulation (third hit). VAP diagnosis remains challenging due to the lack of universal criteria, the overlap with systemic inflammatory response syndrome, and the low specificity of radiological and clinical signs. VAT may represent an intermediate stage within a continuum of ventilator-associated infection. Recent evidence supports the selective use of nebulized antibiotics for VAT, advocating an individualized, locally adapted empirical approach to VAP treatment. Syndromic molecular panels can accelerate the identification of pathogens, enabling the earlier and more appropriate selection of antimicrobials and improving outcomes while preserving stewardship. Understanding the brain–lung–immune axis and improving diagnostic accuracy are essential to enhancing the treatment of respiratory infections in neurocritical care. Integrating clinical assessment, biomarkers and rapid microbiological testing enables timely, targeted therapy and reduces the misuse of antimicrobials. Full article

Background/Objectives: Post-varicella arteriopathy (PVA) is a significant cause of pediatric arterial ischemic stroke (AIS) that typically involves previously healthy children within 12 months of primary varicella infection, mostly with a monophasic course. Diagnosis is based on clinical and imaging findings, and cerebrospinal fluid analysis may confirm it; treatment is empirical and heterogeneous. We describe a typical case of PVA and present a systematic review of its clinical, radiological, therapeutic, and outcome features. Methods: Following PRISMA 2020 and AMSTAR-2 guidelines, data on demographics, clinical presentation, imaging, laboratory confirmation, treatment, and outcomes were extracted across databases (PubMed, Embase, Scopus). Results: Forty-seven studies, encompassing 312 pediatric patients, were included. Mean age was 4 years with a median latency of 3.82 months from varicella to neurologic symptoms. Common presentation included hemiparesis, language impairment, and seizures. Imaging findings showed unilateral focal involvement of anterior circulation arteries, basal ganglia infarctions, and, rarely, bilateral or posterior circulation involvement. CSF VZV-DNA PCR and anti-VZV IgG were positive in 39% and 48% of tested patients. Treatment included intravenous acyclovir (34%), corticosteroids (20%), and low-dose aspirin (77%); two patients underwent acute reperfusion therapy (rt-PA or thrombectomy). Outcomes tended to be moderately favorable: 43% achieved full recovery, 45% had residual deficit, and 11% experienced recurrence. Prothrombotic state was reported, and it may influence disease severity. Conclusions: PVA is a rare distinct cause of pediatric stroke, with a generally favorable prognosis quoad vitam. Standardized guidelines and prospective studies are needed to establish evidence-based management. Clinicians should maintain a high suspicion for its diagnosis. Full article

Emerging evidence suggests periodontitis may contribute to stroke risk via vascular inflammation and endothelial dysfunction, promoting atherothrombosis and atrial fibrillation. This review aims to synthesize the evidence on the presence of oral bacteria and their products in biological samples from stroke patients and assess their potential impact on stroke pathophysiology, clinical outcomes, and prognosis. We conducted a narrative review of epidemiological, serological, and molecular studies examining the presence of oral bacterial DNA, endotoxins and antibodies against oral pathogens in biological samples (blood, saliva and thrombi) from stroke patients. Seropositivity for periodontal pathogens in blood was associated with incident stroke, as well as with poorer prognosis. Oral bacterial DNA, mainly from Streptococcus spp. and Prevotella spp., was consistently detected in thrombi, whereas no DNA from classic periodontal pathogens was found. The presence of P. gingivalis antibodies in thrombi was associated with lower complete reperfusion rates, while Acinetobacter spp. and Enterobacteriaceae correlated with higher early adverse events and poorer prognosis. DNA detection was limited by low-biomass samples and methodological constraints. These findings support a potential link between periodontitis and ischemic stroke. However, further studies using improved molecular methods are needed to clarify underlying mechanisms and to assess the presence of periodontal pathogen DNA in thrombi. Full article

The paper provides a comprehensive review of the relationship between whole blood viscosity (WBV) and acute ischemic stroke (AIS) concerning AIS risk and type, and its treatment and prognosis. A significant increase in diastolic blood viscosity (DBV) at the onset of AIS was established in the small-artery occlusion stroke subtype. In patients with atherothrombotic causes of AIS, systolic (SBV) and DBV values were higher than in those with an embolic cause. The higher WBV at low shear rates on hospital admission is associated with an increased risk of early neurological deterioration and disease progression in the patients with AIS. Most studies reveal the association of increased WBV at the stroke onset with poor functional outcome after applying intravenous thrombolysis or endovascular thrombectomy. However, significant reduction in WBV after the combined use of these therapeutic methods in AIS patients was observed. Whole blood viscosity has an obvious effect on the risk of AIS, its clinical severity and outcome. Further research is needed due to the multiple devices and techniques used, like cone–plate viscometers, scanning capillary viscometers, EMS viscometers, parallel-plate rheometers and the different associations of WBV with some of the applied treatment strategies. Full article

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach Full article

Background/Objectives: Stroke is a serious neurological disorder that significantly affects patients’ quality of life and overall health. The severity of a stroke can vary widely and is influenced by multiple factors, such as clinical presentation, diagnostic findings, and the site of onset. This study aimed to identify and analyze key variables that contribute to stroke severity, with a particular focus on the role of collateral circulation. Methods: This study analyzed clinical, imaging, and biochemical variables—ipsilateral collateral flow on MRA, MRI unilateral–bilateral stroke, systolic blood pressure (SBP), fasting plasma glucose (FPG), and blood urea nitrogen (BUN). Group differences used chi-square and Mann–Whitney U tests. Class imbalance was addressed with SMOTE; Logistic Regression, Random Forest, XGBoost, and SVM were cross-validated, reporting accuracy, precision, recall, and F1 with 95% CIs. Results: Reduced or absent ipsilateral collateral flow and unilateral–bilateral stroke were strongly associated with greater severity (p < 0.001). SBP was significant (p = 0.034), FPG was significant (p = 0.023), and BUN was borderline (p = 0.059). SMOTE improved prediction: Random Forest achieved accuracy 83.3% (CI: 79.1–87.6) and F1 84.0% (CI: 79.1–88.9); XGBoost reached accuracy 80.2% (CI: 71.5–89.0) and F1 81.4% (CI: 73.8–89.0). Logistic Regression improved to F1 70.8% (CI: 55.4–86.2), whereas SVM declined to accuracy 52.2% (CI: 37.5–67.0). Conclusions: Collateral status and unilateral–bilateral stroke are key determinants of severity; SBP and FPG add prognostic value, with BUN borderline. Tree-based ensembles trained on SMOTE-balanced data provide the most reliable predictions for risk stratification. These findings suggest that future work may focus on integrating such predictive models into Clinical Decision Support Systems (CDSSs) to enhance early risk identification, strengthen CDSSs, and enable more personalized care planning for stroke patients. Full article

Background: Obstructive sleep apnea (OSA) is frequent but underrecognized after stroke, worsening prognosis, recurrence, and mortality. Polysomnography is rarely feasible in acute care, and existing screening tools have limited accuracy. We aimed to identify simple OSA clinical predictors to improve risk stratification in stroke patients. Methods: In this prospective study, 116 consecutive acute stroke patients (mean age 73 years, 57% male) underwent standardized clinical evaluation, Berlin Questionnaire, Epworth Sleepiness Scale (ESS), and home sleep apnea test during hospitalization. OSA was defined as apnea–hypopnea index (AHI) ≥ 15. Logistic regression identified independent predictors; the model’s performance was assessed by accuracy, sensitivity, specificity, and ROC curves. Results: OSA was diagnosed in 42 patients (36%). OSA patients showed higher NIHSS at admission (p = 0.048) and higher ESS scores (p = 0.047), but similar vascular risk factors and stroke subtypes compared to non-OSA patients. In a multivariate analysis, age (OR 1.05; 95% CI 1.00–1.10; p = 0.036) and witnessed apneas (OR 6.20; 95% CI 1.31–29.22; p = 0.021) were OSA independent predictors. The two-variable models achieved 72.9% accuracy, 90.3% specificity, 41.2% sensitivity, Nagelkerke R² = 0.223, and AUC = 0.739 (p < 0.001), outperforming both the Berlin Questionnaire (AUC 0.596) and ESS (AUC 0.616). Conclusions: A simple model based on age and witnessed apneas reliably identified stroke patients at high risk for OSA, with good discriminative performance and higher accuracy than standard questionnaires. Its high specificity supports targeted allocation of sleep studies in resource-limited acute settings, potentially improving early detection, secondary prevention, and care pathways after stroke. Full article

Background/Objectives: Superior cerebellar artery (SCA) infarction is a rare but clinically significant subtype of posterior circulation stroke. Extensive swelling in the SCA territory may cause downward brainstem compression and appear as brainstem hypodensity on computed tomography, potentially leading to premature treatment withdrawal. Methods: We report the case of a 50-year-old woman with acute SCA-territory infarction (NIHSS = 7) presenting with vertigo, dysphagia, dysarthria, and diplopia. Initial computed tomography suggested extensive brainstem infarction, prompting withdrawal of treatment. Diffusion-weighted MRI revealed reversible edema with brainstem sparing. The patient underwent suboccipital decompressive craniectomy and ventricular drainage with favorable neurological recovery. In addition, a systematic literature search was conducted according to PRISMA 2020 guidelines in PubMed, Web of Science, and Scopus (studies published since 1 January 2015). Fifteen studies met predefined eligibility criteria. Results: Magnetic resonance imaging findings were decisive in avoiding a falsely dismal prognosis and inappropriate withdrawal of care. Across the literature, infarct volume (>30–35 mL), brainstem involvement and bilateral cerebellar infarction emerged as key predictors of malignant course. Early decompressive surgery was consistently associated with improved survival, though functional outcomes varied. Fast magnetic resonance imaging techniques and volumetric imaging improved risk stratification and surgical decision-making. Conclusions: SCA infarction can mimic brainstem infarction on computed tomography due to secondary compression rather than true ischemia. Magnetic resonance imaging is essential to guide treatment and prevent avoidable mortality. Multimodal imaging combined with interdisciplinary management allows for accurate prognostication and optimized surgical timing in malignant SCA infarction. Full article

Background and Objectives: Semaphorins are immunoregulatory proteins involved in inflammation and neurovascular modulation. Their roles in ischemic stroke pathogenesis and prognosis have recently gained attention. This study aimed to evaluate serum levels of semaphorin 3A, 3F, 4A, 4D, and 7A in patients with acute ischemic stroke and investigate their relationship with disease severity and prognosis. Materials and Methods: A total of 45 patients with acute ischemic stroke and 39 control individuals were enrolled. Serum semaphorin levels were measured using ELISA. Clinical data, including TOAST classification, NIHSS scores, and laboratory parameters, were recorded. Correlations between semaphorin levels and clinical or biochemical variables were analyzed statistically. Results: Semaphorin 4A levels were significantly lower and semaphorin 7A levels significantly higher in the patient group compared to controls (p < 0.001). Semaphorin 7A positively correlated with NIHSS scores (r = 0.390. p = 0.008). Semaphorin 3A and 4A levels showed significant correlations with inflammatory markers and lipid profiles. Semaphorin 3A was higher in female patients. No associations were found with TOAST subtypes or treatment modalities. Five (11.1%) patients died due to stroke-related complications, no significant differences in semaphorin levels were observed between survivors and non-survivors. Conclusions: Semaphorin 3A, 4A, and 7A levels may serve as potential biomarkers for inflammation and disease severity in acute ischemic stroke. Semaphorin 7A, in particular, showed strong prognostic value due to its association with stroke severity. These findings suggest that semaphorins could aid in clinical risk stratification and early intervention planning in ischemic stroke. Full article

Background: Hemorrhagic stroke (HS) accounts for approximately 30% of all stroke cases and has high mortality in the intensive care unit (ICU). The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients. Meanwhile, its dynamic prognostic value in ICU-admitted HS patients remains unclear. This study utilized Group-based Trajectory Modeling (GBTM) to investigate associations between early BUNCR patterns and mortality. Methods: This study was conducted using data from the MIMIC-IV (v2.2) database. HS cases were identified via ICD-9/10. BUNCR trajectories were assessed by applying GBTM during the first 7 days. Outcomes were all-cause mortality (ACM) on day 28, on day 90, and at 1 year, with ICU and in-hospital mortality also evaluated. Kaplan–Meier survival curves and log-rank test compared survival across groups. Multivariable Cox proportional models adjusted for confounders and subgroup analysis assessed robustness. Results: Among 2559 patients (52.48% male), mortality was 10.16% (ICU), 14.07% (in-hospital), 17.00% (28-day), 22.43% (90-day), and 36.97% (1-year). Three BUNCR trajectories were identified: Group 1 (upward–downward, n = 655), Group 2 (stable upward, n = 1270), and Group 3 (downward–upward, n = 634). Group 2 had the highest ACM risk at 28-day, 90-day, and 1-year (p < 0.01), and was identified as a significant risk factor in multivariate Cox regression. Subgroup revealed significant interactions of BUNCR trajectories with age and sepsis. Conclusions: Distinct BUNCR trajectories were significantly associated with ACM in critically ill HS patients. Persistently increasing BUNCR predicted the poorest outcomes, underscoring its potential as a dynamic biomarker for timely risk stratification and informed ICU decisions. Full article

Ischemic stroke remains a leading cause of mortality and long-term disability worldwide, with prognosis influenced by heterogeneous biological and neuroanatomical factors. In the past decade, numerous possible biomarkers—molecular, imaging, and electrophysiological—have been investigated to improve outcome prediction and guide rehabilitation strategies and main objectives. Among them, neurofilament light chain (NFL), a cytoskeletal protein released during neuroaxonal injury, has become an effective marker of the severity of the neurological condition and the integrity of the neurons. Additional circulating biomarkers, including thioredoxin, netrin-1, omentin-1, bilirubin, and others, have been linked to oxidative stress, angiogenesis, neuroprotection, and regenerative processes. Meanwhile, innovations in electrophysiology (EEG and TMS-based predictions) and neuroimaging (diffusion tensor imaging, corticospinal tract lesion load, and functional connectivity) add some additional perspectives on the possibility for brain recovery. This work is a narrative synthesizing evidence from PubMed, Scopus, and Web of Science between 2015 and 2025, including both clinical and experimental studies addressing stroke biomarkers and outcome prediction. The review outlines a framework for the integration of multimodal biomarkers to support precision medicine and individualized rehabilitation in stroke. Full article

Background/Objectives: The C-reactive protein-to-lymphocyte ratio (CLR) has emerged as an inflammatory biomarker reflecting innate and adaptive immune responses. Its prognostic value in acute ischemic stroke patients undergoing mechanical thrombectomy remains unclear. This study investigated whether CLR predicts functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH). Methods: In this multicenter retrospective study, 714 patients with anterior circulation large-vessel occlusion treated with mechanical thrombectomy between January 2024 and January 2025 were analyzed. Clinical, angiographic, and laboratory data, including CLR, were collected. CLR was calculated as CRP divided by lymphocyte count/1000. Outcomes were 90-day modified Rankin Scale (mRS; poor outcome = 3–6; mortality = 6) and sICH per ECASS II. Receiver operating characteristic (ROC) analyses identified optimal CLR cut-offs. Logistic regression analyses determined independent predictors of outcomes. Results: sICH occurred in 39 patients (5.5%). CLR correlated with higher baseline NIHSS and lower ASPECTS. ROC analyses showed that CLR predicted poor functional outcome and mortality with an identical cut-off (≥7.51; AUCs 0.634 and 0.664), and demonstrated strong discrimination for sICH (cut-off ≥ 10.64; AUC 0.855). In multivariable analyses, CLR remained an independent predictor across all outcomes (ORs 1.02, 1.02, and 1.03, all p < 0.001), in addition to established clinical factors. Conclusions: Admission CLR was independently associated with poor outcomes, mortality, and sICH after mechanical thrombectomy. As an easily obtainable marker from routine laboratory tests, CLR may provide additional prognostic information and complement established predictors, but prospective validation is required. Full article