Search Results (286)

Background/Objectives: The COVID-19 pandemic impacted healthcare systems globally, disrupting the management and treatment of acute ischemic stroke (AIS). Understanding how AIS admissions, treatments, and outcomes were affected is critical for improving stroke care in future crises. The objective of this work was to assess the COVID-19 pandemic’s impact on AIS admissions, treatment patterns, complications, and patient outcomes in the U.S. from 2016 to 2021, focusing on differences between pre-pandemic (2016–2019) and peri-pandemic (2020–2021) periods. Methods: This is a retrospective cohort study using the National Inpatient Sample (NIS) database, analyzing weighted discharge records of AIS patients over six years. Data encompass U.S. hospitals, including urban, rural, teaching, and non-teaching facilities. The study included AIS patients aged 18 and older (N = 3,154,154). The cohort’s mean age was 70.0 years, with an average hospital stay of 5.1 days and an adjusted mean cost of $16,765. Men comprised 50.5% of the cohort. We analyzed temporal trends in AIS hospitalizations from 2016 to 2021, comparing pre- and peri-COVID-19 periods. The primary outcome was the AIS admissions trend over time, with secondary outcomes including reperfusion therapy utilization, intubation rates, discharge disposition, and complications. Trends in risk factors and NIH Stroke Scale (NIHSS) severity were also evaluated. Results: AIS admissions rose from 507,920 in 2016 to 535,694 in 2021. Age and sex distribution shifted, with a growing proportion of male AIS cases (from 49.8% to 51.4%) and a decrease in mean age from 70.3 to 69.7 years. Although not statistically significant, White patients were the majority (68.0%), though their proportion declined as Black, Hispanic, and Asian/Pacific Islander cases increased. Reperfusion therapy, especially mechanical thrombectomy, rose from 2.2% to 5.6% over the study period. Intubation rates increased from 4.8% pre-COVID-19 to 5.5% peri-COVID, with higher rates among COVID-positive patients. NIHSS severity declined over time, with severe strokes (NIHSS ≥ 16) decreasing from 14.5% in 2017 to 12.6% in 2021. Conclusions: The COVID-19 pandemic brought significant shifts in AIS patterns, with younger, more diverse patients, increased reperfusion therapy use, and rising complication rates. These changes underscore the importance of resilient healthcare strategies and resource allocation to maintain stroke care amid future public health emergencies. Full article

Background/Objectives: The clinical impact of automated large vessel occlusion (LVO) detection tools using non-contrast CT (NCCT) is still unknown. We evaluated whether the implementation of Heuron ELVO, an artificial intelligence (AI)-driven software for triage and notification of LVO stroke using NCCT, can reduce treatment times and improve clinical outcomes in a real-world setting. Methods: We compared patients with LVO stroke before (pre-AI cohort, 84 patients) and after (post-AI cohort, 48 patients) the implementation of Heuron ELVO at a comprehensive stroke center. Primary outcomes included time-to-treatment initiation, including door-to-IV tPA and door-to-endovascular thrombectomy (EVT) times. Secondary outcomes measured changes in the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. Statistical analyses involved multiple linear regression to adjust for confounders. Results: The implementation of Heuron ELVO significantly reduced the door-to-EVT time (30.2 min, 95% CI, −56. to −4.3), CT-to-neurologist examination time (16.4 min, 95% CI, −27.6 to −5.3), and CT-to-EVT time (29.4 min, 95% CI, −53.6 to −5.0). There was no statistical difference in the door-to-IV tPA time (8.9 min). The post-AI cohort exhibited a greater improvement in the NIHSS score compared to the pre-AI cohort, with a reduction of 4.3 points. While the post-AI cohort demonstrated a higher proportion of good outcomes (mRS 0–1, 26% vs. 40%) at the 3-month follow-up, there was no statistical significance. Conclusions: The implementation of Heuron ELVO demonstrated substantial improvements in the timeliness of stroke interventions and patient outcomes. These findings underscore the potential of AI-driven NCCT analysis in enhancing acute stroke workflows and expediting treatments in real-world settings. Full article

Background/Objectives: Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are severe forms of stroke with high morbidity and mortality rates. HMG-CoA reductase inhibitors, commonly referred to as statins, known for their lipid-lowering abilities, also possess pleiotropic properties, including anti-inflammatory and neuroprotective effects. We aimed to evaluate the impact of statin therapy on the functional outcomes and survival in patients with ICH and SAH. Methods: This retrospective cohort study analyzed data from the Get With The Guidelines (GWTG) stroke registry at a tertiary care center, including patients diagnosed with ICH or SAH between January 2008 and June 2022. Patients were categorized based on prior initiation of statin therapy: no statin, low-intensity statin, or high-intensity statin. The primary outcome was the Modified Rankin Scale (mRS) score at discharge, dichotomized to good (0–2) and poor (3–6) outcomes. A multivariate logistic regression model controlled for age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission. Results: A total of 663 patients with ICH and 159 patients with SAH were included in the analysis. In the ICH patients, low-intensity statin therapy was associated with significantly higher odds of a good functional outcome (aOR 2.56, 95% CI 1.247–5.246, p = 0.0104), as was high-intensity statin therapy (aOR 2.445, 95% CI 1.313–4.552, p = 0.0048). Among the SAH patients, all 39 deaths occurred in the no statin therapy group. Conclusions: Both low- and high-intensity statin therapy are associated with improved functional outcomes in ICH and may offer a survival benefit in SAH. These findings highlight the potential neuroprotective role of statins in hemorrhagic stroke. Further prospective studies and randomized controlled trials are needed to confirm these observations and to clarify the optimal use of statins in this patient population. Full article

Background: Cryptogenic stroke, a challenging subtype of acute ischemic stroke (AIS), is characterized by the absence of an identifiable etiology despite thorough diagnostic assessment. The role of pre-admission antiplatelet therapy (APT) in this population remains poorly understood, as current guidelines are primarily based on evidence from other stroke subtypes. Therefore, this study investigates the impact of pre-admission APT on functional outcomes in patients with cryptogenic stroke. Methods: A total of 224 patients with cryptogenic stroke admitted to the University of Pécs between February 2023 and September 2024 were retrospectively analyzed. Propensity score matching (PSM) with sensitivity analysis was employed to balance baseline characteristics, resulting in a matched cohort of 122 patients. Logistic regression and mediation analysis were used to evaluate the association between pre-admission APT and favorable outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0–2. Results: A favorable outcome was achieved by 39.3% of patients with pre-admission APT (n = 61), compared to 61.7% of those not receiving pre-admission APT (n = 162) (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.22–0.74, p = 0.004). After PSM and adjusting for confounders, including pre-morbidity mRS (pre-mRS) (OR = 0.17, CI: 0.06–0.49, p < 0.001), National Institutes of Health Stroke Scale (NIHSS) at 72 h post-stroke (OR = 0.67, CI: 0.50–0.88, p = 0.004), and smoking status (OR = 0.14, CI: 0.02–0.78, p = 0.025), pre-admission APT remained associated with poorer functional outcomes (adjusted OR [aOR] = 0.21, 95% CI: 0.06–0.76, p = 0.018). Conclusions: Pre-admission APT is independently associated with poorer functional outcomes in cryptogenic stroke patients. These findings challenge traditional assumptions regarding APT’s protective role and highlight the need for prospective studies to refine its use in cryptogenic stroke management. Full article

Background: The time lapse between the acute event and the beginning of rehabilitation seems to play a significant role in determining the effectiveness of rehabilitation together with the severity of neurological deficits and impairments of motor and cognitive functions. The present study aims to further explore the prognostic role of cognitive and motor functions, concerning the different times of the beginning of neurorehabilitation. Methods: A secondary examination was conducted by applying a cluster analysis on the data of 386 stroke patients in the subacute phase who were enrolled in the Cognitive and Recovery of Motor Functions (CogniReMo) study. Results: The Barthel Index at the admission predicts clinical outcome: if BI was 0, it was on average 28.7 ± 24.1 at discharge. For patients with Barthel Index <15 at discharge, the discriminant was unaltered executive functions having an average output of 61.3 instead of 45.5. In the range of BI at admission between 16 and 45, the discriminant variable was to have an NIHSS ≤ 5 to obtain a high outcome (BI = 75.4 instead of BI = 61.9). Subjects with a BI at admission >45 were the best responders to rehabilitation, with a mean BI at discharge of 85 if they have alteration in spatial attention, and 95.3 if they have no deficits in spatial attention. Also, for inpatients hospitalized in a period ranging from the 20th to the 37th day after stroke, spatial attention was a discriminant variable to have a poor outcome (BI = 34.3) vs. a good one (BI = 76.7). Conclusions: The algorithm identified a hierarchical decision tree that might assume a significant role for clinicians in defining an appropriate rehabilitation pathway, depending on the time of rehabilitation beginning and the severity of motor and cognitive deficits. Full article

Background: Central facial palsy (CFP), resulting from upper motor neuron lesions in the corticofacial pathway, is traditionally characterized by the sparing of the upper facial muscles. However, reports of upper facial weakness in CFP due to acute ischemic stroke have challenged this long-held assumption. This study aimed to determine the prevalence of upper facial weakness in CFP and identify its associated clinical factors. Methods: In this cross-sectional study, we evaluated consecutive patients with acute ischemic stroke admitted to a university hospital in Thailand from January 2022 to June 2023. Full-face video recordings were analyzed using the Sunnybrook Facial Grading System. Upper facial weakness was defined as asymmetry in at least one upper facial expression. Multivariable logistic regression was performed to identify factors associated with upper facial weakness. Results: Of 108 patients with acute ischemic stroke, 92 had CFP, and among these, 70 (76%) demonstrated upper facial weakness. Tight eye closure (force and wrinkle formation, both 42%) was the most sensitive indicator for detecting upper facial weakness. Greater stroke severity, as reflected by higher NIHSS scores (adjusted odds ratio [aOR], 1.42; 95% CI 1.07–1.88) and the presence of lower facial weakness (aOR, 6.56; 95% CI 1.85–23.29) were significantly associated with upper facial involvement. Although upper facial weakness was generally milder than lower facial weakness, its severity correlated with increasing lower facial asymmetry during movement. Conclusions: Contrary to traditional teaching, upper facial weakness is common in CFP due to acute ischemic stroke. The severity of stroke and the presence of lower facial weakness are key predictors of upper facial involvement. These findings underscore the need for clinicians to reconsider the diagnostic paradigm, recognizing that upper facial weakness can occur in CFP. Enhanced awareness may improve diagnostic accuracy, inform treatment decisions, and ultimately lead to better patient outcomes. Full article

Background/Objectives: Acute ischemic stroke (AIS) is a leading cause of disability and mortality worldwide. Despite advances in interventions such as thrombolysis (TL) and mechanical thrombectomy (MT), current treatment protocols remain largely standardized, focusing on general eligibility rather than individual patient characteristics. To address this gap, we introduce the Stroke-SCORE (Simplified Clinical Outcome Risk Evaluation), a predictive tool designed to personalize AIS management by providing data-driven, individualized recommendations to optimize treatment strategies and improve patient outcomes. Methods: The Stroke-SCORE was derived using retrospective data from 793 AIS patients admitted to the University of Pécs (February 2023–September 2024). Logistic regression analysis identified age, National Institutes of Health Stroke Scale (NIHSS) score at admission, and pre-morbid modified Rankin Scale (pre-mRS) score as key predictors of unfavorable outcomes at 90 days (defined as modified Rankin Scale [mRS] score > 2). Based on these predictors, a simplified risk score was developed to stratify patients into low-, moderate-, and high-risk groups, guiding treatment decisions on TL, MT, combination therapy (TL + MT), or standard care (SC). Internal validation was performed to assess the model’s predictive performance via receiver operating characteristic (ROC) analysis and isotonic regression calibration with bootstrapping. Results: The Stroke-SCORE was moderately positively correlated with a 90-day mRS score > 2 (odds ratio [OR] = 0.70, 95% confidence interval [CI]: 0.58–0.83, p < 0.001), with an area under the curve (AUC) of 0.86, a sensitivity and specificity of 79% and 81%, respectively, and an overall accuracy of 80%. Simulations indicated that personalized treatment guided by the Stroke-SCORE significantly reduced unfavorable outcomes. Conclusions: The Stroke-SCORE demonstrates strong predictive performance as a practical, data-driven approach for personalizing AIS treatment decisions. In the future, external, multicenter prospective validation is needed to confirm its applicability in real-world settings. Full article

Introduction: Inflammatory biomarkers, including Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), play a significant role in influencing stroke outcomes, particularly in the progression of post-stroke disability. While numerous studies have suggested a correlation between elevated levels of these cytokines and poor functional recovery, further investigation is needed to understand their prognostic value in acute ischemic stroke. Materials and Methods: We conducted a prospective study on 56 patients diagnosed with acute ischemic stroke, evaluating IL-6 and TNF-alpha levels on days 1 and 7 post symptom onset. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and functional outcomes were measured with the modified Rankin Scale (mRS). Statistical analyses were performed to evaluate the association between biomarker levels and stroke severity and recovery. Results: Our study demonstrated that elevated levels of IL-6 and TNF-alpha on both days 1 and 7 were significantly correlated with greater stroke severity and poorer functional outcomes, as indicated by higher NIHSS and mRS scores. These findings are consistent with broader research indicating strong associations between inflammatory cytokines and post-stroke disability, further reinforcing their relevance as prognostic indicators. Conclusions: IL-6 and TNF-alpha are promising biomarkers for predicting stroke severity and functional recovery in acute ischemic stroke. Monitoring these cytokines in the early stages of stroke could aid in identifying patients at higher risk for long-term disability, potentially guiding personalized therapeutic strategies. Further research into anti-inflammatory therapies targeting these cytokines may improve stroke rehabilitation and outcomes. Full article

Background: The prognostic value of the neutrophil–lymphocyte ratio (NLR) in ischemic stroke remains debated due to cohort variability and treatment heterogeneity across studies. This study evaluates the relationship between admission NLR, stroke severity and 90-day outcomes in patients with anterior circulation large vessel occlusion (LVO) undergoing early, successful revascularization. Methods: A retrospective multicenter study was conducted with 1082 patients treated with mechanical thrombectomy for acute ischemic stroke. The relationship between admission NLR, baseline National Institutes of Health Stroke Scale (NIHSS), 24 h NIHSS and 90-day modified Rankin Scale (mRS) outcomes was analyzed using logistic regression. Results: Admission NLR correlated weakly but significantly with both baseline (p = 0.018) and 24 h (p = 0.005) NIHSS scores, reflecting stroke severity. However, multivariate analysis showed that higher 24 h NIHSS scores (OR 0.831, p = 0.000) and prolonged puncture-to-recanalization times (OR 0.981, p = 0.000) were independent predictors of poor 90-day outcomes, whereas NLR was not (p = 0.557). Conclusions: Admission NLR is associated with stroke severity but does not independently predict clinical outcomes at 90 days in patients achieving early and successful revascularization. These findings underscore the critical role of inflammation in the acute phase of stroke but suggest that its prognostic value for long-term outcomes is limited in this context. Full article

Background and Aims: Measuring stroke recovery poses a significant challenge, given the complexity of the recovery process. We aimed to identify a standardized and data-driven set of metrics of stroke rehabilitation in the literature that ensures the inclusion of all recovery domains and subdomains in the literature. Methods: A systematic review was conducted by four reviewers using the PRISMA guidelines on PubMed, MEDLINE, and Embase for stroke recovery articles between 2004 and 2024. The inclusion criteria comprised experimental/observational studies, including ischemic and hemorrhagic stroke. All studies had ≥20 participants who were ≥18 years of age, and had a follow-up of ≥3 months. Outcomes included demographics, geographic origin, stroke mechanism, domains and subdomains, metrics used, and follow-up. A bias assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42024551753). Results: Our search included 324 studies with a sample of 85,156 participants. The study identified seven domains (perception, physical and motor function (PF), speech and language (S&L), cognition, activities of daily living (ADL), quality of life (QoL), and social interaction) and 96 constituent subdomains that encompass the complete landscape of the stroke recovery literature identified. The domains of PF and ADL constituted the vast share of the literature, albeit reducing in their relative representation over time, while domains such as perception and QoL have been increasingly studied since 2004. Using the domains, the study identified the set and frequency of all commonly used metrics to measure stroke recovery in the literature, of which the NIHSS (n = 72), BI (n = 55), and mRS (n = 51) were the most commonly used. We identified eighteen standard metrics that ensure the inclusion of all seven domains and 96 subdomains. Summary of Review and Conclusions: The identified set of domains and metrics within this study can help inform further clinical research and decision-making by providing a standardized set of metrics to be used for each domain. This approach ensures lesser represented domains and subdomains are also included during testing, providing a more complete view and measure of stroke recovery. Full article

Background: Re-occlusion of initially recanalized arteries after thrombectomy is a significant concern that may lead to poor outcomes. This study aimed to identify the risk factors and evaluate the prognosis of arterial re-occlusion following successful thrombectomy in patients diagnosed with emergent large-vessel occlusion (ELVO). Methods: We retrospectively analyzed data from 155 consecutive patients with ELVO who underwent mechanical thrombectomy (MT). Patients were classified into two groups according to whether the initial recanalized artery was re-occluded within 7 days after successful thrombectomy: re-occlusion and non-occlusion groups. Multivariate analysis was performed for potentially associated variables with p < 0.20 in the univariate analysis to identify the independent risk factors of re-occlusion. Differences in clinical outcomes were also assessed in these two groups. Results: Re-occlusion occurred in 10.3% of patients (16/155). Multivariate analysis demonstrated that large artery atherosclerosis (odds ratio [OR]: 3.942, 95% confidence interval [CI]: 1.247–12.464; p = 0.020), the number of device passes (OR: 2.509, 95% CI: 1.352–4.654; p = 0.004), and residual thrombus/stenosis (OR: 4.123, 95% CI: 1.267–13.415; p = 0.019) were independently associated with re-occlusion. Patients with re-occlusion had significantly worse NIHSS scores at discharge and lower opportunities for achieving functional independence at 3 months after MT than patients without re-occlusion. Conclusions: Large artery atherosclerosis, a high number of thrombectomy device passes, and residual thrombus/stenosis seemed to promote re-occlusion after successful recanalization. Timely identification and proper treatment strategies to prevent re-occlusion are warranted to improve clinical outcomes, especially among high-risk patients. Full article

The growing number of stroke survivors face physical, cognitive, and psychosocial impairments, making stroke a significant contributor to global disability. Various factors have been identified as key predictors of post-stroke outcomes. The aim of this study was to develop a standardized predictive model that integrates various demographic and clinical factors to better predict post-stroke cognitive recovery and depression in patients with ischemic stroke (IS). We included IS patients during both the acute phase and six months post-stroke and considered neuropsychological measures (screening scales, individual tests, functional cognitive scales), stroke severity and laterality, as well as functional disability measures. The study identified several key predictors of post-stroke cognitive recovery and depression in IS patients. Higher education and younger age were associated with better cognitive recovery. Lower stroke severity, indicated by lower National Institutes of Health Stroke Scale (NIHSS) scores, also contributed to better cognitive outcomes. Patients with lower modified Rankin Scale (mRS) scores showed improved performance on cognitive tests and lower post-stroke depression scores. The study concluded that age, education, stroke severity and functional status are the most critical predictors of cognitive recovery and post-stroke emotional status in IS patients. Tailoring rehabilitation strategies based on these predictive markers can significantly improve patient outcomes. Full article

Background/objective: Studies suggest that the neutrophil/lymphocyte ratio (NLR) may be a prognostic marker for different diseases with inflammatory components. This study aimed to quantify the NLR in individuals affected by different subtypes and severities of ischemic stroke and associated it with risk factors and treatment, and compared the results with data from healthy individuals. Methods: Clinical and laboratory data from medical records of patients over 18 years of age, victims of ischemic stroke, were collected. Data included leukocyte count and subtype, topography, risk factors, treatment and severity of stroke. For comparison, the number of leukocytes in healthy individuals was also quantified. NLR was determined by dividing the number of neutrophils by the number of lymphocytes. Results: A total of 218 patients were included, 194 stroke patients and 24 healthy individuals. Among all stroke patients, 45% had NLR values > 4 and 35% had values between 2 and 4; otherwise, 71% of healthy individuals had NRL < 2. The data also showed that the greater the severity of the stroke, measured by the NIHSS scale, the higher the NLR, at 24 and 72 h after the stroke. Among the stroke subtypes evaluated, the one with the lowest NLR values was small vessel stroke. Finally, the risk factors for stroke, its topography and treatment were not associated with NLR values. Conclusions: NLR is associated with stroke severity but does not correlate with stroke risk factors, topography, and treatment. The NLR may serve as a marker of stroke severity. Full article

Background and Aims: Stroke is the leading cause of seizures and epilepsy in adults; however, current guidelines lack robust recommendations for treating post-stroke seizures (PSSs) and epilepsy (PSE). This study aims to demonstrate the long-term safety and efficacy of lacosamide combined with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with PSE and atrial fibrillation (AF). Methods: In this prospective longitudinal single-center study, 53 patients with concomitant PSE and AF, admitted between 2022 and 2023, received NOACs for AF management and lacosamide for seizure control. A control group of 53 patients with cardioembolic stroke, receiving NOACs (but without PSE), was matched by age, sex, and NIHSS scores to ensure comparability. Results: Over 24 months, 16 patients in the study group and 15 in the control group experienced new embolic events, with no significant difference between groups (p = 0.82). Seizure control improved significantly in the study group, with reduced frequency and severity. No severe adverse events from lacosamide were observed. Conclusions: The combination of NOACs and lacosamide is a safe and effective treatment for patients with AF and PSE and does not increase the risk of recurrent ischemic or hemorrhagic events. Further studies with larger sample sizes and longer follow-ups are needed to confirm these findings and optimize treatment protocols. Full article

Objectives: Blood pressure (BP) management is challenging in patients with acute ischemic supratentorial stroke undergoing recanalization therapy due to the lack of established guidelines. Assessing dynamic cerebral autoregulation (dCA) may address this need, as it is a bedside technique that evaluates the transfer function phase in the very low-frequency (VLF) range (0.02–0.07 Hz) between BP and cerebral blood flow velocity (CBFV) in the middle cerebral artery. This phase is a prognostically relevant parameter, with lower values associated with poorer outcomes. This study aimed to evaluate whether early cranial computed tomography perfusion (CTP) can predict this parameter. Methods: In this retrospective study, 165 consecutive patients with hemispheric strokes who underwent recanalizing therapy were included (median age: 73 years; interquartile range (IQR) 60–80; women: 43 (26%)). The cohort comprised 91 patients treated with intravenous thrombolysis (IV-lysis) alone (median National Institute of Health Stroke Scale (NIHSS) score: 5; IQR 3–7) and 74 patients treated with mechanical thrombectomy (median NIHSS: 15; IQR 9–18). Regression analysis was performed to assess the relationship between pretreatment CTP-derived ischemic penumbra and core stroke volumes and the dCA VLF phase, as well as CBFV assessed within the first 72 h post-stroke event. Results: Pretreatment penumbra volume was a significant predictor of the VLF phase (adjusted r² = 0.040; β = −0.001, 95% confidence interval (CI): −0.0018 to −0.0002, p = 0.02). Core infarct volume was a stronger predictor of CBFV (adjusted r² = 0.082; β = 0.205, 95% CI: 0.0968–0.3198; p = 0.0003) compared to penumbra volume (p = 0.01). Additionally, in the low-frequency range (0.07–0.20 Hz), CBFV and BP were inversely related to the gain, an index of vascular tone. Conclusion: CTP metrics appear to correlate with the outcome-relevant VLF phase and reactive hyperemic CBFV, which interact with BP to influence vascular tone and gain. These aspects of dCA could potentially guide BP management in patients with acute stroke undergoing recanalization therapy. However, further validation is required. Full article