Neurology

IntroductionPathophysiological distinctions among stroke subtypes--acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and other nontraumatic intracranial hemorrhage (ONIH)--are well described, but their associations with long-term mortality, cognitive outcomes, and dementia risk remain incompletely characterized. We examined whether stroke subtypes differ in post-stroke survival, cognitive performance, dementia risk, and neuroimaging phenotypes. MethodsU...

ImportancePrognosticating functional independence after an acute stroke is critical for anticipatory guidance and rehabilitation planning. Here we demonstrate that poor brain health at the time of incident stroke is linked to worse functional outcomes for women compared to men. ObjectiveTo determine if brain health at time of stroke presentation has a differential effect on functional outcomes between men and women. DesignRetrospective cross-sectional study. SettingAnalysis conducted in 2025 ...

BackgroundStenosis and dolichoectasia of cranial arteries likely reflect distinct mechanisms. Their contributions to lacunar stroke and cerebral small vessel disease (cSVD) remain contentious. We investigated associations of large artery stenosis (LAS) and arterial widening with stroke subtype, cSVD markers, incident infarcts, and clinical outcomes. MethodsWe prospectively recruited patients with lacunar or mild non-lacunar stroke, with demographic, stroke-related, cognitive, functional, and MR...

BackgroundFalls are a frequent and serious complication after stroke, affecting more than 30% of survivors within the first year. While age and comorbidities are established risk factors for falls, stroke-specific contributors--particularly lesion-related impairments in mobility and gait--are less well understood and may inform targeted secondary prevention. MethodsWe analyzed data from 94 patients with disabling subacute ischemic stroke enrolled in the prospective BAPTISe cohort, a predefined ...

BackgroundLarge middle cerebral artery (MCA) infarctions can result in life-threatening cerebral edema. Quantitative brain atrophy may improve risk stratification for severe edema. We examined whether quantitative brain atrophy is associated with severe midline shift after large ischemic stroke and whether incorporating atrophy improves prediction beyond established clinical and radiographic predictors. MethodsThis was a retrospective observational cohort study of patients with [≥][1/2] MCA ...

ObjectiveTo compare early cerebrospinal fluid (CSF) cytokine profiles in intracerebral hemorrhage (ICH) versus subarachnoid hemorrhage (SAH), with a focus on angiography-negative SAH (anSAH). MethodsWe conducted a retrospective observational cohort study of adults with spontaneous hemorrhagic stroke (ICH or SAH). For cytokine analyses, we included patients with external ventricular drains (EVDs) and analyzed the first CSF sample obtained within 72 hours of symptom onset. Cytokines were measured...

ObjectivesTo validate whether cerebrospinal fluid oxyhaemoglobin (CSF-Hb), measured from external ventricular or lumbar drains, is associated with secondary brain injury (SAH-SBI) after aneurysmal subarachnoid haemorrhage (aSAH), and to assess its value as a real-time monitoring biomarker. DesignPreregistered multicentre prospective observational cohort study. SettingEight neurosurgical tertiary centres in Switzerland, Germany, and Austria, between August 2021 and June 2024. Participants366 p...

Background / ObjectivesWe investigated whether the interthalamic adhesion (IA), a midline structure connecting the thalami, is altered in MS and associated with thalamic damages and cognition. MethodsWe prospectively included 32 clinically isolated syndrome/early MS, 31 RRMS, 31 PPMS patients, and 103 matched controls. All underwent anatomical 3T MRI and completed a comprehensive cognitive battery. IA presence, subtype, and volume were assessed by two blinded readers. Thalamic nuclei and other ...

BackgroundSarcopenia is associated with mortality and morbidity following acute ischemic stroke (AIS), but the diagnosis requires specialized equipment or time-consuming assessments. Computed tomography (CT) measures of temporal muscle volume (TMV) and density (TMD) can be opportunistically measured from existing scans and automated using deep learning (DL). This study sought to demonstrate the incremental prognostic value of DL-derived TMV and TMD from CT scans on mortality and length of stay (...

IntroductionThe ischaemic penumbra is the principal therapeutic target in acute ischaemic stroke (AIS). Although perfusion imaging enables identification of salvageable tissue, its availability is limited and iodinated contrast exposure carries risk. Validated blood-based biomarkers could serve as scalable surrogates for imaging-defined penumbra. ObjectiveWe conducted a systematic review and meta-analysis to assess the association between blood-based biomarkers reported in the literature and th...

BackgroundPost-stroke cognitive impairment (PSCI) affects nearly 30% of stroke survivors and significantly impairs functional recovery. Brain-derived neurotrophic factor (BDNF)-tropomyosin receptor kinase-{beta} (Trk{beta}) signalling is crucial for synaptic plasticity and cognitive function. While altered expression of truncated TRK{beta}-T1 isoforms has been linked to stroke, the contribution of the TRK{beta}-SHC isoform to PSCI in humans remains poorly understood. ObjectivesThis study aimed ...

PurposeIntracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) presents distinct challenges, particularly regarding the high risk of reocclusion and the need for specific management strategies. While several prediction scores exist to differentiate ICAD-LVO from embolic LVO (EMB-LVO), their external validity remains unproven. We aimed to externally validate six established prediction scores for differentiating the two. MethodsWe analyzed data from a prospectively maintain...

BackgroundTandem lesion strokes (TLS), defined by the coexistence of an intracranial large- or medium-vessel occlusion and a concomitant cervical internal carotid artery (ICA) stenosis or occlusion, represent a challenging subtype of acute ischemic stroke. Optimal endovascular management remains controversial, particularly regarding the role of emergent carotid artery stenting (eCAS) during mechanical thrombectomy. ObjectiveTo compare the safety and efficacy of emergent carotid artery stenting ...

ImportanceTraumatic brain injury (TBI) is a risk factor for dementia and is known to impact levels of several Alzheimers disease (AD) blood biomarkers. Plasma pTau217/ A{beta}42 ratio has been reported to be 90% accurate for detection of brain amyloid in civilian cohorts. ObjectiveTo evaluate the accuracy of emerging AD blood biomarkers in Veterans with and without TBI history. DesignWe assessed the performance of the FDA-approved plasma pTau217/A{beta}42 ratio and plasma levels of pTau217 and...

BackgroundCerebral small vessel disease (CSVD) is strongly linked to stroke and dementia risk, frequently predating clinical events for years to decades. Preventive efforts focus on treatment of modifiable vascular risk factors (VRF), but the complex changes in VRF over long periods in relation to CSVD burden remain unclear. Thus, we aimed to characterize life-long VRF trajectories in community-dwelling individuals and relate them to CSVD burden. MethodsFramingham Heart Study participants from ...

Background and PurposeEmbolic stroke of undetermined source (ESUS) emains a major diagnostic challenge in vascular neurology, as a substantial proportion of patients lack an identifiable embolic source despite standardized diagnostic workup. The failure of empiric anticoagulation strategies highlights the need for individualized, mechanism-oriented risk stratification. We aimed to develop a machine learning-based framework to estimate the most likely embolic source in ESUS using routinely availa...

Background: Platform trials are an efficient trial design which enable testing of multiple interventions simultaneously. They could advance knowledge of treatments for intracerebral haemorrhage (ICH). We aimed to investigate the views of clinicians involved in stroke research on recruitment to a future platform trial for ICH. Methods: Between April and July 2025, we conducted a UK-wide online survey of clinicians actively involved in stroke research using convenience sampling through professiona...

BackgroundRecurrent ischemic stroke remains a major concern in patients with nonvalvular atrial fibrillation (NVAF) despite anticoagulation. However, not all NVAF-related strokes are purely cardioembolic--concomitant large artery steno-occlusion (cLASO) is frequently observed and may represent an independent contributor to stroke recurrence. Current guidelines address these cases but focusing almost exclusively on the cardioembolic source. This approach contrasts sharply with the management of a...

BACKGROUNDA ccurate and individualized prediction of functional outcome after acute ischemic stroke (AIS) remains challenging. Conventional prognostic markers such as baseline National Institutes of Health Stroke Scale (NIHSS) score and age show substantial inter-patient variability and do not capture the spatial heterogeneity of tissue injury and hemodynamic disturbance. Although multimodal CT imaging is routinely acquired in acute stroke care, its integration into interpretable and generalizab...

ObjectiveWe aimed to do an updated meta- analysis comparing outcomes of mechanical thrombectomy (MT) associated with standard medical treatment (SMT), compared to SMT alone, in adult patients with acute ischemic stroke (AIS) due to medium or distal vessel occlusion (MDVO). MethodologyWe systematically searched PubMed, LILACS, Scielo, Cochrane, and ClinicalTrials.gov databases. Randomized controlled trials (RCTs), retrospective cohort studies, and systematic reviews with meta-analysis comparing ...