Background:A hemorrhagic stroke is a life-threatening emergency that can lead to disability or death without prompt treatment. However, there is limited evidence on factors associated with mortality in hemorrhagic stroke, particularly in eastern Ethiopia. Therefore, this study is aimed at assessing the factors associated with mortality among adult hemorrhagic stroke patients in the Harari region, eastern Ethiopia. Methodology:A retrospective cohort study was conducted among 262 patients with hemorrhagic stroke at public hospitals in the Harari region of eastern Ethiopia, from September 1, 2019, to August 31, 2024. Factors associated with mortality were identified using the Gompertz hazards regression model. Results:Of the 262 patients included in the final analysis, 45 (17.18%; 95% CI: 13.05%-22.26%) died. The mortality rate for hemorrhagic stroke was 10.62 cases per 1000 person-months (95% CI: 7.93-14.23). Mortality was significantly associated with patients having kidney disease (AHR: 3.04; 95% CI: 1.44-6.44; p value: 0.004) and poor Glasgow Coma Scale (GCS) scores (AHR: 3.92; 95% CI: 1.58-9.71; p value: 0.003). Septic shock and aspiration pneumonia had exploratory associations with mortality. Conclusion:In-hospital mortality was observed in approximately one in six hemorrhagic stroke patients treated at public hospitals. Risk factors such as kidney disease, aspiration pneumonia, poor GCS, and septic shock increased mortality risk. Hence, special emphasis should be given to early screening for kidney disease and the management of stroke patients with poor a GCS score.
Cerebral ischemic stroke (CIS) is an acute cerebrovascular disease associated with high morbidity and disability rates. It is characterized by neurological damage caused by the interruption of cerebral blood flow, often accompanied by sequelae such as motor dysfunction and cognitive decline, which seriously affect the quality of life of patients. Despite continuous advancements in treatment methods, challenges persist, such as time window constraints, limited efficacy, and potential adverse reactions. Therefore, finding more proactive and effective treatment approaches has become an urgent problem to be solved. The mechanism of action of terpenoids is not a simple single-target inhibition. Essentially, it lies in the systematic remodeling of the postischemic neural microenvironment. The pathophysiological process of CIS involves complex cascades, including energy failure, excitotoxicity, oxidative stress, neuroinflammation, disruption of the blood-brain barrier, multiple cell death pathways, mitochondrial dysfunction, and impairment of nerve repair. Terpenoids can intervene in ischemic stroke through a dual-mechanism approach of direct neuroprotection and indirect microenvironment regulation by targeting key nodes within the abovementioned pathological network, ultimately achieving the protection and restoration of neural function. The aim of this review was to deepen the understanding of the therapeutic value of terpenoids in stroke; from an integrated perspective, it revealed the scientific essence of the multitarget synergistic effects of natural products, thereby providing a theoretical cornerstone and an innovative direction for the development of next-generation drugs for treating stroke.
Background:Stroke is increasing in low- and middle-income countries. Stroke unit care, including evidence-based practice such as swallowing and hydration protocols, is associated with reduced disability and mortality. Objectives:The aim of this study is to codesign a swallowing and hydration care bundle for nurses to use with acute stroke patients, and to implement and evaluate the bundle on three acute stroke units across India. Methods:A multicentre, preimplementation and postimplementation feasibility study was conducted. We codesigned a care bundle (with stakeholders) which included the Global Evaluation of Swallowing and hydration screening and related actions/management. Implementation used clinical champions, education and training, barrier and enabler identification and site support. Participants included consecutively admitted patients, aged ≥ 18 years, with a clinical diagnosis of acute stroke and a persistent neurological deficit on presentation, who were admitted to a study site within 2 weeks of stroke onset. Results:Fifty-three healthcare staff completed the care bundle training. We recruited 183 participants, preimplementation group (n = 92). Swallowing evaluations using different consistencies increased from 22 (23.9%) to 51 (56%). Calculated osmolarity (cOsm) increased from 0 to 66 (73%) participants. Median cOsm was 288 mmol/L (IQR: 280-295 mmol/L); 15 (23%) participants were dehydrated. Conclusion:Care bundle implementation was feasible and improved swallowing and hydration management in three sites in India.
Background:Acute to postacute care continuum for individuals with stroke significantly influences functional recovery, quality of life, and healthcare utilization. Prior studies have focused largely on older adults with stroke, limiting generalizability for the younger population. Objective:This study is aimed at identifying patient- and hospital-level factors associated with postacute discharge destination following acute stroke hospitalization. Design:This study is a retrospective cohort study. Setting:This study was set in acute care hospitals in Virginia (2017-2021). Participants:Participants are adults ≥ 18 years hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke identified in the Virginia All-Payer Claims Database. Interventions:There were no interventions applicable. Main Outcomes:Postacute care discharge destination was categorized as home, home health, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), or other. Patient-level variables included age, sex, race, insurance, comorbidity burden, stroke type, length of stay, and hospital-acquired complications. Facility-level variables included hospital size, ownership, stroke center status, and county-level clinical care rankings. Multivariable logistic regression models estimated associations between patient and hospital factors and postacute care discharge destination. Results:Older age, higher comorbidity burden, presence of hospital-acquired complications, and longer length of stay were associated with increased likelihood of discharge to post-acute care, particularly IRF and SNF. Male patients were less likely than females to be discharged to home health (OR = 0.90, 95%CI = 0.85-0.95) or to SNF (OR = 0.91, 95%CI = 0.87-0.96). Black patients had higher odds of discharge to home health (OR = 1.13, 95%CI = 1.05-1.22), IRF (OR = 1.10, 95%CI = 1.02-1.19), and SNF (OR = 1.13, 95%CI = 1.05-1.21) compared with White patients. Medicaid beneficiaries had higher odds of discharge to post-acute care settings compared with commercially insured patients, including home health (OR = 1.34, 95%CI = 1.17-1.54), IRF (OR = 1.20, 95%CI = 1.05-1.38), and SNF (OR = 1.17, 95%CI = 1.02-1.34). Conclusions:Postacute care after stroke is associated with both clinical complexity and sociodemographic factors. These findings highlight potential differences and variations in postacute care and support the need for standardized discharge processes that can integrate medical and social determinants of health to optimize long-term recovery.
Aims Use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in adults with Type 2 diabetes (AwT2D) has recently been associated with decreased stroke risk. In this study, we investigate the impact of SGLT2i on stroke. Materials and Methods We conducted a cohort study using an electronic health record (EHR) representing 66 million patients to examine whether AwT2D have a lower incidence of stroke and/or transient ischemic attack (TIA) if treated with SGLT2i. All analyses were completed utilizing high-dimensional propensity score matching to control for confounders. Results AwT2D treated with SGLT2i compared to other antidiabetic medications, assessed after 1 year, starting 2 weeks after the date of prescription of SGLT2i or other antidiabetic drug, had a significantly lower incidence of any stroke (Odds Ratio (OR): 0.84 with 95% Confidence Interval (CI) 0.79-0.91, p < 0.001), hemorrhagic stroke (OR: 0.72 with 95% CI 0.59-0.88, p < 0.001), ischemic stroke (OR: 0.86 with 95% CI 0.77-0.95, p = 0.005), and TIA (OR: 0.87 with 95% CI 0.80-0.95, p = 0.003). Conclusion Among AwT2D, those treated with SGLT2i had lower incidence of stroke and TIA compared with adults treated with other antidiabetic medications.
Aphasia, an acquired communication disorder after a stroke, negatively impacts an individual ' s participation and communicative exchanges in daily life. Speech and language therapy (SLT) serves to either restore or compensate for language capabilities. An intensive and comprehensive aphasia program (ICAP) that emphasizes improving an individual ' s abilities for daily participation and functional communication through a highly intensive schedule has accumulated substantial evidence supporting its efficacy. This study is aimed at comparing the effects of the mentioned treatment models to firstly progress the investigation of an ICAP in comparison with a conventional model, and secondly, at addressing local service gaps and identify how an ICAP could meet the needs of individuals with aphasia. A nonrandomized, dose-controlled crossover, pre-post design. The ICAP and the conventional SLT (c-SLT) were delivered alternately at a local community-based rehabilitation center in Hong Kong, with a minimum of six-month washout period between programs; treatment allocation was determined by the timing of recruitment. Twelve right-handed adults with chronic aphasia were recruited. Both the treatment models provided 39 hours of treatment, using evidence-based approaches and targeting both word and beyond-word levels. The ICAP phase was delivered over 2.5 weeks at an intensity of 3 hours/day, 5 days/week. Treatment components included individual impairment-based, participation-based, technology-based, and group therapy. The c-SLT phase was delivered at an intensity of 2 hours/week, once weekly, providing individual language-only therapy. Each participant received a total of 78 hours of treatment; no dropouts were recorded. Linguistic performance was assessed using two standardized comprehensive language-functioning tests, an individual naming test and a discourse test. Communication confidence and effectiveness were also evaluated. Overall, the ICAP condition demonstrated better linguistic and quality of life treatment outcomes at the individual and group levels. Feedback on the experiences with the two treatment models was collected through interviews, which provided insights into perceived benefits from the user perspective and insights for future participant recruitment.
Background:Achieving independent gait at discharge from an acute care hospital remains challenging, necessitating the identification of factors associated with different levels of gait assistance. Unlike previous studies, this study emphasizes the prognostic value of the Trunk Impairment Scale (TIS) when assessed within 48 h of stroke onset. Our findings highlight the predictive utility of early trunk function assessment in determining gait assistance levels at discharge and provide actionable insights for optimizing rehabilitation planning in acute care settings. Objective:This study is aimed at comparing gait assistance levels at discharge among patients with acute stroke and examining the association between gait assistance and trunk function. Methods:This prospective observational study included 115 stroke patients who were unable to achieve independent gait at discharge from an acute care hospital. Evaluations were conducted within 48 h of stroke onset and the day before discharge. Trunk function was assessed using the TIS, a practical bedside tool for evaluating core stability. Gait ability at discharge was classified as mild, moderate, or severe. Results:Significant differences in TIS scores were observed between the mild and moderate assistance groups (p < 0.05), mild and severe assistance groups (p < 0.001), and moderate and severe assistance groups (p < 0.01). The odds ratio (OR) for TIS scores was 1.53 (95% confidence interval [CI]: 1.06-2.20, p < 0.05) when comparing the mild and moderate assistance groups. For the moderate and severe assistance groups, the OR was 0.70 (95% CI: 0.53-0.92, p = 0.01). No significant associations were found for other variables. Conclusions:TIS score was strongly associated with gait assistance level, underscoring their predictive value for discharge gait ability. Early TIS assessments facilitate accurate prognostication and support the development of individualized rehabilitation plans, potentially improving functional outcomes in acute care settings.
Aims Dyslipidemia is a major modifiable risk factor for stroke; however, it is poorly understood among patients at risk of stroke in Uganda. This study is aimed at determining the prevalence of dyslipidemia and identifying associated factors among a Ugandan sample at risk for stroke. Methods This was a hospital based cross-sectional study conducted across three Ugandan sites. The serum lipid levels were determined following the National Cholesterol Education Program guidelines. Data were analyzed with STATA employing univariable and multivariable logistic regression. Statistical significance was set at p < 0.05. Results We enrolled 247 study participants with a mean age (SD) of 55.4 (12.0) years. Majority of the participants were female, n = 168 (68%). About 81% (N = 199) had elevated serum lipid levels. Sixty-one (24.7%) had elevated levels of total serum cholesterol, whereas half of female participants had abnormally low levels of HDL cholesterol. About a third (N = 82 and 84, respectively) had elevated serum LDL and triglycerides. Nearly 40% (N = 98) were obese and 23.5% had a sedentary lifestyle (N = = 58). Only 20.2% (N = 50) were receiving lipid lowering drugs. Prior family stroke history and personal history of stroke had lower odds of 58% (AOR = 0.42, 95% CI: 0.20-0.88, p = 0.022); and 64% (AOR = 0.36, 95% CI: 0.17-0.76, p = 0.008), respectively, of having dyslipidemia. Conclusions Approximately four in five Ugandans at risk of stroke have dyslipidemia. The majority also have low HDL-c levels. Implementation of systematic screening and provision of statin therapy among those at high risk for stroke is urgently needed to reduce stroke burden in Uganda. Trial Registration ClinicalTrials.gov identifier: NCT04685408
Objective:By considering risk factors of patients with acute ischemic stroke in the neurology department and intensive care unit (ICU), the study explored which indicators affected the patient's condition, and by comparing the biochemical indicators of survival and death patients with ischemic stroke in ICU, the study explored which biomarkers can be associated with the patient's prognosis. Methods:The study retrospectively analyzed 27 patients with acute ischemic stroke from ICU and 43 patients from the neurology department. The analysis indicators include medical history, lifestyle habits, electrocardiogram, biochemical indicators, and inflammatory cytokines. The study compared the differences in the above factors between patients admitted to the ICU and those not admitted to the ICU. Multivariable logistic regression analyses were performed to identify predictors affecting the death of patients transferred to ICU. Results:Neutrophilic granulocyte and D-dimer in patients with ischemic stroke from ICU were significantly increased (p < 0.05). In ICU, compared with patients alive, we found that cardiac troponin I in patients who finally died was significantly increased (p < 0.05, OR is 29.250, and 95% CI is 2.789, 306.811). Conclusions:Acute ischemic stroke patients with higher neutrophils and D-dimer were more likely to enter into the ICU. Cardiac troponin I elevation seems to be associated with the poor prognosis of patients in ICU.
Background:Stroke is a major global health issue with numerous contributing risk factors. One of the most important risk factors of stroke is cardiovascular disease. Other risk factors include dyslipidemia, obesity, diabetes, and thyroid dysfunction which are known to increase the risk of cardiovascular disease. As dysfunction of the thyroid and its related hormones such as thyroid-stimulating hormone (TSH) are in correlation with cardiovascular disease, which may lead to stroke, investigating the correlation between TSH levels and the severity of stroke is worth attention. Methods:This cross-sectional study was conducted in Imam Reza Hospital in Tabriz, Iran, from March 2021 to March 2023. In this study, 204 stroke patients whose TSH levels were evaluated were included. Data on age, gender, comorbidities, TSH levels, stroke subtype, and disability severity (measured by the modified Rankin scale [mRS] before admission, during admission, at discharge, and after 3 months) were analyzed using SPSS Version 22. Results:Out of 204 patients, TSH levels of 35 (17.2%) patients were below the range (TSH < 0.39), 154 (75.5%) patients within the range (TSH: 0.39-6.19), and 15 (7.4%) patients had TSH levels above the range (TSH > 6.19). There is a weak to moderate but statistically significant correlation between mRS and TSH level during admission (R = -0.25, p < 0.01) and at discharge (R = -0.28, p < 0.01). However, there is a nonsignificant correlation before admission (R = -0.10, p = 0.174) and 3 months after discharge (R = -0.12, p = 0.137). There is not a significant difference among TSH groups comparing their age, gender, type of stroke, and CT scan findings. Conclusion:Elevated TSH levels may be associated with less severe stroke symptoms at both admission and discharge. Further studies with larger sample sizes are necessary to better understand the relationship between thyroid function and stroke.
Stroke is a major global health concern and a leading cause of disability and mortality, emphasizing the need for early risk prediction and intervention. This study leverages statistical analysis, machine learning (ML) classification, clustering, and survival modeling to identify key stroke predictors using a dataset of 5110 records. Descriptive statistics reveal that age, glucose levels, BMI, hypertension, and heart disease are the most influential risk factors. Stroke prevalence is notably higher among hypertensive (13.25%) and heart disease patients (17.03%), as well as among former (7.91%) and current smokers (5.32%). Clustering analysis using PCA and t-SNE highlights high-risk groups with elevated glucose levels and advanced age. Among ML models, XGBoost offers the best trade-off between precision and recall, while naïve Bayes achieves the highest recall (0.404), detecting more stroke cases despite higher false positives. Feature importance analysis ranks glucose, BMI, and age as dominant predictors, with XGBoost emphasizing cardiovascular conditions. Survival analysis confirms increasing stroke risk beyond age 60, with the Kaplan–Meier and Cox models showing a 31.9% risk increase linked to hypertension. These findings underscore the importance of early screening, lifestyle intervention, and targeted care. Future research should explore data-balancing methods like SMOTE and develop real-time tools to support clinical decision-making.
Ischemic stroke is the leading cause of stroke all around the world. Ischemic stroke can cause severe and irreversible damage to the brain. Brain neuroprotection is a promising treatment strategy. Moleac (MLC) 901, a traditional Chinese medicine, is one alternative adjunctive therapy that enhances neuroprotection. The molecular mechanism of MLC 901 in reducing brain damage in stroke needs to be further explored. Therefore, a review was conducted. MLC 901 effectively improves cognitive function and aids in poststroke recovery by promoting neuroprotection and neuroplasticity in neurons that have suffered ischemic damage. It also increases blood supply to the brain. Studies have shown that MLC 901 operates through complex pathways, particularly by stimulating brain-derived neurotrophic factor (BDNF) expression, facilitating neurogenesis, promoting cell proliferation, and aiding in neuronal growth. These mechanisms collectively contribute to its neuroprotective effects by helping neurons survive, repairing brain tissue, and enhancing functional recovery after a stroke. Ischemic stroke induces a cascade leading to apoptosis. MLC 901 has neuroprotective and neuroplasticity effects by stimulating cell proliferation, synaptogenesis, and neuronal growth by various pathways, thereby inhibiting apoptosis and inflammation in acute ischemic stroke. MLC 901 reduces brain damage, improves motor function, and increases survival rate in acute ischemic stroke.
Stroke ranks among the Top 3 leading causes of death and disability in Ghana. This review examines the current state of stroke in the country, focusing on recent developments and challenges in stroke care and rehabilitation. Historical and contemporary research indicates a rising prevalence of stroke-related morbidity and mortality, accompanied by a gradual shift from hemorrhagic to ischemic stroke, attributed mainly to the increasing adoption of Western lifestyles. Significant challenges to effective stroke care and rehabilitation exist, suggesting a potential worsening of the situation if these challenges are not addressed. With stroke morbidity and mortality expected to increase in the coming decades, there is an urgent need for substantial investments in stroke care, particularly in training healthcare professionals and providing adequate facilities and resources. Additionally, a comprehensive review of government health policies and stakeholder initiatives is necessary to enhance the quality of stroke care and mitigate the growing burden of stroke in Ghana.
Background: Intracranial haemorrhage (ICrH) is the most frequent cause of bleeding-related death. However, few studies describe the national incidence of ICrH-related acute hospitalisations and mortality. We report the national burden and incidence of hospitalisation and mortality of ICrH and its subtypes. Methods: A population-based review in England between 2014 and 2019 of acute admissions or deaths was undertaken. Admission and mortality data were obtained from electronic databases (traumatic death data were unavailable). ICrH events were identified by the International Classification of Diseases Version 10 codes. ICrH were subclassified by anatomical site and either traumatic or atraumatic cause. Results: In the 6-year study period, there was a total of 468,996 hospitalisations for ICrH, of which 280,003 (59.7%) were atraumatic and 188,993 (40.3%) were traumatic. Then, 50,004 atraumatic ICrH-related deaths were recorded; of these deaths, 43,061 were subclassified by anatomical site. The mean annual incidence rates (per 100,000 person years) were 141.0 for ICrH-related hospitalisations and 15.0 for atraumatic ICrH-related mortality. Males had a 7% higher incidence rate for atraumatic ICrH-related hospitalisations (OR 1.07, 95% CI 1.05-1.09, p < 0.0001). Females had a higher mean annual atraumatic ICrH-related mortality (OR 1.21, 95% CI 1.16-1.26, p < 0.0001). Then, 23.4% (n = 109,770) of all ICrH hospitalisations occurred in patients ≥ 85 years. Conclusion: The majority of ICrH acute hospitalisations (59.7%) were atraumatic. Sex differences were seen in outcome measurements: males had a higher overall incidence of hospitalisation; however, females had a higher incidence of atraumatic ICrH-related mortality.
Background: Moyamoya disease (MMD) is a complex cerebrovascular disorder. While its neurological manifestations are well documented, the association between MMD and short stature remains underrecognized. This review explores potential mechanisms linking MMD with growth impairment, with a focus on endocrine and syndromic contributors. Methods: A systematic review was conducted in accordance with PRISMA guidelines using PubMed and Scopus databases. Studies reporting cases of MMD with short stature or growth impairment were included. Data were extracted on patient demographics, endocrine findings, genetic mutations, neuroimaging, management, and outcomes. A narrative synthesis approach was used due to heterogeneity in study designs. Results: Across 25 studies, 30 individuals with MMD and clinically significant short stature were identified, predominantly pediatric (2.5–52 years). Presentations frequently included seizures ( n = 21), TIAs ( n = 8), hemiparesis ( n = 7), cognitive impairment ( n = 8), and headaches ( n = 3); in many, growth failure predated neurological events. Height deficits ranged from −2.13 to −23.7 SDS. Endocrine involvement was common: growth hormone deficiency ( n ≈ 6), delayed bone age ( n = 3), and other pituitary–thyroid–gonadal disturbances; a rare pituitary stalk duplication was reported. Management varied. Indirect revascularization in selected cases reduced recurrent ischemia; growth hormone therapy improved height velocity. Antiplatelets were commonly used; anticoagulation occasionally led to complications. Outcomes were heterogeneous; four deaths occurred, typically in patients with severe multisystem disease. Conclusion: Growth retardation in MMD is generally a manifestation of hypothalamic–pituitary dysfunction, chronic cerebral hypoxia, or genetic syndromes. The observations in the present study suggest that MMD may be part of a more generalized multisystemic disorder in some patients and needs multisystemic assessment and management.
Background: Hypertension is the most common cause of intracerebral hemorrhage (ICH). The presentation, etiology, and outcome of ICH among young adults may vary compared to other age groups. The prior literature from our region has described a variety of etiologies with an inconsistent relationship to hypertension, which is the commonest cause of primary ICH in adults overall. Objective: We aimed to determine the demographic pattern, clinical presentation, underlying etiology, radiological characteristics, and outcome of ICH among young adults in our population. Methods: This was an IRB-approved chart review that included patients from January 2016 to December 2020. Descriptive young adults were defined as people between 15 and 45 years and arbitrarily divided into threee further age groups. A variety of demographic, clinical, and radiological features were compared among the subgroups and presented as descriptive and comparative analyses. Results: A total of 120 patients were included; 110 (91.7%) were males. The mean age was 26.8 ± 7.4 years. Majority, 86 (73.5%), presented with loss of consciousness; 22 (18.8%) had seizures, 14 (13.2%) had headaches, and 13 (11.9%) had vomiting. Traditional vascular risk factors, hypertension (5.8%) and diabetes mellitus (2.5%) were uncommon. Mean GCS was 7 ± 4. The commonest cause was trauma in 101 (84.2%) patients. Lobar hemorrhage was the commonest, 99 (83.2%); 92 (81.4%) had ICH volume < 30 mL, and ventricular involvement was seen in 43 (36.1%). Median ICH score was 2. Higher odds of mortality were observed among the oldest age group (OR 4.30, 95% CI 1.23-14.98, p = 0.022), higher ICH scores (OR 3.37, 95% CI 1.86-6.09, p < 0.001), ICH volume > 30 mL (OR 16.40, 95% CI 5.35-50.26, p < 0.001), ventricular extension (OR 5.60, 95% CI 2.14-14.68, p < 0.001), and nontraumatic ICH etiology (OR 3.59, 95% CI 1.26-10.26, p = 0.017). Conclusions: In our cohort, ICH was more common in young males; trauma being the leading cause of ICH. ICH resulted in significant morbidity and mortality in this population. Larger hemorrhages, ventricular involvement, and relatively older age were poor prognostic factors.
Background and Aims: Histological analysis of thrombi can enhance the understanding of pathophysiology. We aimed to analyze EVT-retrieved thrombi in cerebral venous thrombosis (CVT), compare them with acute ischemic stroke (AIS) thrombi, and correlate their composition with CT density. Methods: Retrospective case-series, including five CVT and 10 AIS cases treated with EVT. Thrombus sections were stained with hematoxylin and eosin; Picro Mallory for RBCs, fibrin, and collagen; and Prussian Blue for iron plus immunohistochemical staining with anti-CD61 (platelets), anti-MPO (neutrophils), anti-CD3 (T-cells), anti-CD20 (B-cells), anti-CD34 (endothelial cells), anti-CD68 (macrophages), and anti-citH3 (NETs). Thrombus components were quantified (Orbit) and expressed as a percentage of total area. The CVT-thrombus relative density (rHU) was calculated as HU thrombus/HU contralateral. Results: All CVT cases showed extensive thrombosis. Four patients had prior anticoagulation, and four had rHU > 1.00 with CT hyperdensity. The etiologies were heterogeneous. CVT thrombi were rich in red blood cells and displayed variable histological features, including signs of early organization. Compared to arterial thrombi, venous thrombi exhibited larger size (surface area 185.6 mm2 [IQR 83.0-237.9] vs. 21.8 mm2 [IQR 8.8-77.8]; p = 0.028) and lower fibrin content (16.6% [IQR 13.9-31.5] vs. 46.5% [IQR 25.1-49.5]; p = 0.036), with no other significant differences in composition. Low fibrin content and high RBC-to-fibrin ratio (R -0.9 and R 0.9, respectively; p = 0.047 for both) showed a significant correlation with rHU. Conclusion: Our exploratory study first shows that CVT thrombi are larger than AIS thrombi, with higher RBC content and lower fibrin, matching CT density. These findings enhance the understanding of CVT pathophysiology but need validation.
Background: Cognitive impairments and depression are common after stroke. Noninvasive treatments like transcranial direct current stimulation (tDCS) and mindfulness-based interventions have shown potential for improving these outcomes, though their effects on stroke survivors remain unclear. This study is aimed at evaluating the efficacy of mindfulness and tDCS in enhancing cognitive function and alleviating depression in stroke survivors. Methods: This randomized controlled trial, conducted from July 2021 to July 2022, included 30 stroke survivors divided into three groups: mindfulness (n = 5), tDCS (n = 14), and control (n = 11). Cognitive function was measured using Addenbrooke's Cognitive Examination-III (ACE-III), and depression was assessed using the Beck Depression Inventory-II (BDI-II) before and after interventions. The tDCS group received 10 sessions of anodal stimulation, and the mindfulness group underwent eight weekly sessions of mindfulness-based stress reduction. Data were analyzed using paired t-tests for within-group comparisons and ANOVA for between-group differences. Results: The tDCS group showed significant improvement in cognitive function, with ACE-III scores increasing by 9.14 ± 8.24 points (p = 0.02). Fluency and orientation scores also improved significantly in this group (p < 0.001 and p = 0.01, respectively). No significant cognitive changes were observed in the mindfulness group. Depression scores (BDI-II) did not change significantly in any group. Conclusions: tDCS significantly improved cognitive performance, particularly in fluency and orientation, while mindfulness showed no significant cognitive or depression-related effects. Future studies should explore the long-term impact of these interventions in stroke rehabilitation. Trial Registration: ClinicalTrials.gov identifier: IRCT20090716002195N3.
Background: Calcified cerebral emboli (CCEs) represent a rare cause of acute ischemic stroke and can pose technical challenges for neurointerventionalists. The few studies on endovascular thrombectomy (EVT) of CCE to date show poor recanalization rates and unfavorable outcomes. Objective: This study is aimed at investigating the technical and clinical results concerning EVT of CCE compared with noncalcified cerebral emboli (NCCEs). Methods: All cases of EVT for acute stroke from January 2014 to December 2021 from a single center were analyzed retrospectively. Emboli with a maximum density of ≥ 130 Hounsfield units on preinterventional CT scans were considered calcified. Propensity score matching was performed to compare technical and clinical results between patients with CCE and NCCE. Results: CCEs were present in 26 of 1004 cases (2.6%). Successful recanalization (mTICI ≥ 2b) was achieved less frequently in CCE (CCE: 62%, NCCE: 92%, p = 0.009). Also, first‐pass reperfusion was less common in CCE (CCE: 12%, NCCE: 46%, p = 0.006). In CCE, infarct growth was more frequent (CCE: 81%, NCCE: 42%, p = 0.004) and more severe ( p = 0.005). National Institutes of Health Stroke Scale improvement after EVT was lower in CCE patients (CCE: median 2, range −23 to 20, interquartile range (IQR) 2.75; NCCE: median 5, range −8 to 17, IQR 11, p = 0.008). Conclusion: First‐pass reperfusion is less common in EVT of CCE. Also, there is a more frequent and severe infarct growth in CCE patients after EVT, which helps to understand the poorer clinical results. Thrombectomy devices optimized for CCE are desirable to improve outcomes in this subgroup of stroke patients.
Poststroke cognitive impairment (PSCI) refers to any level of cognitive decline occurring after a stroke, ranging from mild to severe impairments, while PSCI with dementia describes a more severe form where the cognitive decline significantly affects daily functioning and meets the clinical criteria for dementia. PSCI occurs in more than half of individuals who have had a stroke. Despite its high prevalence, the pharmacotherapeutic options for PSCI are limited. Several pharmacotherapeutic options like cholinesterase inhibitors (e.g., donepezil, galantamine, and rivastigmine) and N-methyl-D-aspartate receptor antagonists (e.g., memantine) have shown potential in improving cognitive functions. However, their overall effectiveness remains inconsistent across different studies and patient populations. Newer drugs such as citicoline, cilostazol, and antidepressants have shown promise, but further research is needed to validate their efficacy and safety specifically for PSCI management.
