Background and purpose:Stroke is a leading cause of death globally, placing a particularly high burden on Hungary and China. Our study aimed to compare the epidemiology, acute management, and stroke prevention strategies based on Hungarian and Chinese data. Methods:We conducted a comprehensive literature review using Hungarian and Chinese epidemiological data, national health reports and guidelines, local protocols for stroke management, and publications related to prevention strategies. Data collection involved PubMed and MEDLINE databases; we also included results from the Global Burden of Disease Study to compare stroke incidence and mortality data in the two populations. The analysis of data from the two countries allowed for the identification of key trends. Results:Despite the global decline in stroke-related mortality, Hungary's age-standardized stroke mortality rate remains above the European average, while a 32% increase has been seen in stroke-related deaths since 1990 in China. Even with the implementation of national stroke prevention initiatives, an increasing trend is observed in the prevalence of cardiovascular risk factors in both countries. The stroke management protocols of both nations align with international guidelines, including recommendations for intravenous thrombolysis and mechanical thrombectomy, as well as efforts to establish stroke center networks and systems that enhance prehospital care efficiency. Conclusion:While advancements in stroke management are evident in both Hungary and China, challenges persist in optimizing stroke prevention, reducing "stroke-to-needle time", and expanding rehabilitation services.

INTRODUCTION:Early identification of stroke aetiology, hemodynamic monitoring and detection of complications represent key challenges for vascular neurologists. Stroke-point-of-care ultrasound (Stroke-POCUS) has emerged as a structured framework for integrating multimodal bedside ultrasound into stroke management. PATIENTS AND METHODS:Stroke-POCUS involves the comprehensive bedside use of various ultrasound modalities, including cervical and transcranial ultrasound, orbital ultrasound, echocardiography, venous system ultrasound, lung ultrasound, abdominal ultrasound and interventional ultrasound. These modalities are applied in an integrated manner to assess stroke patients in the acute setting, aiming to support diagnosis, etiological investigation, detection of complications and monitoring of treatment response, as an adjunct, not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive ultrasound examination. RESULTS:The integration of multiple ultrasound modalities within Stroke-POCUS enables clinicians to obtain rapid, noninvasive answers to well-defined clinical questions at the patient's bedside and in real time. This capability is particularly critical for patients requiring expedited diagnostics prior to urgent treatment initiation, for clinically unstable patients in whom intrahospital transport carries an increased risk of complications, as well as for assessing potential underlying causes, identifying secondary complications and monitoring treatment efficacy. DISCUSSION AND CONCLUSION:Stroke-POCUS represents a comprehensive bedside imaging strategy that enhances the evaluation and management of stroke patients. By integrating multiple ultrasound techniques, it provides a more holistic view of stroke pathophysiology, complications and treatment monitoring, potentially improving clinical decision-making and individualised patient care.

Human brain tissues obtained from autopsies, as well as muscle and nerve samples derived from biopsies, constitute indispensable resources for translational research investigating the pathomechanisms of neuropsychiatric disorders. In this study, we introduce the Nervous System Tissue Bank of University of Debrecen, which contains formalin-preserved and formalin-fixed paraffin-embedded (FFPE) brain samples, as well as frozen nerve and muscle biopsy specimens. Database was established containing clinical and pathological parameters. For autopsy cases, the following variables were recorded: sex, age, number of hospitalization days, admission diagnosis, comorbidities, cause of death, post-mortem interval, general autopsy findings, and macro- and microscopic brain pathology diagnoses. For biopsy samples, we recorded: sex, age, biopsy site, and microscopic and molecular genetic diagnoses. Based on the recorded parameters and their temporal changes, retrospective statistical analyses were performed. Formalin-fixed brain samples and FFPE blocks were available from 2425 deceased individuals, and nerve/muscle samples from 257 patients. The brain samples originate from the period between 1990 and 2012. The most frequent admission diagnoses included ischemic stroke (n = 1070), hemorrhagic stroke (n = 462), subarachnoid hemorrhage (n = 102), epilepsy (n = 103), brain metastasis (n = 70), primary brain tumor (n = 60), parkinsonism (n = 28), dementia (n = 21), and amyotrophic lateral sclerosis (n = 21). Prevalence of hypertension (67.6

Abstract Background and aims Carotid atherosclerosis is a major cause of acute ischemic stroke (AIS) and is driven by vascular risk factors promoting endothelial dysfunction and plaque progression. While platelet-related mechanisms have been extensively studied, the association between the extent of carotid stenosis and global coagulation activation remains unclear. This study aimed to investigate the relationship between carotid stenosis severity and hypercoagulability using thrombin generation assay. Methods This prospective observational study included asymptomatic patients with moderate carotid atherosclerosis (1-49% stenosis) and advanced carotid atherosclerosis (50-99% stenosis or occlusion), complemented by an additional group of patients with advanced carotid atherosclerosis presenting with AIS. Carotid stenosis was assessed by Doppler ultrasonography. Venous blood samples were collected for laboratory assessment. Thrombin generation was measured in platelet-poor plasma using the calibrated automated thrombogram method, evaluating endogenous thrombin potential (ETP), peak thrombin, time to peak and lag time. Results Ninety patients were analyzed, with 30 patients in each study group across the predefined clinical categories. Patients with advanced stenosis and AIS demonstrated significantly higher thrombin generation, reflected by increased ETP and peak thrombin, compared with both moderate and advanced asymptomatic stenosis groups (p<0.01). hsCRP correlated positively with peak thrombin and ETP and in the asymptomatic groups (r=0.2629, p=0.0425; r=0.3016, p=0.019) and the overall cohort (r=0.2973, p=0.0047; r=0.3611, p=0.0005). ETP correlated with cholesterol levels both in the asymptomatic groups (r=0.4134, p=0.0011) and across all patients (r=0.4540, p<0.0001). Conclusions Advanced carotid stenosis, particularly when accompanied by acute ischemic stroke, is associated with increased thrombin generation, with parallel associations observed with inflammatory and lipid markers. Conflict of interest István Szegedi: nothing to disclose. Linda Lóczi: nothing to disclose. Dóra Bomberák: nothing to disclose. Renáta Pataki: nothing to disclose. Zsolt Barnabás Éles: nothing to disclose. László Oláh: nothing to disclose. László Csiba: nothing to disclose. Zsuzsa Bagoly: nothing to disclose.

Background/Objectives: Several therapeutic approaches, including phlebotomy and rheopheresis, are used to improve hemorheological parameters. While the effects of phlebotomy on cerebral circulation have been described, the impact of rheopheresis on cerebral hemodynamics remains poorly understood. This study primarily aimed to evaluate the within-group effects of phlebotomy and rheopheresis on cerebral blood flow velocity changes evoked by neuronal activation and on cerebrovascular reactivity in patients with elevated hematocrit or hyperviscosity, respectively. Methods: In our present study, we used transcranial Doppler to examine the effects of phlebotomy (n = 11) and rheopheresis (n = 9) on cerebral hemodynamics in patients with elevated hematocrit and hyperviscosity, respectively. Measurements included resting flow velocity (FV) in the posterior cerebral artery (PCA) and middle cerebral artery (MCA), the visually evoked FV response in the PCA (neurovascular coupling) and the hypercapnia-induced FV response in the MCA (cerebral vasoreactivity). In addition to flow velocity data, visual evoked potential (VEP) parameters were also recorded to assess neuronal activation. Results: Phlebotomy significantly reduced hematocrit and hemoglobin levels, while rheopheresis led to a significant decrease in both blood and plasma viscosity. Although we observed no differences in resting FV values before and after either intervention, the FV increase in response to visual stimulation and hypercapnia was greater after rheopheresis than before, whereas no such difference was observed following phlebotomy. VEP parameters remained similar before and after both phlebotomy and rheopheresis. Conclusions: Our data indicate that rheopheresis reduces blood and plasma viscosity in patients with hyperviscosity and leads to a significant improvement in cerebral vasoreactivity and neurovascular coupling, without affecting VEP parameters. The improvement in cerebral vasoreactivity, but no changes in VEP parameters, suggests that the improved FV response to visual stimulation after rheopheresis is most likely caused by better vascular response rather than improved neuronal activation.

Abstract Background and aims Intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) is an effective treatment for acute ischemic stroke (AIS), but intracranial hemorrhage (ICH) remains a major complication. Reliable prediction of therapy-associated ICH at treatment initiation is lacking. This prospective observational study investigated whether rotational thromboelastometry (ROTEM) can predict the safety and outcome of thrombolysis, and whether assay modification improves its predictive value. Methods Blood samples were collected from 114 AIS patients before and immediately after intravenous rt-PA administration. ROTEM was performed at both timepoints using citrated whole blood in a ROTEM SIGMA device. To mimick the in vivo effect of rt-PA, the test was also performed in the presence of 140 ng/mL rt-PA (mROTEM-t-PA) added directly to pre-thrombolysis samples. Therapy-associated ICH was classified according to ECASSII. Short-term outcome was assessed by NIHSS change on day 7 relative to admission. Long-term outcomes were defined at 3 months post-event by the modified Rankin Scale. Results The mROTEM-tPA assay correlated strongly with both pre- and post-thrombolysis ROTEM clot formation parameters, indicating reliable modeling of rt-PA effects. Higher pre-thrombolysis clot firmness (A5, MCF) was associated with more severe stroke. Pre-thrombolysis EXTEM A5 demonstrated modest predictive value for unfavorable short-term outcome (AUC=0.64, p=0.022). No standard ROTEM parameter predicted 90-day functional outcome or ICH. The mROTEM-tPA EXTEM LI60 strongly predicted ICH, as all cases showed complete clot lysis (LI60=0%). An LI60 >0% excluded post-lysis ICH with 100% sensitivity and negative predictive value (p=0.038). Conclusions These results suggest that modified ROTEM testing may help exclude thrombolysis-associated ICH using pre-treatment samples. Conflict of interest István Szegedi: nothing to disclose. Rita Orbán-Kálmándi: nothing to disclose. Dóra Bomberák: nothing to disclose. Linda Lóczi: nothing to disclose. Tamás Árokszállási: nothing to disclose. László Oláh: nothing to disclose. László Csiba: nothing to disclose. Zsuzsa Bagoly: nothing to disclose.

Hemiplegic migraine (HM) is a rare subtype of migraine with aura characterized by transient unilateral motor weakness during attacks. Although monoclonal antibodies (mABs) targeting the calcitonin gene-related peptide (CGRP) pathway have shown efficacy in migraine prevention, their role in HM remains largely unexplored, since these patients are generally excluded from randomized clinical trials aimed at developing migraine preventive drugs. We present a case of a middle-aged woman with chronic migraine and recurrent hemiplegic episodes treated with fremanezumab. After 11 months of monthly 225 mg subcutaneous fremanezumab injections, the patient experienced a substantial reduction in monthly headache days, aura episodes, and symptom severity, without safety concerns. This case adds to the emerging evidence supporting CGRP mABs as a potential therapeutic option for HM. Further research is needed to elucidate their precise mechanism and determine their efficacy in broader HM populations.

Sleep deficiency increases the risk of cerebrovascular diseases. However, the effects of sleep deprivation (SD) on cerebral blood flow have been poorly studied. We examined the effect of 24-h of SD on the resting posterior cerebral artery (PCA) and middle cerebral artery (MCA) flow velocities (FV), the visually evoked FV response in the PCA (neurovascular coupling), and the hypercapnia-induced FV response in the MCA (cerebral vasoreactivity). Visual evoked potential (VEP) and transcranial Doppler examinations were performed in 25 healthy adults before and after 24-h of SD. Cerebral vasoreactivity was measured by breath-holding test in left and right MCA. The visually evoked FV response was evaluated in left and right PCA. There was a tendency for increased resting mean FV in PCA (p = 0.08) and MCA (p = 0.07) after SD. Both the visually evoked FV response in the PCA and the hypercapnia-induced FV increase in the MCA were significantly lower after than before SD, however, no change in VEP amplitudes was found. Our study suggested that the impaired functional stimulation-evoked FV response after SD was not due to a reduced neuronal activation, but probably to a decreased vasodilatory response. Negative effects of SD on cerebral hemodynamics were also demonstrated by reduced cerebral vasoreactivity.

Background and purpose - Carotid revascularization through carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well established secondary preventive measures after ischemic stroke in unilateral carotid artery stenosis, but in the presence of contralateral carotid occlusion (CCO) the evidence regarding the optimal management of the stenotic carotid is not as clear even though the risk of ischemic stroke is high. The purpose of our review is to summarize recent findings and suggest its future implications. Methods - We conducted a systematic literature review using PubMed and ScienceDirect databases supplemented with studies found from Google Scholar. Results - Recent guidelines recommend CAS over CEA in patients with CCO, but in contrast some studies favor CEA over CAS after analysis of the complications and clinical outcome. Discussion - The decision between CEA and CAS depends upon a variety of factors such as neurological status, surgical risk factors, medical comorbidities, age, and imaging findings (presence of silent infarcts, plaque characteristics and the state of collateral circulation). Due to the contradictory observations the authors suggest further multicenter studies to establish the optimal management of patients with carotid stenosis and CCO and also summarize their personal opinion.

The use of monoclonal antibodies targeting Calcitonin Gene-Related Peptide (CGRP) is an established treatment for chronic migraine (CM). However, its efficacy in CM patients with medication overuse headache (MOH) remains underexplored, and data on the safety and patient compliance of standard-to-high doses, especially Eptinezumab and Erenumab, over at least three months are limited. This study aims to evaluate the efficacy and safety of anti-CGRP therapy (Eptinezumab and Erenumab) in CM and MOH patients. Specifically, it assesses changes in monthly migraine days (MMDs) after 12 weeks, risk of treatment-emergent adverse events (TEAEs) leading to discontinuation, serious TEAEs, common adverse effects, and MOH remission at 6 months. A systematic search of PubMed, Cochrane, and Scopus databases identified randomized controlled trials (RCTs) evaluating standard or high dose anti-CGRP therapy in CM patients strictly with MOH. Studies included were required to report a ≥ 50

The impact of acute alcohol consumption at the onset of spontaneous non-traumatic intracerebral hemorrhage (ICH) remains unclear. We evaluated the association between elevated blood alcohol concentration (BAC) at admission and clinical outcomes in patients with ICH. This retrospective single-center cohort study analyzed 1081 patients admitted with ICH between 2000 and 2023. BAC was measured at admission when alcohol use was suspected. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS). Outcomes—7-day neurological deterioration (ND), mortality, 90-day modified Rankin Scale (mRS) scores—were analyzed using logistic and Cox regression models to assess associations with acute alcohol consumption. Patients that were BAC positive (alcohol group; n = 31, 2.9

The prevalence of neurocognitive impairment subsequent to haemorrhagic stroke is notably high, thus constituting a significant predictor of survival and functionality. To date, however, there has been a paucity of studies that have described the profile of specific cognitive impairments in patients suffering from haemorrhagic strokes. The objective of the present study is twofold: firstly, to analyse in detail cognitive impairment after haemorrhagic stroke; secondly, to investigate the improvement in cognitive function and to determine its association with potential prognostic factors. The present pilot study comprised 17 haemorrhagic stroke patients who underwent a detailed cognitive assessment on day 14 and 3 months after the haemorrhage using the Montreal Cognitive Test, Rey Auditory-Verbal Learning Test, Letter Fluency and Semantic Fluency Tests, Number Span Test and CANTAB. At baseline, 18.8% of patients exhibited minor neurocognitive impairment, while 43.8% demonstrated major neurocognitive impairment. A number of significant changes were observed between the two time points in spatial-visual abilities, executive functions, attention/concentration, short-term memory and orientation. A subsequent investigation into the laterality of the haemorrhage revealed a significant discrepancy, as determined by the t-test results. Specifically, the right hemisphere haemorrhage exhibited a reduced degree of cognitive impairment. Among the factors influencing improvement, a significant correlation was identified between residual bleeding and perifocal edema size as seen on the 3rd month CT. The findings of our subsequent study demonstrated considerable neurocognitive and domain-specific impairments subsequent to haemorrhagic stroke. It is important to note that improvement was observed in several cognitive domains three months after the event, and we were able to identify prognostic factors influencing recovery. It is hypothesised that these findings may inform the design of rehabilitation programmes. This is due to the fact that they provide clinicians with a more precise understanding of the cognitive status of patients suffering from post-haemorrhagic stroke.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most common sleep-related breathing disorder. Longer term, repeated episodes of hypercapnia and hypoxemia during sleep are associated with inflammatory and atherosclerosis-related factors. The aim of this study was to explore the effect of continuous positive airway pressure (CPAP) therapy on cerebral vasoreactivity and early atherosclerosis in patients with severe OSAHS. Forty-one patients with severe OSAHS were enrolled. The mean follow-up time was 39.8 ± 9.1 months. Cardiovascular risk factors were assessed, and laboratory tests, carotid artery intima-media thickness (CIMT) measurement and cerebrovascular reserve capacity (CRC) measurement were performed. After the baseline examination, 28 patients received CPAP therapy (treated group), which was not available for 13 patients (untreated group). Parameters were compared before and after treatment, between treated and untreated patients. Cardiovascular risk factors, baseline polysomnographic parameters, laboratory values, CIMT and CRC of the two groups were similar at baseline. At the follow-up, CRC did not differ between the two groups, but CIMT was significantly lower in the treated group than in the untreated group (0.73 ± 0.11 mm vs. 0.84 ± 0.21 mm, p = 0.027). The CIMT of both groups increased significantly during the follow-up period (from 0.65 ± 0.11 mm to 0.73 ± 0.11 mm in the treated group, and from 0.69 ± 0.11 mm to 0.84 ± 0.21 mm in the untreated group), but the increase in the treated group was smaller than in the untreated group (0.09 ± 0.09 mm vs. 0.15 ± 0.15 mm). In patients with severe OSAHS, CPAP treatment significantly reduced the progression of CIMT.

Background: Ischemic stroke is a leading cause of mortality worldwide, and intravenous thrombolysis, while improving functional outcomes, still leaves a significant mortality rate. This study aimed to investigate the clinical and pathological data of thrombolysed stroke patients who subsequently died and underwent autopsy, focusing on hemorrhagic transformation (HT). Methods: Over a 10-year period, 1426 acute ischemic stroke patients received thrombolysis at our center, with an in-hospital mortality rate of 11.7%. Autopsies were performed on 98 of the 167 deceased patients. Results: HT was found in 47% of these cases, only less than half occurring within a day of thrombolysis. Significant independent predictors of HT included higher lactate dehydrogenase (LD) levels and higher INR values at admission. HT directly caused death in 30% of cases, often through herniation, while other complications (pulmonary embolism, pneumonia) were also common. Conclusions: These findings highlight the importance of postmortem investigations to accurately determine the incidence of HT and contributing factors. Our data indicate that in the vast majority of HT cases, the role of contributing factors other than rt-PA may be important. Of the routinely assessed clinical and laboratory parameters at admission, only LD and INR were found to be independent predictors of HT in the autopsied studied cohort.

Since its clinical introduction in 2015, endovascular treatment has become the standard method of reperfusion thera py in acute ischaemic stroke with largevessel occlusion. Endovascular treatment requires a multidisciplinary appro ach, which can be achieved mainly in comprehensive stroke centres. The former stroke chain of survival has been extended: interhospital transport has become necessary, neurointervention and anaesthesia teams have joined the stroke care. Today, advanced radiological diagnostics include multimodal imaging, rapid data transfer and software decision support. The primary goal of therapeutic efforts is revascularization within the time window. Reperfusion therapy beyond the standard time window can be performed in selected cases with penumbra imaging. The tempora ry viability of the penumbra is ensured by a variable collateral circulation. In reperfusion therapy, intravenous throm bolysis has retained its previous role and its indications have been broadened. Endovascular treatment is clearly an effective method in cases of confirmed largevessel occlusion, but its availability is limited and the success of its exe cution is influenced by personal, institutional and organisational factors as well as anaesthetic considerations. The clinical role of endovascular treatment, its true importance and the organisational changes in heathcare system are poorly understood in the general medical community

Az endovascularis terápia a 2015. évi klinikai bevezetése óta az akut ischaemiás stroke nagyérelzáródással járó formáiban a revascularisatio standard módszerévé vált. Az endovascularis terápia multidiszciplináris megközelítést igényel, mely elsősorban komprehenzív stroke-centrumokban valósítható meg. A korábbi stroke-ellátási lánc kibővült: interhospitális transzport vált szükségessé, neurointervenciós és aneszteziológiai team csatlakozott az ellátók közé. A korszerű radiológiai diagnosztika multimodális képalkotás mellett gyors adattovábbítást és szoftveres döntéstámogatást is magában foglal. A terápiás erőfeszítések elsődleges célja az időablakon belüli revascularisatio. A még megmenthető agyterület (penumbra) átmeneti életképességét variábilis kollaterális keringés biztosítja. Standard időablakokon túl végzett revascularisatióra válogatott esetekben, penumbra-képalkotás mellett nyílhat lehetőség. A revascularisatióban az intravénás thrombolyis megőrizte eddigi szerepét, és indikációs köre a korábbiakhoz képest kibővült. Igazolt nagyérelzáródás esetén az endovascularis terápia egyértelműen hatékony módszer, elérhetősége azonban korlátozott, a kivitelezés sikerességében pedig személyi és szervezési tényezők is szerepet játszanak. Mindezek mellett aneszteziológiai szempontok is megjelentek. Az endovascularis terápia klinikai szerepe, valódi jelentősége és a bevezetés kapcsán kialakult szervezési változások az általános orvosi köztudatban kevéssé ismertek. Orv Hetil. 2024; 165(1): 14–23.