Swallowing is regulated by cortical networks and the caudal brainstem. Damage to central pattern generators, commonly seen after stroke, can result in severe dysphagia with limited treatment options. Pharyngeal electrical stimulation (PES) presents a promising therapy as it may enhance sensory input to impaired brainstem networks by targeting pharyngeal sensory afferents, the primary site of dysfunction in brainstem infarction. This single-case study reports on a 78-year-old woman with a confirmed left-sided infarction in the dorsolateral medulla oblongata, resulting in severe dysphagia. PES was delivered 2 days after the onset of symptoms using the Phagenyx® system via a nasogastric catheter. The stimulation was applied at 5 Hz for 10 min daily over 4 days. The initial fiberoptic endoscopic evaluation of swallowing (FEES) showed severe dysphagia with saliva aspiration. Assessment revealed a Penetration-Aspiration-Scale (PAS) score of 8 for half a tablespoon of ice chips, alongside a score of 3 on Murray's Secretion Scale (MSS) and 7 on the New Zealand Secretion Scale (NZSS). No other consistencies were tested. After 4 consecutive days of stimulation followed by a 48-h period without stimulation, follow-up FEES revealed normal swallowing frequency and adequate saliva control, with a score of 0 on MSS. The patient safely swallowed all tested consistencies, scoring 1 on the PAS. On the NZSS, both fluids and solids scored 0. With pudding, residue in the pyriform fossae resulted in a score of 1. PES appears to be a targeted and effective approach for the treatment of severe dysphagia after brainstem stroke.
Background Despite abundant evidence linking hyperglycemia to stroke, its heterogeneous effects across stroke etiologies and lesions remain unclear. We examined the associations between admission glycated hemoglobin (HbA1c) levels and stroke subtypes, lesions, and functional outcomes. Methods Adults with acute ischemic stroke admitted between 2016 and 2020 were analyzed using a Japanese nationwide registry. Patients were grouped by admission HbA1c (<6.0%, 6.0–6.9%, 7.0–7.9%, and ≥ 8.0%). Stroke subtypes were determined using the Trial of Org 10,172 in Acute Stroke Treatment criteria. Lesion was categorized as cerebral cortex, basal ganglia/corona radiata, thalamus, brainstem, or cerebellum. Unfavorable outcome was defined as discharge modified Rankin Scale (mRS) >2 for patients with premorbid mRS ≤2, or higher discharge mRS than premorbid mRS for others. Associations were assessed using multivariable mixed-effects logistic regression analysis. Results Among 13,569 patients, HbA1c was <6.0% in 7001 (51.6%), 6.0–6.9% in 4201 (31.0%), 7.0–7.9% in 1264 (9.3%), and ≥ 8.0% in 1103 (8.1%). Higher HbA1c levels were associated with a greater proportion of large artery atherosclerosis (adjusted OR for HbA1c ≥8.0% vs <6.0%, 1.40; 95% CI, 1.19–1.65) and lower proportion of cardioembolism (0.63; 0.50–0.79). Elevated HbA1c levels were associated with higher prevalence of brainstem lesions (2.35; 1.82–3.02) and lower prevalence of cerebral cortex and basal ganglia/corona radiata lesions, even after adjusting for stroke subtype. Unfavorable outcomes were more common in patients with higher HbA1c levels (overall, 1.56; 1.31–1.85), particularly in those with large artery atherosclerosis and cardioembolism. Conclusions Higher admission HbA1c levels were associated with a higher proportion of large artery atherosclerosis and a lower proportion of cardioembolism, with a higher proportion of brainstem lesions and a lower proportion of cortical and basal ganglia/corona radiata lesions, and with worse functional outcomes.
Background:Stroke as the major cause of mortality and morbidity worldwide, requires early assessment of severity and prognosis for effective treatment. There is an emerging role of inflammatory markers in stroke severity. Thus, we aimed to determine the correlation of neutrophil to HDL-cholesterol ratio (NHR) and monocyte to HDL-cholesterol ratio (MHR) with the severity of acute ischemic stroke (AIS). Methodology:A single Centre cross-sectional study involving adult patients with AIS. Patients were grouped into mild and moderate-severe stroke by National Institute of Health Severity Scale (NIHSS). Demographic, clinical and laboratory data of participants were collected.Spearman correlation analysis, univariate and multiple logistic regression analysis were utilized to explore the correlation between MHR with AIS severity. A receiver operating characteristic curve was created to determine the discriminatory ability of MHR in assessing stroke severity. Results:Male gender, diabetes, hypertension, monocyte count, triglyceride, total cholesterol, CRP, uric acid and MHR were found statistically significant between the mild and moderate-severe stroke groups. Spearman correlation analysis produced a weak but statistically significant positive correlation between MHR and NIHSS score with a correlation coefficient of 0.201 (P = 0.026). Binary logistic regression analysis demonstrated that MHR had statistically insignificant positive association with higher NIHSS scores (OR = 2.275, 95% CI: 0.924-5.6, p = 0.074). Multiple logistic regression analysis revealed that MHR was not independently associated with stroke severity scale (adjusted OR = 1.527, 95% CI: 0.559-4.173, p = 0.409). The area under the curve (AUC) for MHR association with AIS was 0.588 (95% CI: 0.485-0.691, p = 0.101) with specificity of 87.5% and sensitivity of 40.5%. Conclusion:MHR could serve as a new, readily accessible and inexpensive indicator of the severity of AIS.
Cognitive decline with age and other clinical conditions are linked with reduced hypothalamic-pituitary-adrenal (HPA) axis function. Stimulating the HPA axis with supplemental growth hormone (GH) treatment can improve cognition, however, potential direct effects of stimulation with growth hormone releasing hormone (GHRH) are not established. In a double-blind, placebo-controlled pilot trial, we assessed 22 subjects with baseline cognition ranging from normal cognition to mild cognitive impairment before and after 10 weeks of treatment with low-dose tesamorelin (1 mg; GHRH analog) or placebo. We compared groupwise changes in body composition, fatigue, sleep, physical performance, glucose tolerance, cognitive function, and brain morphometry and functional connectivity. Low-dose GHRH treatment was not directly linked with significant changes in study measures. Using advanced machine learning (ML) models to further examine the data we identified potential treatment-related differences in areas of the brain related to cognitive function including the right anterior cingulate and left superior frontal occipital fasciculus. This pilot study highlights the potential benefits of pairing cognitive tests and neuroimaging with ML tools to achieve greater sensitivity for treatment-related effects. The clinical trial registration number is: NCT02553603.
Background:Atrial fibrillation (AF) is the most common cardiac rhythm disturbances associated with increased risks of mortality. Oral anticoagulant (OAC) reduces AF-related strokes. However, the pattern of OAC use among AF patients is unknown in Ethiopia. This study evaluated the appropriateness of OAC therapy and associated factors among hospitalized AF patients. Methods:A retrospective cross-sectional study was conducted among AF patients hospitalized in medical ward of Adigrat general hospital. Previously validated CHA2DS2-VASc and HAS-BLED scores were used to predict risk of stroke and bleeding, respectively. Multivariate logistic regression was used to identify factors associated with OAC therapy. Data was analyzed using Statistical Package for Social Sciences, setting p-value < 0.05 as a statistically significant. Results:Of the total 84 AF patients, more than half (52.4%) were females and their median age was 64.50 (75-39.5). About 42.9 and 31.0% of the patients were at high risks of stroke and bleeding, respectively. Thirty seven (44.0%) of the patients received no antithrombotics and almost half (48.8%) of them were not prescribed OAC. On the other hand, 51.2% of patients received OAC containing regimen, 40.5% were prescribed with OAC monotherapy and 4.8% received aspirin monotherapy. Among patients at high risk of stroke, 36.1% of them received no antithrombotic drug. Regarding risk of bleeding, the prescription of OAC containing regimen among patients at high risk of bleeding was lower than in those at low risk of bleeding (41.9% versus 56.6%). Almost two third (61.9%) of AF patients were prescribed inappropriately, dominantly being underprescribed (44.0%). Admission time for AF was significantly associated (p < 0.001) with prescription of OAC (Adjusted Odds ratio = 6.587, CI: 2.273 - 19.091 ) . Conclusions:Substantial proportions of AF patients at high risk of stroke were inappropriately prescribed with OACs. Inappropriate prescription was characterized by underprescription. The cardiologists of the hospital should follow AF guidelines to improve prescription patterns with an ultimate goal of improving treatment outcomes.
Spinal cord injury (SCI) presents formidable challenges, with current regenerative treatments such as stem cell therapy and spinal stimulation showing inconsistent results in clinical trials. Advances in understanding the pathophysiology of SCI have directed regenerative strategies toward reducing inflammation and promoting angiogenesis. Hyperbaric oxygen therapy (HBOT), typically applied in pulmonary and dermatological contexts, emerges as a promising off-label treatment for SCI. This manuscript examines HBOT's mechanisms, clinical considerations, and outcomes in SCI, emphasizing its potential to enhance oxygenation, stimulate angiogenesis, reduce inflammation, and modify gene expression. Although further research is required to validate its efficacy fully, our analysis indicates that HBOT could significantly improve motor and sensory recovery in SCI patients, positioning it as a valuable therapeutic option.
Background:Despite major advances in acute stroke therapy, particularly mechanical thrombectomy (MT) for large-vessel occlusion, predicting outcomes in acute ischemic stroke (AIS) remains challenging. Secondary injury mechanisms such as neuroinflammation and neuronal damage contribute substantially to poor recovery, yet are insufficiently captured by clinical and imaging models alone. Interleukin-6 (IL-6) and neuron-specific enolase (NSE) represent complementary biomarkers of these processes, but their combined and serial prognostic value in MT-treated patients has not been fully defined. Aim:To evaluate the prognostic significance of serial plasma IL-6 and NSE measurements for predicting stroke severity, complications, and functional recovery in AIS patients undergoing MT. Methods:In this prospective study, 70 patients with AIS due to large-vessel occlusion treated with MT were enrolled. IL-6 and NSE were measured on Day1 and Days7-10. Associations with neurological severity (NIHSS), hemorrhagic transformation, and functional outcome (mRS) were analyzed. Multivariate linear regression and hierarchical logistic regression models were used to assess the incremental prognostic value of biomarkers beyond established clinical predictors. Results:Higher IL-6 and NSE levels were associated with greater neurological severity, unfavorable functional outcomes, and hemorrhagic transformation at both time points. NSE showed moderate correlations with NIHSS and mRS (R2 = 0.19-0.23). In multivariable models, IL-6 and NIHSS independently predicted mRS at discharge. Serial IL-6 measurements significantly improved prediction of unfavorable outcome beyond NIHSS alone, increasing the AUC from 0.847 to 0.914 in the fully adjusted model (ΔAUC = +0.067, p < 0.001), whereas NSE provided complementary biological information on neuronal injury. Conclusion:Serial assessment of IL-6 and NSE offers clinically meaningful insight into inflammatory and neurodestructive mechanisms that influence recovery after AIS treated with MT. In particular, dynamic IL-6 measurements provide measurable incremental prognostic value beyond baseline neurological severity, supporting their integration into multimodal risk-stratification strategies for personalized post-stroke management.
Background:Hereditary transthyretin amyloidosis (ATTRv) is a systemic disorder that may mimic motor neuron disease (MND), leading to misdiagnosis and delayed access to disease-modifying therapies. Case report:We report the first genetically confirmed case of ATTRv mimicking amyotrophic lateral sclerosis (ALS) in Saudi Arabia. A 47-year-old male presented with progressive right-sided limb weakness (proximal > distal) and dysarthria over 18 months. Neurological examination revealed fasciculations, distal atrophy, and brisk reflexes with normal muscle tone and no spasticity. Electrophysiological studies demonstrated a length-dependent sensorimotor axonal neuropathy with widespread denervation changes involving bulbar, cervical, and lumbosacral regions. Brain and spine MRI, along with whole-body CT, excluded structural or paraneoplastic causes. Genetic testing identified a pathogenic heterozygous variant in the TTR gene: NM_000371.4:c.424G > A (p.Val142Ile). Transthoracic echocardiography revealed mild concentric left ventricular hypertrophy. There was no clinical evidence of autonomic, renal, or ocular involvement. Discussion:This case underscores the importance of considering ATTRv in patients presenting with atypical MND, particularly when clinically significant sensory symptoms, absent upper motor neuron signs, or unexplained cardiac abnormalities are present. Early diagnosis enables access to targeted therapies such as TTR stabilizers and gene-silencing agents, which can alter disease trajectory.
Introduction Training in LMICs for hyperacute stroke relies on didactic methods. This study describes the development and evaluates the impact of a high-fidelity simulation-based interprofessional stroke code training course in Pakistan, aiming to improve teamwork, communication, and clinical decision-making. Methods A quasi-experimental mixed-methods study was conducted at Aga Khan University (AKU) in September 2024. Participants encountering hyperacute stroke participated across Pakistan. A total of 25 participants completed this national-level course across 5 stroke centers. Results Statistical analysis revealed significant improvements in self-efficacy scores across all tasks, except for manage uncontrolled high blood pressures in patients receiving TPA (p = 0.05583). Notable gains were observed in areas such as interdepartmental communication, prioritizing hyperacute stroke cases during triage and code activation, accurate ASPECT and NIHSS calculation, execution of the hyperacute stroke algorithm and assessment of r-tPA eligibility (p < 0.001).Questionnaire results demonstrated enhancements across all three learning domains cognitive, affective, and psychomotor with individual learning objectives showing improvements ranging from 25% to 40%.Qualitative analysis highlighted key challenges, including the absence of standardized stroke pathways, lack of adherence to evidence-based practices, and delays in patient arrival and workflow efficiency. Participants underscored the need for structured training programs, improved interdepartmental coordination, and the creation of algorithmic workflows. Conclusion This study demonstrates that high-fidelity simulation-based training enhances stroke code management skills among healthcare professionals in LMICs. Implementing structured, team-based simulation programs can improve acute stroke care and patient outcomes, thereby improving and streamlining workflows.
Listeria infections are uncommon in our clinical practice and often overlooked as a differential diagnosis. It is also difficult to uncover due to presentation with a variety of non-specific clinical signs and symptoms, that could mimic other conditions. In our case report, we discuss a rare and challenging case of a middle-aged alcoholic man with Listeriosis affecting the rhombencephalon. He presented with non-specific symptoms, including agitation and confusion, preceded by flu-like illness. These were accompanied by seizures and fever in hospital, as well as intermittently changing neurological deficits. Although his symptoms were put down to alcohol withdrawal initially, the timely identification of Listeria monocytogenes in blood cultures could aid to point towards the correct diagnosis and hence prompt a lifesaving treatment. It was later confirmed with MRI imaging of the brain, showing inflammation around the brainstem. Lumbar puncture results were also alluding to a meningoencephalitis picture. Despite the high mortality rate, our patient survived and was discharged from hospital six weeks after the initial admission. We will compare our case with other case reports from the literature. Finally, the discussion will highlight the importance of considering Listeria when treating possible encephalitis/ meningitis in patients at risk.
Spastic paraplegia type 79 (SPG79) is a rare form of hereditary spastic paraplegia caused by variants in ubiquitin C-terminal hydrolase L1 (UCHL1). SPG79B, an early-onset autosomal recessive subtype, frequently presents with lower motor neuron involvement, with myokymia as a characteristic feature. In contrast, SPG79A, a late-onset autosomal dominant form, rarely shows lower motor neuron signs, and myokymia has not previously been reported. We report the first documented case of myokymia in SPG79A.A 74-year-old man with an 8-year history of progressive gait disturbance underwent detailed evaluation.The patient exhibited slowly progressive spastic paraplegia and impaired proprioception in the lower extremities. Myokymia was observed in the extremities and trunk. Needle electromyography revealed spontaneous, repetitive discharges of motor unit potentials consistent with myokymia. Genetic testing identified a heterozygous nonsense variant in UCHL1 (c.532C > T: p. Arg178*), confirming a diagnosis of SPG79A.The pathogenesis of both SPG79A and SPG79B likely involves partial loss of UCHL1 function, explaining their overlapping phenotypes. Symptom variability may reflect the extent of residual UCHL1 function, with SPG79B showing broader features, including myokymia. This case suggests that myokymia, though rare in hereditary spastic paraplegias, can also occur in SPG79A and may serve as a diagnostic clue.
Background:Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms that substantially affect quality of life (QoL). While dopaminergic dysfunction is central to PD pathology, the cross-sectional relationship between striatal dopaminergic activity and clinical outcomes remains incompletely understood. This study investigated associations between dopaminergic activity, measured via DATSCAN imaging, and clinical outcomes including cognitive performance, mobility, and QoL. Methods:In this cross-sectional observational study, PD patients (n = 146; age 37.9-85.6 years) and healthy controls (n = 37; age 32.2-86.7 years) were evaluated. Cognitive and communication-related QoL were assessed using Neuro-QoL, motor and non-motor symptoms were quantified with MDS-UPDRS, and cognitive performance was measured using COGSTATE and derived indices (COGDECLN, COGCHG). DATSCAN imaging quantified striatal dopaminergic activity in the caudate and putamen. Correlations between DATSCAN metrics and clinical outcomes were analyzed, accounting for multiple comparisons. Results:DATSCAN metrics showed no significant associations with cognitive performance or QoL, and only modest correlations with mobility measures. Sensitivity analyses confirmed robustness of these findings. The limited predictive value of DATSCAN underscores the complexity of PD, including contributions of non-dopaminergic mechanisms. Conclusions:Although DATSCAN is valuable for confirming PD diagnosis, its ability to predict clinical outcomes such as cognition, QoL, or motor complications is limited. These results highlight the multifactorial nature of PD and the need to integrate dopaminergic imaging with comprehensive clinical assessments for personalized patient care.
Background Multiple sclerosis is a chronic, inflammatory, autoimmune disease of the central nervous system. Accumulating neurological disability has a substantial impact on the lives of patients with MS. The Expanded Disability Status Scale is a method of quantifying disability in MS. Objective The aim of this study was to analyze the disability trajectory across years of patients living with MS seen at the Neurological Institute and to explore factors associated with the rate of change per year. Methods A single-center study was conducted at the Neurological Institute located in the city of Medellin based on medical records obtained from 2013 to 2021. The clinical and demographic characteristics were analyzed using descriptive statistics. To recognize changes in the rate of increase in disability measured by the EDSS with increasing time lived with the disease, a polynomial model was used. Results Disability measured by the EDSS was not linear over time, there were times when disability progressed more rapidly and other times when it was slower. The bivariate model showed that variables such as gait medications and botulinum toxin had the highest beta values; however, the multivariate model showed that clinical and sociodemographic variables such as initial cerebellar symptoms and sex had the highest significant beta values. Conclusion This type of study facilitates predictions of natural history within the risk scheme. Prognostic models for chronic diseases are needed to guide management decisions and counseling of patients and their families. Such models can consider outcomes ranging from response to treatment to changes in disability.
Background:Headache with papilledema is a critical neurological symptom that necessitates prompt evaluation for underlying central nervous system pathology. While often associated with conditions such as aneurysmal subarachnoid hemorrhage, hypertensive emergencies can also present with similar features and require immediate management to prevent end-organ damage. Case presentation:A 41-year-old man with no significant medical history presented with acute severe headache, vomiting, and blurred vision in the left eye. His blood pressure was markedly elevated at 200/130 mmHg. Fundoscopic examination revealed optic disc swelling, flame-shaped hemorrhages, and exudates in both eyes. Brain MRI demonstrated asymmetric hyperintensities in the brainstem, consistent with hypertensive brainstem encephalopathy (HBE). Lumbar puncture revealed elevated intracranial pressure without evidence of infection or hemorrhage. Blood pressure control with intravenous calcium channel blockers resulted in rapid symptom resolution, and subsequent antihypertensive therapy led to complete recovery of brainstem lesions and significant improvement in papilledema. Conclusion:HBE can present with severe headache and papilledema but minimal neurological deficits despite striking MRI abnormalities. Early recognition through neuroimaging and prompt blood pressure management are crucial in preventing irreversible damage and optimizing patient outcomes.
Background: Limited data exists on long-term stroke trends in low- and middle-income countries, including Pakistan, despite its growing burden. Understanding these trends is crucial for informing healthcare strategies and public health interventions. This study examines 20-year trends in stroke characteristics, risk factors, and mortality at a tertiary care center in Pakistan. Methods: In this retrospective study, a secondary analysis was conducted using clinically digitized records from the Aga Khan University Hospital. Patients aged ≥18 years, admitted with stroke, and discharged between January 1, 1999, and December 31, 2018, were included. Stroke subtypes were classified using ICD-9 CM codes as ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) and cross checked against discharge diagnosis and neuroimaging reports to validate case identification. The retrospective, single-center design and possible variability in coding accuracy should be considered limitations when interpreting results. Results: The final cohort included 12,837 patients: 71.4 % ischemic stroke, 21.2 % ICH, and 7.4 % TIA. The median age was 62 years (IQR: 52–70). Stroke admissions rose over time (n = 1975 in 1999–2002 vs. n = 3829 in 2015–2018). Stroke prevalence increased among patients aged 18–40 (p = 0.005) and > 80 (p = 0.002). Risk factors including hypertension, diabetes, atrial fibrillation, smoking, and carotid artery stenosis rose significantly (all p < 0.001). The most frequent comorbidity cluster was hypertension and diabetes (26.3 %), followed by hypertension, diabetes, and dyslipidemia (5.6 %). Unadjusted in-hospital mortality was 9.1 %, declining from 10.4 % to 9.1 % (p = 0.022), primarily due to decreased ICH mortality (24.1 % to 16.4 %, p < 0.001). Mortality predictors included age > 80 (OR 1.70), ICH (OR 3.21), early admission years, complicated diabetes, atrial fibrillation, and multiple comorbidities. Conclusion: Stroke patterns are shifting toward younger age and greater risk factor clustering, though in-hospital mortality has declined. Continued surveillance and targeted interventions are essential.
We report neuroimaging findings from a 74-year-old right-handed male with Alzheimer’s disease (AD) and lesions of cerebral amyloid angiopathy (CAA), utilizing 11C-PiB-PET, 18F-THK5351-PET, and 18F-MK-6240-PET. 11C-PiB-PET showed positive findings consistent with AD. 18F-THK5351 accumulated in regions of astrogliosis due to tau pathology, subcortical hemorrhage, cortical superficial siderosis (cSS), and monoamine oxidase-B rich areas. 18F-MK-6240 accumulated in regions with tau pathology, subcortical hemorrhage, and cSS, but not notably in CAA-related microbleeds (CMBs). 99mTc-ECD SPECT, conducted 9 years post-diagnosis, revealed reduced cerebral blood flow in the bilateral lower temporal lobes and the right posterior temporo-parietal lobes, overlapping the subcortical hemorrhage and cSS. The patient exhibited progression of global cognitive decline and persistent word fluency deficits (name listing) on neuropsychological examination from the early stage of the disease, irrespective of the right hemorrhagic lesions in the non-dominant hemisphere, suggesting possible crossed aphasia. This is the first report of 18F-MK-6240 binding to a subcortical hemorrhage and cSS lesions, highlighting its binding differences compared to smaller vascular leakages, such as CMBs due to CAA. These results may help refine PET imaging interpretation and diagnostic accuracy for AD with concurrent CAA.
Background:Fatigue is a prevalent and disabling consequence of ischemic stroke in young adults, yet its multifactorial nature and impact on recovery remain underexplored. This study investigates predictors of post-stroke fatigue and association with return to work (RTW) and other variables at a one-year follow-up (1y-FU) after ischemic stroke. Methods:We analysed data from 130 patients aged 15-49 years with MRI-confirmed acute ischemic stroke enrolled in the Norwegian Stroke in Young Study II. Fatigue and cognitive symptoms were assessed using standardized self-report and clinical evaluations at 1y-FU. Multivariable logistic regression identified independent predictors of persistent fatigue, adjusting for age, sex, and stroke severity. Results:At 1y-FU, 50 % of patients reported persistent fatigue. Fatigue was independently associated with failure to RTW (OR 3.2, 95 % CI 1.8-5.6), migraine without aura (OR 2.1, 95 % CI 1.3-3.4), hearing difficulties (OR 2.0, 95 % CI 1.1-3.8), concentration problems (OR 2.4, 95 % CI 1.5-4.0), and pain (OR 2.6, 95 % CI 1.5-4.5). Patients with resolved fatigue were significantly more likely to RTW (65.9 %) compared to those with persistent symptoms (34.2 %, p < 0.001). Cognitive impairment at admission was common (45.9 %), and among these patients, 52.2 % reported persistent deficits at 1y-FU. Fatigue severity was not associated with educational attainment but increased with age and NIHSS score. Conclusions:Fatigue affects half of young ischemic stroke survivors after 1 year, substantially hindering RTW. Novel associations with migraine, hearing and cognitive deficits, and pain suggest underrecognized contributors that may be amenable to individually targeted rehabilitation. Integration of fatigue management into early stroke rehabilitation programs, with a focus on cognitive, sensory, and pain-related domains, may help optimize vocational and functional outcomes.
•Postpartum stroke can reveal an underlying autoimmune disease.•Coexistence of lupus and Takayasu arteritis is rare.•Small/medium- and large-vessel vasculitis increases vascular risk.•Immunosuppressive therapy led to clinical and radiological improvement.•Early recognition of dual autoimmune vasculitis prevents severe complications.
