Cervical artery diseases, encompassing both atherosclerotic and non-atherosclerotic disorders of the carotid and vertebral arteries, remain a major cause of ischemic stroke and transient ischemic attack (TIA) worldwide. Although luminal stenosis has traditionally guided diagnostic and therapeutic decision-making, recent advances have shifted the focus toward comprehensive vascular assessment, incorporating plaque vulnerability, vessel wall pathology, inflammatory activity, and individualized cerebrovascular risk stratification. Simultaneously, substantial progress in multimodal vascular imaging, intensive medical therapy, carotid revascularization techniques, and endovascular interventions has transformed the contemporary management of cervical artery disease. This review provides a comprehensive and clinically oriented overview of the diagnosis and management of extracranial carotid and vertebral artery diseases, including both atherosclerotic and non-atherosclerotic etiologies such as cervical artery dissection, fibromuscular dysplasia, and large-vessel vasculitides. Current evidence regarding clinical presentation, screening strategies, physical examination, multimodal imaging, optimal medical therapy, carotid endarterectomy, carotid artery stenting, and endovascular treatment is critically reviewed in light of the most recent international guidelines and landmark clinical trials. Particular emphasis is placed on emerging concepts including vulnerable plaque imaging, high-resolution vessel wall magnetic resonance imaging, advanced computed tomography techniques, and evolving imaging biomarkers that facilitate personalized risk assessment and treatment selection. Future perspectives regarding artificial intelligence, radiomics, quantitative plaque characterization, and precision cerebrovascular medicine are also discussed. By integrating current evidence with practical clinical decision-making, this review aims to provide clinicians with an updated framework for the diagnosis, risk stratification, and evidence-based management of cervical artery diseases while highlighting evolving directions that are expected to shape future stroke prevention strategies.
Objective: The aim of this study was to evaluate the association of various inflammatory parameters with early neurologic damage and three-month functional outcomes in patients with acute distal middle cerebral artery (MCA) occlusion who received intravenous thrombolytic treatment (IV tPA). Materials and Methods: This retrospective exploratory study included 75 patients who underwent IV tPA for distal MCA infarction and had complete clinical and laboratory data. Inflammatory indices were calculated from blood parameters at admission, early neurologic status was assessed using the National Institutes of Health Stroke Scale (NIHSS), and three-month functional status was assessed using the Modified Rankin Score (mRS). Results: Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI) and Neutrophil-to-Albumin Ratio (NAR) were positively correlated with mRS in univariate analyses. The NAR also showed an association with the NIHSS score at presentation and demonstrated modest discrimination for the mRS 3-6 group on ROC analysis (AUC=0.694). In multivariable logistic regression adjusted for baseline clinical confounders and onset-to-needle time, the inflammatory indices lost their independent predictive significance, while admission NIHSS remained the strongest independent predictor. Conclusions: While indices such as SII, SIRI and NAR show potential preliminary associations with early neurologic damage and unadjusted three-month functional outcomes in patients with distal MCA infarction treated with IV tPA, they do not carry robust independent prognostic value beyond initial clinical severity. Admission NIHSS remains the most critical predictor of clinical course.
Objective: Describe the clinical presentation, diagnostic challenges, and surgical management of Bow Hunter’s Syndrome, detailing the operative strategy, technical considerations, and postoperative outcomes associated with decompressing the mechanically compressed vertebral artery. Case Presentation. A 41-years-old man with a history of multiple cervical injections presented with an eleven-month history of gait disturbance and chronic vertigo, exclusively induced by rightward head rotation and relieved in the neutral position. Neurological examination was largely unremarkable aside from features consistent with vertebrobasilar insufficiency. Dynamic angiography demonstrated an >80% reduction in the caliber of the left vertebral artery during contralateral head rotation. Surgical decompression was thererefore indicated. Intraoperatively, several fibrous bands compressing the vertebral artery were identified and resected, and the C1 transverse foramen was enlarged to achieve complete decompression. Postoperatively the patient experienced an uneventful recovery, with full resolution of symptoms and imaging confirming adequate decompression. Conclusion: Prior cervical interventions may predispose to the development of fibrous adhesions and should be considered during etiologic assessment. Surgical decompression can provide definitive symptom resolution in patients with refractory or disabling dynamic vertebrobasilar insufficiency.
Objective: Stress hyperglycemia reflects the neuroendocrine stress response of the body during acute illness, independent of chronic glycemic status. This study aimed to evaluate the association between the stress hyperglycemia ratio (SHR) and clinical outcomes in patients with cerebral venous thrombosis (CVT). Methods: A total of 72 adult patients diagnosed with cerebral venous thrombosis (CVT) were retrospectively analyzed. The stress hyperglycemia ratio (SHR) was calculated as the ratio of admission plasma glucose to estimated average glucose (eAG). Variables between groups were compared using the chi-square test and Mann–Whitney U test, as appropriate. Receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analyses were performed to evaluate the prognostic significance of SHR. Results: Of the patients, 61.1% (n=44) were female, and the median age was 38.0 years (IQR: 32.0–47.2). Acute onset and hemorrhagic transformation were significantly more frequent in patients with poor outcomes (p=0.016 and p=0.029, respectively). SHR and admission glucose levels were significantly higher in the poor outcome group (p<0.001). ROC analysis demonstrated that SHR had a high predictive value for poor outcomes (AUC: 0.895; 95% CI: 0.810–0.981), with an optimal cut-off value of 1.30, yielding a sensitivity of 95.5% and a specificity of 80.0%. Multivariable logistic regression analyses demonstrated that both SHR and admission glucose were independently associated with poor clinical outcomes. Conclusion: This study suggests that the stress hyperglycemia ratio (SHR) may be associated with poor clinical outcomes in patients with CVT. These findings indicate that SHR could have potential prognostic relevance not only in arterial stroke but also in cerebrovascular diseases of venous origin.
Fibrocartilaginous embolism (FCE) is a rare and highly morbid cause of spinal cord infarction. Diagnosis can be difficult in the absence of predisposing factors. Treatment is controversial. The probable mechanism is retrograde embolism of nucleus pulposus material into the arterial system of the spinal cord. A previously healthy 70-year-old male patient presented to our emergency department with neck and back pain that started 24 hours after carrying firewood, followed by sudden quadriparesis. The patient’s clinical findings and neuroimaging results were consistent with spinal cord ischemia secondary to acute vertebral disc herniation at the C4-5 level (extending between C5-8). Laboratory investigations revealed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. After ruling out other possible diagnoses, he was diagnosed with spinal cord ischemia secondary to fibrocartilaginous embolism. We wanted to present this rare phenomenon, which often goes undiagnosed unless it’s considered.
Hematoma expansion (HE) is defined as an increase in intracerebral hemorrhage volume on serial neuroimaging during the acute phase and occurs in approximately 20% of patients with spontaneous intracerebral hemorrhage (ICH). HE is associated with early neurological deterioration and worse functional outcome and has therefore been studied as a potential therapeutic target. Identification of patients at higher risk of expansion may inform clinical monitoring strategies and the design of interventional trials. This narrative review summarizes imaging markers that have been evaluated for predicting HE, with emphasis on noncontrast computed tomography (NCCT) signs described over the past decade. We review commonly used definitions of HE and the pathophysiological rationale underlying density-based markers (hypodensities, blend sign, black hole sign, swirl sign) and shape-based markers (island sign, satellite sign, irregular hematoma shape), as well as the CT angiography spot sign. We also outline integrated prediction models and emerging approaches using radiomics and machine-learning techniques.
Background: Serum albumin and albumin based immunonutritional indices have been investigated as prognostic and/or risk factors in various vascular diseases. Based on this evidence, we aimed to evaluate their potential contribution to predicting stroke recurrence. Methods: Albumin, Prognostic Nutritional Index (PNI), and C-Reactive Protein–Albumin–Lymphocyte (CALLY) indices were analyzed in 963 patients retrospectively to assess differences for recurrence in 2 year median follow-up. Logistic regression were constructed in three models, and cox regression analysis was also performed to assess temporal effect. Results: Albumin (p = .002) and PNI (p = .032) were significantly associated with recurrence in comparative analyses. In logistic regression lower albumin quartiles—even within the normal range—were associated with recurrence (Q1≤3.7 g/dL: OR=2.36, 95%CI=1.27–4.38, p=.007; Q2=3.71–4.0 g/dL: OR=2.13, 95%CI=1.12–4.03, p=.021). After adjustment for other biochemical markers (free T4, potassium, uric acid), albumin retained its significance (Q1: OR=2.05, 95%CI=1.09–3.87; Q2: OR=2.00, 95%CI=1.05–3.83). However, when major clinical predictors (previous stroke and adherence to antithrombotic therapy) were added to the model, this statistical significance was lost. In Cox regression, previous stroke was the only variable that remained associated with recurrence. Discussion and Conclusion: Albumin may represent a more stable indicator of nutritional risk compared with PNI and CALLY, which are potentially more susceptible to fluctuations driven by lymphocyte count or inflammation. Although malnutrition risk may contribute to recurrence, the predictive value of albumin does not exceed that of major clinical determinants. Therefore, albumin may serve as a complementary risk marker in secondary stroke prevention but is unlikely to function as an independent predictor.
Background: Intravenous thrombolysis (IVT) is essential for the treatment of ischemic stroke (IS). The objective of the study was to identify reasons and predictors associated with No-IVT in patients with IS. Methods: Observational, cross-sectional, retrospective and analytical cohort study of consecutive patients with suspected EVCI in an advanced stroke center. Kolmogorov-Smirnov normality test, median, interquartile range, non-parametric Kruskal-Wallis test for quantitative variables and frequencies, percentages and Chi2 in qualitative variables. Univariate and multivariate analysis in binary logistic regression for variables with P9h (onset of symptoms-door>9h) (21.7%), non-disabling minor IS (NDMIS) (12 .01%), ASPECTS 4.5h (OR: 3.8179, p
Background: Aneurysmal subarachnoid hemorrhage (aSAH), a life-threatening neurological emergency, is characterized by blood accumulation in the subarachnoid space due to the rupture of an aneurysm. In this study, we investigated the effect of the Prognostic Nutritional Index on the prognosis and quality of life in patients with aneurysmal subarachnoid hemorrhage. Methods: A total of 126 aSAH patients who underwent endovascular treatment at the Stroke Center of Dicle University, Department of Neurology between January 1, 2020, and January 1, 2024, were included. After excluding 2 patients with chronic kidney failure, 1 with malignancy, 1 with a procedure-related complication, and 8 due to early mortality, 114 patients were included in the study. Results: As a result of our study, a relationship was found between preoperative and postoperative 72-hour PNI values and functional status. Additionally, a relationship was identified between postoperative 72-hour PNI values and mortality as well as infection. In our study, multivariable logistic regression analysis was used to evaluate the relationship between postoperative 72-hour PNI values and mortality. Postoperative 72-hour PNI was found to have a statistically significant relationship with the SF-36 energy subscale (p = 0.007). Discussion and Conclusion: Albumin and lymphocyte values used to calculate PNI can be utilized to predict prognosis in patients with aSAH. The simplicity, low cost, and non-invasive nature of PNI calculation make it a clinically valuable tool.
Introduction: The global disruption to healthcare systems caused by the pandemic has had a particular impact on time-sensitive emergencies such as acute ischaemic stroke. This study aimed to evaluate the impact of the pandemic on the pre-hospital and hospital management of acute ischemic stroke patients receiving recanalisation therapies. Methods: This single-center retrospective study compared 227 pre-pandemic (2019–2020) and 206 pandemic-era (2020–2021) AIS patients treated with intravenous thrombolysis (IV rt-PA) or mechanical thrombectomy (MT). Data included demographics, time metrics (e.g., onset-to-door, door-to-needle), NIHSS/mRS scores, and outcomes. Results: A total of 433 patients were included in the study; 227 were treated pre-pandemic, and 206 were treated during the pandemic. No significant differences were found in the demographic characteristics of the patients in the two periods. During the pandemic, we observed a decline in MT referrals from other centres, as well as a shift in ambulance usage patterns. Among IV rtPA patients, EMS dispatch time decreased while scene and hospital delivery times increased (P<.01). Door-to-CT and door-to-needle times were prolonged in both groups during the pandemic (P<.05). The proportion of patients receiving IV rtPA within the 0–3-hour window remained stable. NIHSS scores at admission increased significantly in the MT group (P=.005). Functional outcomes and mortality worsened significantly in the IV rtPA group during the pandemic (P<.05), whereas outcomes in the MT group remained unchanged. Discussion and Conclusion: The negative impact of the pandemic on several components of acute ischaemic stroke care, particularly prehospital timelines and emergency department efficiency in cases involving IV rtPA, contributed to poorer functional outcomes. These findings emphasise the importance of maintaining stroke care pathways and preparedness strategies during public health emergencies.
Recent advances in acute ischemic stroke management have led to significant updates in clinical practice guidelines. The 2026 AHA/ASA guideline introduces important changes in prehospital organization, reperfusion strategies, and early in-hospital management. System-level improvements, including mobile stroke units and regional stroke networks, are emphasized to reduce treatment delays and optimize patient outcomes. In reperfusion therapy, updated recommendations expand the use of intravenous thrombolysis and mechanical thrombectomy, with greater reliance on imaging-based patient selection, particularly in extended time windows. The guideline also highlights the importance of rapid decision-making, streamlined workflows, and avoidance of unnecessary delays in treatment initiation. These updates reflect a shift toward individualized, time-sensitive, and system-oriented stroke care. This review summarizes the key changes and discusses their implications for daily clinical practice.
Background: Bee stings usually cause local reactions, whereas ischemic stroke is a rare complication. We report a case of large vessel occlusion due to internal carotid artery instent thrombosis shortly after a bee sting in the absence of anaphylaxis. Case Presentation: A 77-year-old man who had undergone left internal carotid artery stenting 15 days earlier developed sudden right hemiplegia and aphasia 30 minutes after a bee sting. Neurological examination revealed an NIHSS score of 20. Imaging demonstrated occlusion of the left internal carotid artery stent and a large left hemispheric infarct. Mechanical thrombectomy was performed 300 minutes after symptom onset. Balloon angioplasty and repeat aspiration were required. The patient was discharged with a favorable functional outcome (mRS 2 at 3 months). Conclusion: Acute ischemic stroke should be considered in patients presenting with neurological deficits after a bee sting. In those with recently implanted vascular stents, early stent thrombosis may represent the underlying mechanism.
Vertebrovertebral arteriovenous fistulas are relatively rare vascular lesions that can be treated with endovascular approach. We present a 9-year-old girl with a large cervical vertebral artery arteriovenous fistula causing arterial steal. The fistula was treated with combined percutaneous, arterial and venous routes using Woven EndoBridge (WEB) device assisted liquid embolization. The fistula was occluded completely with patent vertebral artery. The child remained neurologically intact during the early postoperative period and clinical follow-up. On control digital subtraction angiography, there was no residual fistula and both vertebral arteries were patent. WEB was originally designed as an intrasaccular flow disruptor device for the endovascular embolization of wide-necked intracranial aneurysms however this device can be used during treatment of arteriovenous fistulas and malformations.
Background: No prior research has determined whether brainstem white matter hyperintensities (b-WMHs) are associated with first-ever stroke. This study aims to investigate whether b-WMHs can predict first-ever stroke. Methods: This was a retrospective study. Clinical records and magnetic resonance imaging (MRI) scans reviewed to identify patients with and without brainstem white matter hyperintensities (b-WMHs). A total of 180 individuals with b-WMHs and no prior history of stroke, and 205 individuals without b-WMHs, were included. Stroke incidence within a three‑year observation window was determined retrospectively from medical records and confirmed by neuroimaging, following American Heart Association/American Stroke Association (AHA/ASA) guidelines. Predictors of stroke were evaluated using Cox regression analysis. Results: Within the three‑year observation window, 37 patients (9.6%) experienced a first‑ever stroke, 40.5% in the anterior circulation and 59.5% in the posterior circulation. Stroke incidence was significantly higher among patients with b‑WMHs (13%) compared with those without (6%) (OR, 2.27; 95% CI, 1.12–4.61; P=0.02). In multivariable Cox regression analysis, stroke occurrence was independently associated with hypertension (HR, 5.39; P<0.001), diabetes mellitus (HR, 4.39; P=0.007), hyperhomocysteinemia (HR, 2.66; P=0.004), and atrial fibrillation (HR, 3.00; P<0.01). The association between b‑WMHs and stroke remained significant after adjustment for age, sex, and supratentorial WMHs (s‑WMHs), but lost statistical significance when additional vascular risk factors were included. Conclusion: Brainstem white matter hyperintensities are associated with first-ever stroke but are not independent risk factors. Further studies are needed to explore the mechanisms linking b-WMHs to stroke risk.
Objective: Transient ischemic attack (TIA) is a warning event for ischemic stroke and may be accompanied by psychological sequelae. While depression and anxiety following TIA have been increasingly recognized, changes in superstitious beliefs after TIA have not been systematically investigated. This study aimed to evaluate depression, anxiety, and superstitious beliefs in patients with TIA compared with healthy controls and to examine their clinical correlates. Materials and Methods: This cross-sectional observational study included 220 patients with a history of TIA and 200 age- and sex-matched healthy controls. Participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the Superstition Scale (SS) during the first-month follow-up after TIA. Comparisons were performed between groups and according to TIA symptom characteristics. Multivariate linear regression analysis was conducted to identify independent predictors of superstitious beliefs. Results: Patients with TIA had significantly higher BDI, BAI, and SS scores compared with controls (P
