Background Treatment of embolic events, especially ischaemic stroke with large vessel occlusions (LVOs) in the context of prosthetic valve dysfunction, is a management challenge. Stroke might be the harbinger of prosthetic valve thrombosis. Timely management of ischaemic stroke and prosthetic valve thrombosis is essential to offer optimal outcomes. Methods We report our experience in the management of a young woman, a known patient with rheumatic heart disease, status post double valve replacement (St Jude mechanical valves) on anticoagulation, who presented with acute right middle cerebral artery occlusion and ‘double prosthetic valve’ thrombosis. We present a systematic review of the utility of thrombolysis in the management of prosthetic valve thrombosis. Results The patient presented within the ‘window period’ with left hemiparesis and hemineglect. Imaging revealed a right striatocapsular infarct with occlusion of the right middle cerebral artery stem. She underwent mechanical thrombectomy, which resulted in successful reperfusion. Post-procedure, she developed acute pulmonary oedema, and echocardiography (ECHO) revealed severe biventricular dysfunction with mitral and aortic valve thrombosis. As she was critically ill, she was immediately thrombolysed with two doses of reteplase. Her pulmonary oedema subsequently improved, with repeat ECHO showing normal prosthetic valve function. She was discharged on day 3 with no neurological deficits. Conclusions Coordinated input from a multidisciplinary team guided the choice of treatment strategy and was central to the favourable outcome achieved. Our findings support thrombolysis as a reasonably safe therapeutic choice for critically ill patients with prosthetic valve dysfunction.
Background Recruitment of participants in stroke research is particularly challenging when targeting low-prevalence subgroups, such as young adults. Conventional recruitment strategies, including hospital-based enrolment, rehabilitation-centre recruitment and third-party research services, may be limited by high financial costs, administrative delays and restricted access to eligible participants. Objective To describe the use of social media as a cost-effective and accessible alternative recruitment strategy for stroke research involving uncommon populations. Methods This article is presented as a descriptive recruitment case study methodological feasibility report, rather than a formal comparative evaluation of recruitment strategies. We evaluated the feasibility of traditional recruitment approaches for a case-control study examining risk factors in young adults, including recruitment through clinical sites, rehabilitation centres and third-party polling firms. Targeting recruitment was subsequently conducted through stroke-specific online communities on Reddit and Facebook. Recruitment feasibility, reach and methodological considerations relevant to stroke epidemiology and stroke care research were assessed. Results Traditional recruitment methods yielded limited enrolment and were associated with substantial costs, administrative burden, or both. Social media recruitment facilitated rapid dissemination of study materials, increased engagement among eligible participants and broader geographic reach through established stroke survivor communities. Approximately 450 of 500 participants were recruited through social media, representing about 90% of the final analytic sample. Important limitations included potential selection bias, inability to independently verify stroke diagnosis and platform-specific demographic constraints. Conclusion Social media may be a feasible adjunct to conventional recruitment strategies for uncommon stroke populations, particularly when resources are limited.
Background Outcome variability in anterior circulation acute ischemic stroke is partly attributable to differences in collateral perfusion. The adequacy of leptomeningeal collateral recruitment influences infarct progression and neurological recovery. We evaluated whether computed tomography angiography (CTA)-based collateral assessment can serve as a prognostic indicator of functional status in this population. Aim To determine the proportion of patients achieving a favorable functional outcome in acute anterior circulation ischemic stroke using CTA collateral grading systems and to compare the predictive performance of different collateral scoring scales. Materials and Methods This observational analytical study included consecutive patients presenting within 48 h of symptom onset with imaging-confirmed anterior circulation ischemic stroke. Collateral circulation was graded using multiple established CTA scoring systems. Each scale was analyzed for its ability to predict functional independence at 3 months. Results A total of 206 patients were studied. Most patients (68%) were aged 41-70 years, and 69% were male. The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 8.64 ± 6.58. Hypertension was the most frequent vascular risk factor (58.3%). Alcohol intake and tobacco chewing were significantly associated with unfavorable outcomes. Among the evaluated grading systems, the multiphase CTA (mCTA) and Miteff scales demonstrated the highest sensitivity (93%) for predicting a favorable 3-month functional outcome. The mCTA scale achieved an overall accuracy of 71.36%. The Maastricht Acute Stroke Assessment Scale (MAAS) scale showed greater specificity but comparatively lower sensitivity. Functional independence (Modified Rankin Scale (mRS) <2) at 3 months was observed in 74.8% of patients with good collateral grades. Conclusion CT angiographic collateral grading provides meaningful prognostic information in acute anterior circulation ischemic stroke. Among the assessed systems, the mCTA scale demonstrated superior overall predictive performance. Favorable collateral status was strongly associated with good functional recovery at 3 months.
Background and Purpose To evaluate the role of the double stent retriever (SR) technique in mechanical thrombectomy (MT) for acute ischemic stroke with bifurcation occlusions and long thrombi on magnetic resonance imaging (MRI). Methods The retrospective observational study was conducted between February 2023 and September 2024 on acute ischemic stroke patients with anterior circulation large vessel occlusion who underwent MT with multiple SRs. Technical success was defined as successful recanalization (mTICI ≥ 2b) without additional techniques. The primary efficacy outcome was an independent functional status (modified Rankin score 0-2) at 90 days. Results Sixteen patients (median age [IQR], 58.5 [47.5-67] years; males, 12/16 [75%]) underwent MT with the double SR technique. SRs were deployed into both middle cerebral artery (MCA) divisions (8/16, 50%), anterior cerebral artery and MCA (3/16, 18.8%), one division of MCA in parallel (2/16, 12.5%), M1 and M2 segments of the MCA in series (1/16, 6.3%), or internal carotid artery (ICA) and MCA in series (1/16, 6.3%). In one case, three SRs were deployed in series in the ICA and MCA. The first pass recanalization rate with the double SR technique was 60% (6/10). The technical success rate was 62.5% (10/16), and the final recanalization rate was 81.3% (13/16). Eight patients (50%) had independent functional status at 90 days, while two (12.5%) had symptomatic intracranial hemorrhage. Conclusion The double SR technique has a moderately high recanalization rate in patients with acute ischemic stroke when the thrombus is long or involves the ICA or MCA bifurcation on MRI.
Mechanical thrombectomy has transformed the management of acute ischemic stroke caused by large vessel occlusion, evolving from early intra-arterial thrombolysis and first-generation devices into a Class I, Level A standard of care in anterior circulation stroke. Landmark randomized trials and pooled analyses have demonstrated robust improvements in functional independence with early-window, late-window, posterior circulation, and now large-core thrombectomy. Recent large-core trials show that carefully selected patients with substantial baseline infarction can still derive meaningful benefit from endovascular therapy, challenging traditional exclusion thresholds. In contrast, randomized medium- and distal-vessel occlusion (MeVO/DVO) studies to date have been neutral, emphasizing the need for more refined patient selection and dedicated small-vessel devices. Ongoing platform trials, advances in devices and combined techniques, and AI-enabled workflow optimization are poised to further expand the horizons of mechanical thrombectomy, particularly in resource-limited settings and previously undertreated stroke populations.
Background and Purpose Atrial fibrillation (AF) is an established risk factor for stroke. Poststroke seizures (PSS) are a known complication after stroke. This review aimed to explore whether AF increases the likelihood of seizures after stroke and whether seizures might also be linked to the later development of AF. Methods We reviewed 11 observational studies involving patients with ischemic and hemorrhagic strokes, with substantial representation from Asian populations. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for both directions of association. Subgroup analyses were conducted based on stroke subtype, region, epilepsy-specific outcomes, sex, and age. Results AF was not significantly associated with the overall odds of PSS (OR = 1.00, P = .93). In ischemic stroke, AF showed a non-significant trend toward increased odds of PSS (OR = 1.28, P = .16), while no association was observed in hemorrhagic stroke (OR = 0.96, P = .80). A significant association was identified when focusing on poststroke epilepsy (OR = 2.09, P < .001). Studies from Asia demonstrated a stronger association (OR = 1.94, P < .001). Two studies examining PSS after AF found a significant association (OR = 2.87, P < .01). Female sex was slightly more common in patients with seizures (OR = 1.08, P = .02), particularly in ischemic stroke (OR = 1.11, P < .01). Patients with seizures were also marginally younger (Hedges’ g = −0.15, 95% CI: −0.20 to −0.11, P < .001). Conclusions AF may be associated with PSS, especially in epilepsy-focused and region-specific contexts. More studies are needed to understand the biological pathways behind these findings.
Background and Aims Various radiological parameters reflect thrombus characteristics in acute ischemic stroke (AIS). Although numerous studies on thrombus characteristics in AIS have been conducted, none have been reported from India. Therefore, we aimed to compare thrombus permeability and burden between AIS from large-artery atherosclerosis (LAA) and cardioembolism (CE) and to assess their association with outcomes. Materials and Methods This prospective, exploratory, longitudinal study enrolled consecutive patients with LAA and CE over 1 year. Patients with thrombotic occlusion were included in the analysis of thrombus indices. Non-contrast computed tomography (NCCT) and CT angiography (CTA) were used to measure thrombus attenuation, thrombus attenuation index (TAI), clot length, clot burden score (CBS), and basilar artery on computed tomography angiography (BATMAN) score. Multivariate analyzes evaluated whether these thrombus indices were associated with the 90-day modified Rankin scale (mRS). Results Of the 305 AIS patients screened, CE and LAA comprised 10.5% (32) and 42.6% (130), respectively. Of these, 89 patients underwent CTA, 43 LAA patients, and 5 CE patients exhibited thrombotic occlusion. TAI values were lower in the CE group compared to the LAA group (8.60 ± 1.49 vs. 14.60 ± 10.96; P = .281). Clot length (cm) was significantly longer in LAA (1.9 vs. 0.7 cm, P = .014), while TAI and CBS did not differ. None of these indices was independently associated with poor 90-day mRS. Conclusion TAI and clot burden did not differ significantly between the LAA and CE. Clot length was longer in the LAA. None of the thrombus indices were associated with functional outcomes.
Background Hemiplegic shoulder pain (HSP) is a common complication following stroke, with an incidence of up to 84%. It negatively affects participation in rehabilitation, functional recovery, and quality of life. Suprascapular nerve block (SSNB) is an established intervention for other shoulder pathologies, but evidence for effectiveness in HSP remains limited. Objective To evaluate the effectiveness of landmark-guided SSNB in patients with HSP on a stroke rehabilitation unit. Methods A retrospective service evaluation was conducted in patients receiving landmark-guided SSNB for HSP on a stroke rehabilitation unit between March 2022 and November 2023. All injections used 10 mL of 0.5% bupivacaine without a steroid. Pain was assessed using the Numerical Rating Scale (NRS) across four domains (rest, night pain, personal care, and therapy). Secondary outcomes included passive range of movement (PROM) and spasticity assessed using the Modified Ashworth Scale. Outcomes were recorded preintervention and at 1 h, 24-48 h, and 7 days postintervention. Results Fourteen patients were included. Statistically significant improvements in NRS pain scores were observed across all domains at 7 days postintervention compared with baseline, with the greatest reduction seen at 24-48 h. PROM improved in all planes, most notably in forward flexion. Spasticity improved in 50% of patients with preexisting spasticity. No complications were recorded. Conclusion Landmark-guided SSNB using local anesthetic appears to be a safe and effective short-term intervention for reducing pain and improving PROM in HSP. Further controlled studies are required to assess long-term outcomes and functional impact.
Introduction Stroke remains a leading cause of death and disability worldwide, with a high burden in low-resource settings like Nepal. Timely administration of intravenous thrombolysis is critical for improving outcomes in patients with acute ischemic stroke. However, delays in receiving thrombolysis can significantly reduce its effectiveness and impact recovery. This study aimed to explore and understand the reasons contributing to delays in thrombolysis among stroke patients in emergency departments within low-resource settings through a qualitative approach. Methods A qualitative study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Eighteen participants, including ten stroke patients and eight witnesses, were interviewed using a semi-structured guide. Data were analyzed using thematic analysis to identify common themes regarding treatment delays. Results The study identified four primary reasons contributing to delays in thrombolysis treatment: (a) failure of patients and witnesses to recognize stroke symptoms early, (b) limited availability of thrombolysis services in the hospitals, (c) financial barriers to seeking care, and (d) delayed diagnosis or misdiagnosis by healthcare professionals. Conclusion This study highlights the significant barriers to thrombolysis delays in Nepal. Key interventions, such as improving public awareness of stroke symptoms, increasing access to thrombolysis services, and reducing financial barriers, are necessary to improve outcomes in stroke patients.
This narrative review synthesizes the latest evidence on TeleStroke implementation and proposes a structured protocol for developing an advanced TeleStroke network. A structured search was conducted in PubMed, Scopus, Web of Science, and Institute of Electrical and Electronics Engineers (IEEE) Xplore (2000-2024) using “telemedicine” OR “TeleStroke” combined with “regulatory aspects,” “ethics,” “information architecture,” “artificial intelligence (AI),” and “training.” The review sections were consensually defined by four vascular neurologists and two digital health experts. An advanced network was consensually defined as one that enables synchronous communication, secure data storage, compliance with data protection laws, remote neuroimaging visualization, integration with prehospital emergency systems, and a validated AI tool. Studies were analyzed for best practices, regulatory considerations, and AI-driven innovations. We included 142 publications between 2000 and 2024 in the final review. Key components of a TeleStroke network include deploying neurologists trained in cerebrovascular care and telemedicine, adopting secure cloud-based technologies for imaging and data storage, and utilizing blockchain to enhance data security. Embedded AI tools, such as neuroimaging analysis and natural language processing (NLP), expedite diagnostics and decision-making. Georeferenced algorithms direct ambulances to appropriate stroke centers based on patient severity and available resources. Integrating telemedicine into ambulance systems enables real-time consultation, while automated documentation within electronic medical records (EMRs) ensures continuity of care. Adhering to data privacy laws and maintaining shared clinical responsibility are essential for complete implementation. A multidimensional approach integrating technology, regulation, and clinical training is crucial for an advanced TeleStroke network. AI-driven solutions, mobile platforms, and cloud-based infrastructure enhance clinical outcomes and metrics.
Neurogenic stress cardiomyopathy (NSC), triggered by acute brain injuries like stroke, manifests as transient cardiac dysfunction, including electrocardiogram (ECG) abnormalities and left ventricular (LV) wall motion changes. Management remains supportive due to high morbidity and mortality. Takotsubo cardiomyopathy, a catecholamine-driven mimic of acute coronary syndrome, is a hallmark of NSC. A 76-year-old hypertensive woman presented with sudden onset giddiness, blurred vision, dysphagia, swaying to the left side, and slurred speech following a posterior circulation stroke. Initial non-contrast computed tomography (NCCT) brain and CT angiogram were unremarkable, but neurological deficits (cranial nerve IX/X palsy, partial left Horner’s syndrome, left cerebellar signs) emerged. Post-thrombolysis, the patient developed hypoxia. Cardiac evaluation revealed elevated troponin, ischemic ECG changes, and echocardiographic findings of apical hypokinesia with basal hyperkinesis, consistent with Takotsubo cardiomyopathy. Normal coronary angiography confirmed NSC. NSC pathophysiology involves excessive catecholamine release, causing myocardial stunning, linked to brain–heart crosstalk. Key medullary regions—rostral ventrolateral medulla (RVLM), nucleus tractus solitarius (NTS)—regulate sympathetic outflow and are often affected in posterior circulation strokes, as in this case. Estrogen deficiency in postmenopausal women may exacerbate susceptibility. Early recognition and intensive care are critical, as delayed diagnosis worsens outcomes. This case highlights NSC’s association with posterior circulation stroke, a novel observation. Clinicians should maintain high vigilance for NSC in acute brain injury, utilizing prompt cardiac monitoring and imaging to differentiate it from primary cardiac events. Aggressive supportive care, including hemodynamic stabilization, is essential. This report expands understanding of NSC’s clinical spectrum, emphasizing the need for interdisciplinary management to mitigate risks in vulnerable populations.
Post-stroke movement disorders are a spectrum of rare complications associated with subcortical strokes. While these disorders tend to spontaneously resolve, early symptomatic management can complement ongoing stroke rehabilitation. There is no standardized management rationale for these disorders, which include chorea, athetosis, and hemiballismus, but treatment revolves around neurotransmitter modulation. We discuss a 91-year-old Caucasian male with a history of hypertension and type 2 diabetes mellitus who suffered a thalamic stroke with left-sided vascular choreoathetosis. The choreoathetosis markedly improved over 2 weeks with sodium valproate and risperidone, which were continued throughout rehabilitation and in the outpatient setting. The patient was readmitted a month later with a recrudescence of slurred speech and decreased mobility due to a suspected respiratory tract infection but reported no re-exacerbation of choreoathetosis. Risperidone was ceased during the second admission, and the patient was discharged on sodium valproate, with subtle evidence of residual left upper-limb chorea.
Takayasu arteritis (ta) is a rare large-vessel vasculitis that may present with neurological complications. we report the case of a 22-year-old male developed recurrent transient vision loss, vertigo, and left hemiparesis. examination revealed absent upper limb pulses and carotid bruits. imaging showed carotid and subclavian artery occlusions with chronic and subacute brain infarcts, consistent with ta. he improved with corticosteroids and azathioprine. this case emphasizes the need to suspect ta in young stroke patients with absent pulses.
A 36-year-old female developed an acute stroke due to a nonthrombotic biological native valve embolism following mitral valve replacement for severe rheumatic mitral stenosis. The organic embolus was successfully removed from the internal carotid artery bifurcation via mechanical thrombectomy.
Despite timely thrombolysis, language recovery in post-stroke aphasia is highly variable. We report a patient with severe Broca’s aphasia following a left middle cerebral artery (MCA) infarct whose only verbal output for 6 weeks was the utterance “yani.” Introduction of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the right inferior frontal gyrus, combined with speech-language therapy, led to significant improvements, including production of 3-4-word length sentences with occasional paraphasia. This case highlights how neuromodulation may unlock recovery when conventional therapy alone stalls and provides a way forward. Informed consent was obtained for publication.
We report a case of acute pseudo–progressive supranuclear palsy caused by a paramedian thalamopeduncular infarct. The patient presented with a sudden vertical gaze palsy, staring look, and postural instability, mimicking progressive supranuclear palsy. Magnetic resonance imaging showed an acute medial thalamic infarct extending into the midbrain, confirming a vascular etiology.
Stroke presents with variable clinical profiles across different geographical locations. Therefore, studying stroke and conducting long-term follow-ups in specific subpopulations will guide us in the initiation of better treatment and preventive measures. To assess tenecteplase’s safety and effectiveness, as well as the clinical characteristics and long-term monitoring of stroke patients in Coimbatore. One hundred individuals with acute ischemic stroke who received tenecteplase within a 4.5-h timeframe were included in this prospective research. The period of these patients’ admissions was August 2018-February 2022. Following patient consent and ethical committee permission, we examined the patients’ clinical characteristics, tenecteplase safety profile, primary and secondary outcomes, and long-term follow-up for a maximum of 18 months. The mean age of the 100 patients was 58.9 years, with 71 being men and 29 being women. Fourteen of the patients were younger than 45. The TOAST categorization showed that 34 had lacunar strokes, 14 had cardioembolic strokes, and 55 had massive infarcts. Regardless of their vegetarianism or alcohol consumption, 48 individuals showed either hyperhomocysteinemia or a B12 deficiency. The middle cerebral artery (MCA) was the source of 75 of the 87 anterior circulation strokes and 13 posterior circulation strokes that were found. The average door-to-needle duration was 75.7 min, and the average time of stroke onset (TSO) was 2.7 h. The immediate National Institutes of Health Stroke Scale (NIHSS) score following tenecteplase injection (within 1 h) was 7.6, while the mean NIHSS score at admission was 9.56. Two patients suffered intracerebral hemorrhage, whereas 47% of patients obtained the primary endpoint, and 67% reached the secondary outcome. Recurrent vascular events, such as myocardial infarction (7), peripheral vascular disease (3), recurrent stroke (10), and mortality (16), occurred in 36 patients during the 18-month follow-up. Within the 4.5-h window, tenecteplase is a safe and efficient thrombolytic treatment for acute ischemic stroke. In contrast to earlier stroke studies conducted in India, the mean age of presentation in our study was 58.9 years. Therefore, our society should implement basic preventive measures that are effective and based on the population. B12 deficiency and hyperhomocysteinemia are significant vascular risk factors for macrovascular events that require appropriate screening and management. Recurrent macrovascular events, including mortality, occurred in 36% of patients during their follow-up, which is a greater rate even with secondary preventive interventions. This emphasizes how our community has to implement strong primary and secondary prevention measures.
Lacunar infarcts are small, deep brain infarctions traditionally attributed to intrinsic small vessel disease, such as lipohyalinosis and microatheroma formation. However, emerging evidence suggests that a subset of lacunar strokes may result from embolic occlusions originating from proximal large arteries or the heart. Identifying the underlying etiology is crucial for optimizing secondary prevention strategies, as embolic strokes require different management approaches compared to non-embolic small vessel disease. This study aims to evaluate the prevalence of proximal embolic sources in patients with lacunar infarcts and assess their clinical and imaging characteristics to determine whether embolism plays a significant role in their pathogenesis. In this prospective observational study over 18 months at a tertiary care hospital, 337 ischemic stroke patients were screened. Sixty patients (17.8%) with radiologically confirmed lacunar infarcts were enrolled. Demographic data, vascular risk factors, and clinical presentations were recorded. Investigations included computed tomography (CT) angiography to assess large-artery pathology, 2D echocardiography to identify cardiac embolic sources, and 72-h Holter monitoring to detect atrial fibrillation or other arrhythmias. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were assessed using the modified Rankin scale (MRS). The prevalence of lacunar strokes was 17.8%, with the majority (60%) occurring in individuals aged 41-60 years. Hypertension was the most common risk factor (45%), followed by diabetes mellitus (31.67%) and dyslipidemia (41%). Proximal embolic sources were identified in 36.6% of patients based on CT angiography, with the most common sites being the internal carotid artery (40.9%) and the middle cerebral artery (13.6%). Cardiac abnormalities were detected in 18.3% of cases on echocardiography, and Holter monitoring identified atrial fibrillation in 3.3%. Functional outcomes showed moderate to severe disability (MRS 3-5) in 43.34% of patients, with neurological deterioration occurring in 40% within the first week. This study suggests that embolic mechanisms contribute to a significant proportion of lacunar infarcts. Routine vascular and cardiac imaging should be considered in lacunar stroke patients to identify potential embolic sources, which may necessitate anticoagulation for secondary stroke prevention. Further research is needed to refine diagnostic criteria and optimize treatment strategies for embolic versus non-embolic lacunar strokes.
Stroke is the second leading cause of death worldwide, with both the scale and impact growing annually. Over 25% of ischaemic stroke sufferers have previously had a transient ischaemic attack (TIA), allowing a unique window of opportunity to diagnose, treat and adapt modifiable cardiovascular risk factors. Despite this, clinical teams are limited by a lack of appropriate methodologies to identify TIA patients at greatest risk of stroke, outside of identifying common cardiovascular risk factors. PREDICT-EV adopts a two-pronged approach, looking both prospectively and retrospectively at novel characteristics in TIA patients who go on to suffer with a stroke. A prospective nested, case-controlled design will allow analysis of novel extracellular vesicles, coagulative risk and a host of informative cohort characteristics. Patients and controls will be followed over the duration of the study, with stroke as the primary clinical outcome. Retrospectively, the Secured Anonymised Information Linkage databank, UK, will provide population data to track coagulative risk in TIA patients who do and do not go on to suffer with a stroke over a 20-year period. We anticipate the identification of a suite of novel biomarkers for TIA patients at greatest risk of suffering a stroke to be vastly impactful on stroke prevention strategies.
Brain cancer-associated stroke represents a complex interplay of oncological and cerebrovascular factors, distinct from conventional stroke mechanisms. Tumor-induced hypercoagulability, inflammation, and vascular disruption converge to create a unique clinical challenge that demands precision in diagnosis and management. This review synthesizes current evidence on the pathophysiological mechanisms, diagnostic innovations, and therapeutic strategies for brain cancer-related stroke while introducing two transformative frameworks designed to improve patient outcomes. We propose the Tumoral Bleeding Classification System (TBCS), a novel phenotypic framework categorizing tumoral bleeding into intratumoral and peritumoral subtypes, with further subdivisions to guide clinical decision-making. By linking these classifications to diagnostic biomarkers, such as D-dimer, and advanced imaging techniques, such as magnetic resonance imaging, the TBCS may enhance risk stratification and therapeutic targeting. Building on these insights, the CanStroke protocol offers an integrated, multidisciplinary, evidence-based management strategy tailored for brain cancer patients at risk of stroke. This protocol bridges oncology, neurology, and vascular medicine to address key challenges, including early recognition of stroke risk, individualized treatment plans, and mitigation of complications. Central to this approach is the integration of molecular diagnostics and pharmacogenomic data to optimize treatment pathways, aligning with precision medicine principles. This article highlights the critical need for diagnostic-therapeutic frameworks in brain cancer-related stroke, underscoring the value of the TBCS and CanStroke protocol in transforming care. By linking diagnostic biomarkers, imaging techniques, and therapeutic strategies, these innovations pave the way for improved survival, reduced morbidity, and enhanced quality of life in this vulnerable population.
