Explore the vast range of titles available.

Objective Carotid artery stenting (CAS) has become an established alternative to carotid endarterectomy (CEA). However, new ischemic lesions, detected by diffusion-weighted imaging (DWI), are frequently observed following the procedure, and their prognostic significance remains controversial. This study aimed to evaluate the impact of new DWI lesions following CAS on long-term stroke recurrence in patients who underwent CAS for carotid artery stenosis. Methods This retrospective cohort study analyzed 46 consecutive patients who underwent CAS for symptomatic carotid stenosis between January 2008 and December 2015. All participants had a DWI performed before and within 24 hours after the procedure. Patients were stratified into DWI-positive (DWI+) and DWI-negative (DWI-) groups based on the presence of new ischemic lesions. The primary endpoint was stroke or transient ischemic attack (TIA) recurrence during long-term follow-up. Statistical analysis included the Mann-Whitney U test for continuous variables, the Chi-square test for categorical variables, and Kaplan-Meier survival analysis for time-to-event outcomes. Results New DWI lesions were identified in 20 of 46 patients (43.5%) following CAS. Of the 46 patients, eight (17.4%) were lost to follow-up; thus, 38 were analyzed (16 DWI+ and 22 DWI-). During a mean follow-up period of 36.5 months (range, 12-60 months), stroke recurrence occurred in 2 of 16 patients (12.5%) in the DWI+ group, while no stroke recurrence was observed in the 22 patients of the DWI- group (p = 0.170). No significant difference was found between groups regarding myocardial infarction development (DWI+: 2/16 (12.5%) vs. DWI-: 3/22 (13.6%), p = 1.000). Conclusion New DWI lesions following CAS may serve as a potential risk marker for long-term stroke recurrence, although statistical significance was not achieved in this cohort. These findings suggest that patients with new post-procedural DWI lesions may represent a higher-risk subgroup; however, this hypothesis requires validation in larger, adequately powered cohorts before guiding clinical practice. Validation studies in larger patient cohorts are needed to confirm these preliminary findings.

Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19–2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20–1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82–3·29) for intracranial haemorrhage and 1·23 (1·08–1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08–6·72] for intracranial haemorrhage vs 1·47 [1·19–1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36–9·05] vs 1·43 [1·07–1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69–15·81] vs 1·86 [1·23–2·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48–84] per 1000 patient-years vs 27 intracranial haemorrhages [17–41] per 1000 patient-years; and for ≥20 cerebral microbleeds, 73 ischaemic strokes [46–108] per 1000 patient-years vs 39 intracranial haemorrhages [21–67] per 1000 patient-years). In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden. British Heart Foundation and UK Stroke Association.

Keywords: Holmes tremor, hypertrophic olivary degeneration, Guillain-Mollaret triangle, brainstem lesions Anahtar Kelimeler: Holmes tremoru, hipertrofik olivar dejenerasyon, Guillain-Mollaret ucgeni, beyinsapi lezyonu

Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. British Heart Foundation and Stroke Association.

Objectives: Acute ischemic stroke (AIS) is a significant cause of death and disability worldwide. Inflammation affects brain damage and prognosis in ischemic stroke, while malnutrition significantly impacts clinical outcomes. The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are used to assess nutritional and inflammatory status, respectively. The aim of our study was to determine the role of PNI and NLR in predicting the prognosis of ischemic stroke. Methods: A total of 215 acute ischemic stroke patients hospitalized in our neurology intensive care unit between September 2020 and November 2021 were retrospectively analyzed. Stroke classifications, vascular risk factors, laboratory parameters, and mortality rates of acute ischemic stroke cases were evaluated. PNI and NLR were calculated, and PNI values were dichotomized into two groups using a cutoff point of 42.5, determined via receiver operating characteristic (ROC) analysis. Results: Over a 60-day period, a multivariable logistic regression analysis for neurological prognosis revealed that coronary artery disease (hazard ratio [HR]:3.9, p=0.021), initial National Institutes of Health Stroke Scale (NIHSS) score (HR:1.16, p<0.001), and PNI (HR:0.022, p<0.001) were significant independent predictors of neurological outcomes. Additionally, Cox regression analysis for overall patient survival indicated that age (HR:1.93, p=0.009), initial NIHSS score (HR:1.04, p=0.008), blood urea nitrogen (BUN) level (HR:1.69, p=0.012), and PNI (HR:0.27, p=0.007) were independent factors influencing mortality. Conclusion: PNI and NLR are accessible and cost-effective biomarkers. These indicators provide insights into patients' inflammatory and nutritional profiles, enabling clinicians to make informed treatment decisions and serving as predictors of prognosis in AIS patients. Keywords: Acute ischemic stroke; Neutrophil-to-lymphocyte ratio; Prognostic nutritional index. Amac: Akut iskemik inme (AII), dunya genelinde onemli bir olum ve sakatlik nedenidir. Inflamasyon, iskemik inmede beyin hasarini ve prognozu etkilerken; malnutrisyon da klinik sonlanimi onemli olcude etkilemektedir. Prognostik nutrisyonel indeks (PNI) ve notrofil-lenfosit orani (NLR), sirasiyla beslenme durumu ve inflamatuvar yaniti degerlendirmek amaciyla kullanilmaktadir. Bu calismanin amaci, PNI ve NLR'nin iskemik inme prognozunu belirlemedeki yerini ortaya koymaktir. Yontem: Eylul 2020 ile Kasim 2021 tarihleri arasinda noroloji yogun bakim unitemizde izlenen toplam 215 akut iskemik inme hastasi retrospektif olarak analiz edilmistir. Hastalarin etyolojik siniflamalari, vaskuler risk faktorleri, laboratuvar parametreleri ve mortalite oranlari degerlendirilmistir. PNI ve NLR degerleri hesaplanmis, ROC analizi ile belirlenen 42,5 kesme degeri esas alinarak PNI iki gruba ayrilmistir. Bulgular: Altmis gunluk izlem sonunda yapilan cok degiskenli lojistik regresyon analizinde, koroner arter hastaligi (Risk Orani [HR]:3,9; p=0,021), giris Ulusal Saglik Enstitusu Inme Olcegi (NIHSS) skoru (HR:1,16; p<0,001) ve PNI (HR:0,022; p<0,001) norolojik sonuclarin anlamli bagimsiz belirleyicileri olarak bulunmustur. Ayrica, genel sagkalimi degerlendiren Cox regresyon analizinde yas (HR:1,93; p=0,009), giris NIHSS skoru (HR:1,04; p = 0,008), kan ure azotu (BUN) seviyesi (HR:1,69; p=0,012) ve PNI (HR:0,27; p=0,007) mortaliteyi etkileyen bagimsiz faktorler olarak saptanmistir. Sonuc: PNI ve NLR, kolay ulasilabilir ve dusuk maliyetli biyobelirteclerdir. Bu belirtecler, hastalarin inflamatuvar ve beslenme profilleri hakkinda bilgi saglayarak klinik karar sureclerini desteklemekte ve AII prognozunun ongorulmesinde kullanilabilmektedir. Akut iskemik inme; Notrofil-lenfosit orani; Prognostik nutrisyonel indeks.

BackgroundPatients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.MethodsWe used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.Results11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) −2.10 mL/min/1.73 cm2 (95% CI −3.39 to −0.81)) and mixed microbleeds (aMD −2.42 (95% CI −3.70 to −1.15)), but not strictly deep microbleeds (aMD −0.67 (95% CI −1.85 to 0.51)).ConclusionsIn patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms.Materials and Methods: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received “effective” treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Cerebral small vessel disease (SVD) is associated with various cerebrovascular outcomes, but data on sex differences in SVD are scarce. To investigate whether the frequency, severity, and distribution of cerebral microbleeds (CMB), other SVD markers on magnetic resonance imaging (MRI), and outcomes differ by sex. This cohort study used pooled individual patient data from the Microbleeds International Collaborative Network, including patients from 38 prospective cohort studies in 18 countries between 2000 and 2018, with clinical follow-up of at least 3 months (up to 5 years). Participants included patients with acute ischemic stroke or transient ischemic attack with available brain MRI. Data were analyzed from April to December 2023. Outcomes of interest were presence of CMB, lacunes, and severe white matter hyperintensities determined on MRI. Additionally, mortality, recurrent ischemic stroke, and intracranial hemorrhage during follow-up were assessed. Multivariable random-effects logistic regression models, Cox regression, and competing risk regression models were used to investigate sex differences in individual SVD markers, risk of recurrent cerebrovascular events, and death. A total of 20 314 patients (mean [SD] age, 70.1 [12.7] years; 11 721 [57.7%] male) were included, of whom 5649 (27.8%) had CMB. CMB were more frequent in male patients, and this was consistent throughout different age groups, locations, and in multivariable models (female vs male adjusted odds ratio [aOR], 0.86; 95% CI, 0.80-0.92; P < .001). Female patients had fewer lacunes (aOR, 0.82; 95% CI, 0.74-0.90; P < .001) but a higher prevalence of severe white matter hyperintensities (aOR, 1.10; 95% CI, 1.01-1.20; P = .04) compared with male patients. A total of 2419 patients (11.9%) died during a median (IQR) follow-up of 1.4 (0.7-2.5) years. CMB presence was associated with a higher risk of mortality in female patients (hazard ratio, 1.15; 95% CI, 1.02-1.31), but not male patients (hazard ratio, 0.95; 95% CI, 0.84-1.07) (P for interaction = .01). A total of 1113 patients (5.5%) had recurrent ischemic stroke, and 189 patients (0.9%) had recurrent intracranial hemorrhage, with no sex differences. This cohort study using pooled individual patient data found varying frequencies of individual SVD markers between female and male patients, indicating potential pathophysiological differences in manifestation and severity of SVD. Further research addressing differences in pathomechanisms and outcomes of SVD between female and male patients is required.