Background Potential causes of embolic stroke of undetermined source (ESUS) include occult malignancy, venous thrombosis (VTE) with paradoxical embolism, and hypercoagulable disorders. Given the association of markers of coagulation and hemostatic activation (MOCHA) with these causes, the objective of this study was to validate the utility of the MOCHA profile in identifying the underlying cause of

Background Endovascular thrombectomy (EVT) is highly effective but may also lead to hemorrhagic transformation (HT) and edema, which may be more pronounced in severe ischemia. We sought to determine whether glibenclamide can attenuate HT and edema in a severe ischemia-reperfusion model that reflects EVT. Methods Using a transient middle cerebral artery occlusion (tMCAo) rodent model of stroke, we studied

Objectives Inflammation is associated with the occurrence and prognosis of ischemic stroke. The aim of this study was to evaluate the association between inflammatory biomarkers and the short-term clinical outcomes of acute ischemic stroke (AIS) patients after intravenous thrombolysis (IVT). Materials and Methods A total of 208 AIS patients treated with IVT were enrolled in this retrospective study

Background Postoperative atrial fibrillation (POAF) is associated with an increased risk of short and long-term stroke. Our aim is to identify the independent predictors of cerebrovascular accident (CVA) development in the patients who underwent isolated coronary artery bypass graft (CABG) surgery and developed POAF which lasted within 48 h. Method 301 consecutive patients who underwent isolated CABG

Aim: Optimal blood pressure (BP) management in vertebrobasilar circulation stroke patients undergoing thrombectomy remains undetermined. We aimed to evaluate the impact of perioperative BP on clinical outcome after MT in acute basilar artery occlusion (BAO) patients. Methods: We retrospectively analyzed all consecutive patients hospitalized with acute basilar artery occlusion administered endovascular

The case of a 70-year-old male presenting an ischemic stroke related to COVID-19 infection is described. He was initially admitted to the hospital with respiratory insufficiency syndrome secondary to pneumonia caused by SARS Co2. In the next days, he developed rapid neurological deterioration characterized by drowsiness which progressed to deep coma. D-dimer was elevated. Brain CT scan showed bilateral

Objectives We report a 61-year-old woman who developed left hemiparesis following a right frontal stroke. She underwent rehabilitation and regained function of the left side of her body. Three years after her first stroke, she developed a large left subdural hematoma and again presented with left hemiparesis. Materials and Methods Prior to the cranioplasty, an fMRI scan involving left and right hand

Objectives The ongoing literature recommends carotid endarterectomy (CEA) primarily for patients with neurological symptoms, however CEA can be precluded by the onset of a severe stroke or a total carotid occlusion. The present study aims to evaluate the effect of unheralded strokes in patients with a previously asymptomatic carotid stenosis (ACS) possibly considered for CEA. Materials and Methods

Objective To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients. Methods Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging

Background Recent studies have demonstrated an association between the gut microbiome and cognitive function. However, the associations between the gut microbiome and brain parenchyma damage, and their underlying mechanisms, remain unclear. Materials and Methods We performed a cross-sectional sub-analysis using data from our prospective cohort study to determine the association between the gut microbiome

Objectives The transradial approach (TRA) is technically feasible for both diagnostic and therapeutic neurointerventions. It improves patient comfort and is not associated with increased procedural complications when compared to the transfemoral approach (TFA). To date, no studies have looked at barriers to adoption of TRA in the neurointerventionalist community. This study aims to obtain neurointerventionalist

Background In all of randomized controlled trials of mechanical thrombectomy, the target vessels were proximal. Herein we report a clinical trial of the Tron FX stent retriever, including the smallest size of 2/15 mm for distal intracranial large vessel occlusion (LVO). Objective Eligible patients presented within 8 h of onset with proximal or distal LVOs, and the Tron FX 4/20 mm or 2/15 mm were used

Introduction Cerebral small vessel disease (CSVD) causes a quarter of all strokes and is the most common pathology underlying vascular dementia. However, the mechanism of CSVD remains unclear. Numerous studies have investigated whether the angiotensin-converting enzyme (ACE) intersection/deletion (I/D) polymorphism influences the risk of CSVD, but the results are controversial. Methods We searched

Objectives In a previous pilot study, we found an association between high factor XII levels and risk of haemorrhagic stroke suggesting that factor XII is a risk marker for intracerebral haemorrhage (ICH). The aim of this study was to further investigate the association between factor XII and risk of ICH in a larger population. Materials and Methods This study was conducted as a prospective nested

Objectives How race/ethnic disparities in acute stroke care contribute to disparities in outcomes is not well-understood. We examined the relationship between acute stroke care measures with mortality within the first year and 30-day hospital readmission by race/ethnicity. Materials and methods The study included fee-for-service Medicare beneficiaries age ≥65 with ischemic stroke in 2010–2013 treated

Objective To investigate the radiographic features, temporal evolution, and outcome of patients who develop non-traumatic intracerebral hemorrhage (ICH) while hospitalized for other causes. Methods We retrospectively reviewed consecutive Emergency Department ICH (ED-ICH) and in-hospital ICH (IH-ICH) over an 8-year period. Variables including demographics, medical history, lab values, lead time to diagnosis

Objectives The relationship between stroke etiology and clot pathology remains controversial. Materials and Methods We performed histological analysis of clots retrieved from 52 acute ischemic stroke patients using hematoxylin and eosin staining and immunohistochemistry (CD42b and oxidative/hypoxic stress markers). The correlations between clot composition and the stroke etiological group (i.e., cardioembolic

Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case

Background We aimed to determine whether combined assessments of single movement tasks could predict falls in community dwelling people with stroke and it was more precision than the berg balance Scale consists of 14 movements. Methods This prospective cohort study performed at five rehabilitation hospitals in Japan. Participants comprised 78 patients with ambulatory stroke. The single movement task

Objectives The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS

Objectives Cilostazol has promise as an alternative to aspirin for secondary stroke prevention given its vasodilatory and anti-inflammatory properties in addition to platelet aggregation inhibition. We aimed to conduct a systematic review and meta-analysis to estimate the efficacy and safety of cilostazol compared to aspirin for stroke prevention in patients with previous stroke or transient ischemic

Objectives Despite the proven efficacy of endovascular thrombectomy (EVT) for large vessel occlusion stroke, over half treated remain functionally disabled or die. Infarct topography may have implications for prognostication, patient selection, and the development of tissue-specific neuroprotective agents. We sought to quantify white matter injury in anterior circulation acute infarcts post-EVT to

Objectives Inflammation plays an important role in the development of atherosclerotic vascular disease, which is the leading cause of morbidity and mortality in the adult population. Several clinical trials have shown that suppression of the inflammatory response can delay or decrease the atherosclerotic process. The aim of this study was to investigate carotid intima-media thickness (CIMT) between

Introduction In previous studies the risk of stroke recurrence has been associated with the left atrial appendage (LAA) morphology (non-chicken wing (NCW)), knowing those with a greater risk as malignant LAA. Recently, a simpler morphological classification has been suggested with two categories: Low-risk (LAA-L) and High-risk (LAA-H); which could be easier to apply and may correlate better with the

Objective This study aimed to develop a predictive model of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). Methods The present retrospective cohort study considered patients with AIS who were admitted to a tertiary hospital in Shenzhen, China between January 2014 and December 2018. An increase of 2 points or more on the National Institute of Health Stroke Scale

Background and Purpose Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic. Methods Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals

Purpose Non-contrast CT ASPECTS (NCCTasp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTAasp) may be superior to NCCTasp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPSasp) would

Introduction Urinary titin is a biomarker of muscle atrophy, which is a serious complication after stroke. However, there are currently no clinical data regarding urinary titin in stroke patients. Methods Consecutive stroke patients admitted to the stroke care unit were included. Spot urine samples were collected immediately after admission, and on days 3, 5, and 7. The primary outcome was the trend

Objectives To compare three commonly used large-bore aspiration catheters in terms of final successful recanalization rate and first-passage successful and complete recanalization rates (the so called “first-passage effect”). Materials and methods it is an observational retrospective multicenter study conducted in three Italian high-volume tertiary stroke centers between January 2017 and May 2019.

Objective This study is to investigate the role of microRNA (miR)-30b in the pathogenesis of hypoxic-ischemic encephalopathy (HIE) in neonates. Methods Totally 26 cases of neonatal HIE were included in this study. The protein expression levels of CD26P and PAI-1 were detected with ELISA. Serum levels of miR-30b and PAI-1 mRNA was measured by quantitative real-time PCR. Human brain microvascular endothelial

Background Cerebral infarction is one of the most common causes of disability and death worldwide. It is reported that electric acupuncture was able to improve the prognosis of cerebral infarction by promoting angiogenesis. However, the corresponding signal pathways of angiogenesis promotes by electric acupuncture treatment needs to be further explored. Methods MCAO rat was employed as the animal model

Pseudoxanthoma elasticum (PXE) is a rare systemic genetic disorder and an uncommon cause of ischaemic and haemorrhagic strokes. Its rarity and variable presentation may delay recognition and diagnosis of the primary disorder or associated conditions. Here, we describe a patient of European ancestry diagnosed with PXE in her 20s who presented in her 50s with a haemorrhagic stroke. Subsequent workup

Objectives Coronavirus disease 2019 (COVID-19) is primarily known as a respiratory illness; however, a wide variety of symptoms and complications of the central nervous system (CNS), such as ischemic cerebrovascular accidents (CVA) have been reported. Hereby, we provide a systematic review and a meta-analysis of the literature, investigating the incidence of ischemic CVA and the mortality due to it

Objective Infective endocarditis (IE) is considered to be an absolute contraindication for intravenous tissue plasminogen activator treatment (IVtPA) in acute ischemic stroke (AIS). However, during the hyperacute stroke evaluation, the exclusion of IE may be difficult. We sought to report the prevalence of undiagnosed IE in AIS patients who received IVtPA. Methods We reviewed consecutive patients hospitalized

Objectives/Background Medical therapy is the first line of treatment for intracranial atherosclerotic disease (ICAD). Percutaneous transluminal angioplasty and stenting (PTAS) are mainly considered for those patients with severe stenosis and recurrent events despite aggressive medical therapy. In this review, we discuss the application of PTAS as a treatment option for ICAD and its future prospect

Objectives: Intracranial pressure (ICP) monitors have been used in some patients with spontaneous intracranial hemorrhage (ICH) to provide information to guide treatment without clear evidence for its use in this population. We assessed the impact of ICP monitor placement, including external ventricular drains and intraparenchymal monitors, on neurologic outcome in this population. Materials and Methods

Objectives The inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-activating peptide (AP)-induced platelet aggregation have not been fully elucidated. The present study aimed to investigate the inhibitory effects of P2Y12 receptor antagonist on PAR1- and PAR4-AP-induced platelet aggregation using platelet-rich plasma (PRP) from individuals including patients with stroke or transient

Background Despite recent progress in the multidisciplinary management of large middle cerebral artery infarcts, the neurological prognosis remains worrying in a non-negligible number of cases. The objective of this study is to analyze the contribution of optic nerve and perioptic sheath measurement on MRI to the acute phase of large middle cerebral artery infarcts. Methods A retrospective case-control

Purpose Cerebral ischemic injury contributes to severe dysfunction of the brain, which triggers extremely high mortality and disability. The role of microRNA (miR)-181a-5p is documented in cerebral ischemic injury. Therefore, this study intended to further figure out the mechanism of miR-181a-5p in cerebral ischemic injury. Methods miR-181a-5p expression in middle cerebral artery occlusion (MCAO) mouse

Background The oculomotor nerve has two major fibers: the outer autonomic fiber innervates the ciliary muscles and sphincter pupillae involved in pupil constriction, and the inner somatic fiber innervates the levator palpebrae superioris in the eyelid and four extraocular muscles involved in oculomotor dysfunction. We present a rare case of oculomotor nerve palsy with internal carotid artery (ICA)

Background and Purpose Perforator stroke is one of the most common complications of vertebrobasilar arterial stenting. We investigated whether perforator stroke after vertebrobasilar arterial stenting is associated with plaque enhancement in patients with severe vertebrobasilar artery stenosis. Methods We studied patients with symptomatic vertebrobasilar arterial stenosis who underwent stenting from

Objectives The efficacy of thrombolytic therapy with tissue plasminogen activator (tPA) is highly time dependent. Although clinical guidelines do not recommend written informed consent as it may cause treatment delays, local policy can supersede and require it. From 2014 to 2017, three out of five public hospitals in Singapore changed from written to verbal consent at different time points. We aimed

Introduction COVID-19 is a multi-system infection which predominantly affects the respiratory system, but also causes systemic inflammation, endothelialitis and thrombosis. The consequences of this include renal dysfunction, hepatitis and stroke. In this systematic review, we aimed to evaluate the epidemiology, clinical course, and outcomes of patients who suffer from stroke as a complication of COVID-19

Background Accumulating evidences have demonstrated the roles of several long non-coding RNAs (lncRNAs) in depression. We aim to examine the capabilities of lncRNA growth arrest-specific transcript 5 (GAS5) on mice with depression-like behaviors and the mechanism of action. Methods Fifty-six healthy mice were selected for model establishment. Morris water maze test and trapeze test were performed for

Objectives Higher glycemia on admission has been associated with diffusion weighted imaging (DWI) lesions in patients with spontaneous intracerebral hemorrhage (sICH). However, the influence of longitudinal glycemia after admission and during a patient's hospitalization on DWI lesions in sICH has not been studied. Our aim was to compare longitudinal glycemia in sICH patients with and without DWI lesions

Objectives: The aim of the current study was to examine longitudinal changes in quadriceps muscle mass and intramuscular adipose tissue in chronic stroke survivors. Materials and Methods: In this longitudinal study included 34 chronic stroke survivors who lived in the community. Ultimately, 20 chronic stroke survivors received an after 3-year assessment. Fourteen chronic stroke survivors were lost

Aim This study aims to analyze the effects of rhythm of music therapy on gait in patients with ischemic stroke, and explore the value of music therapy in walking training in stroke. Methods The present study is a prospective clinical study. Sixty patients with ischemic stroke, who were admitted to our hospital from October 2017 to December 2018, were enrolled. These patients were divided into two groups

Objective To report six consecutive patients with confirmed coronavirus disease-2019 (COVID-19) who underwent Transcranial Doppler (TCD) ultrasonography evaluation for cerebral microemboli in the setting of suspected or confirmed acute ischemic stroke. Methods Patient data were obtained from medical records from Northwestern Memorial Hospital, Chicago, IL between May and June 2020. All patients with

Objects In this study, we investigated the association between plasma total homocysteine(tHcy) levels and the risk of early hemorrhagic transformation(HT) in patients with acute ischemic stroke(AIS). Methods Consecutive hospitalized participants who met the inclusion criteria were enrolled and grouped according to plasma tHcy levels. Participants were divided into a low homocysteine level(L-tHcy) group

Objectives to investigate the relationship between insulin resistance (IR) and clinical outcomes in non-diabetic ischemic stroke patients treated with intravenous thrombolysis. Methods We recruited non-diabetic ischemic stroke patients treated with intravenous thrombolysis prospectively. IR was defined as homeostasis model assessment–estimated insulin resistance index ≥2.80. Initial stroke severity

The brain and kidney both uniquely are highly susceptible to vascular injury from shared vascular risk factors. However these are not sufficient to explain the complete extent of cerebrovascular disease especially small vessel disease in its myriad presentations that patients with chronic kidney disease manifest. They both require a large amount of blood supply to function optimally. Shared anatomical

Background and Purpose The coronavirus disease 2019 (COVID-19) pandemic has had a comprehensive impact on healthcare services worldwide. We sought to determine whether COVID-19 affected the treatment and prognosis of hemorrhagic stroke in a regional medical center in mainland China. Methods Patients with hemorrhagic stroke admitted in the Neurosurgery Department of West China Hospital from January

Background Intracerebral hemorrhage (ICH) is associated with high mortality, morbidity, and recurrence. Studies have reported the accuracy of several blood biomarkers in predicting clinical outcomes; however, their independent contribution in prediction remains to be established. Aim To investigate the incremental accuracy in predicting clinical outcomes in patients with ICH in a north Indian population

Background Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a group of systemic disorders characterized by inflammation of blood vessels and eosinophilia. Simultaneous brain and splenic infarcts are extremely rare in patients with EGPA. Case description We report a case of a 61-year-old male with a history of asthma and sinusitis who presented with paresthesia and purpura in the lower extremities

Background Revascularization of the symptomatic carotid artery is performed with endarterectomy or stenting. Rarely, patients may develop cerebral hyperperfusion syndrome (CHS) following revascularization. This usually occurs in the cerebral hemisphere ipsilateral to revascularized carotid stenosis. CHS rarely involves the contralateral hemisphere. Objective To present a case of CHS involving bilateral

Objectives To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. Materials and Methods Stroke patients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation

Chronic kidney disease (CKD) is associated with a high risk of cognitive impairment (CI). Both vascular and metabolic factors are implicated in the causation of CI in CKD. The traditional risk factors for CI are more prevalent in CKD and interact reciprocally. CI in CKD is associated with reduced functional capacity, poor quality of life and mortality. Cognition declines significantly after initiation

Background Ticagrelor is a novel antiplatelet agent that is frequently used for secondary prevention in coronary artery disease and has emerging evidence in stroke after the recent results of SOCRATES and THALES trials. The use of intravenous thrombolysis with alteplase in acute ischemic stroke (AIS) patients on ticagrelor is a topic of debate as the safety profile of ticagrelor in this setting is