Stroke Research and Treatment最新文献

Stroke is a major global health concern and a leading cause of disability and mortality, emphasizing the need for early risk prediction and intervention. This study leverages statistical analysis, machine learning (ML) classification, clustering, and survival modeling to identify key stroke predictors using a dataset of 5110 records. Descriptive statistics reveal that age, glucose levels, BMI, hypertension, and heart disease are the most influential risk factors. Stroke prevalence is notably higher among hypertensive (13.25%) and heart disease patients (17.03%), as well as among former (7.91%) and current smokers (5.32%). Clustering analysis using PCA and t-SNE highlights high-risk groups with elevated glucose levels and advanced age. Among ML models, XGBoost offers the best trade-off between precision and recall, while naïve Bayes achieves the highest recall (0.404), detecting more stroke cases despite higher false positives. Feature importance analysis ranks glucose, BMI, and age as dominant predictors, with XGBoost emphasizing cardiovascular conditions. Survival analysis confirms increasing stroke risk beyond age 60, with the Kaplan-Meier and Cox models showing a 31.9% risk increase linked to hypertension. These findings underscore the importance of early screening, lifestyle intervention, and targeted care. Future research should explore data-balancing methods like SMOTE and develop real-time tools to support clinical decision-making.

Ischemic stroke is the leading cause of stroke all around the world. Ischemic stroke can cause severe and irreversible damage to the brain. Brain neuroprotection is a promising treatment strategy. Moleac (MLC) 901, a traditional Chinese medicine, is one alternative adjunctive therapy that enhances neuroprotection. The molecular mechanism of MLC 901 in reducing brain damage in stroke needs to be further explored. Therefore, a review was conducted. MLC 901 effectively improves cognitive function and aids in poststroke recovery by promoting neuroprotection and neuroplasticity in neurons that have suffered ischemic damage. It also increases blood supply to the brain. Studies have shown that MLC 901 operates through complex pathways, particularly by stimulating brain-derived neurotrophic factor (BDNF) expression, facilitating neurogenesis, promoting cell proliferation, and aiding in neuronal growth. These mechanisms collectively contribute to its neuroprotective effects by helping neurons survive, repairing brain tissue, and enhancing functional recovery after a stroke. Ischemic stroke induces a cascade leading to apoptosis. MLC 901 has neuroprotective and neuroplasticity effects by stimulating cell proliferation, synaptogenesis, and neuronal growth by various pathways, thereby inhibiting apoptosis and inflammation in acute ischemic stroke. MLC 901 reduces brain damage, improves motor function, and increases survival rate in acute ischemic stroke.

Background: Intracranial haemorrhage (ICrH) is the most frequent cause of bleeding-related death. However, few studies describe the national incidence of ICrH-related acute hospitalisations and mortality. We report the national burden and incidence of hospitalisation and mortality of ICrH and its subtypes. Methods: A population-based review in England between 2014 and 2019 of acute admissions or deaths was undertaken. Admission and mortality data were obtained from electronic databases (traumatic death data were unavailable). ICrH events were identified by the International Classification of Diseases Version 10 codes. ICrH were subclassified by anatomical site and either traumatic or atraumatic cause. Results: In the 6-year study period, there was a total of 468,996 hospitalisations for ICrH, of which 280,003 (59.7%) were atraumatic and 188,993 (40.3%) were traumatic. Then, 50,004 atraumatic ICrH-related deaths were recorded; of these deaths, 43,061 were subclassified by anatomical site. The mean annual incidence rates (per 100,000 person years) were 141.0 for ICrH-related hospitalisations and 15.0 for atraumatic ICrH-related mortality. Males had a 7% higher incidence rate for atraumatic ICrH-related hospitalisations (OR 1.07, 95% CI 1.05-1.09, p < 0.0001). Females had a higher mean annual atraumatic ICrH-related mortality (OR 1.21, 95% CI 1.16-1.26, p < 0.0001). Then, 23.4% (n = 109,770) of all ICrH hospitalisations occurred in patients ≥ 85 years. Conclusion: The majority of ICrH acute hospitalisations (59.7%) were atraumatic. Sex differences were seen in outcome measurements: males had a higher overall incidence of hospitalisation; however, females had a higher incidence of atraumatic ICrH-related mortality.

Stroke ranks among the Top 3 leading causes of death and disability in Ghana. This review examines the current state of stroke in the country, focusing on recent developments and challenges in stroke care and rehabilitation. Historical and contemporary research indicates a rising prevalence of stroke-related morbidity and mortality, accompanied by a gradual shift from hemorrhagic to ischemic stroke, attributed mainly to the increasing adoption of Western lifestyles. Significant challenges to effective stroke care and rehabilitation exist, suggesting a potential worsening of the situation if these challenges are not addressed. With stroke morbidity and mortality expected to increase in the coming decades, there is an urgent need for substantial investments in stroke care, particularly in training healthcare professionals and providing adequate facilities and resources. Additionally, a comprehensive review of government health policies and stakeholder initiatives is necessary to enhance the quality of stroke care and mitigate the growing burden of stroke in Ghana.

Background: Moyamoya disease (MMD) is a complex cerebrovascular disorder. While its neurological manifestations are well documented, the association between MMD and short stature remains underrecognized. This review explores potential mechanisms linking MMD with growth impairment, with a focus on endocrine and syndromic contributors. Methods: A systematic review was conducted in accordance with PRISMA guidelines using PubMed and Scopus databases. Studies reporting cases of MMD with short stature or growth impairment were included. Data were extracted on patient demographics, endocrine findings, genetic mutations, neuroimaging, management, and outcomes. A narrative synthesis approach was used due to heterogeneity in study designs. Results: Across 25 studies, 30 individuals with MMD and clinically significant short stature were identified, predominantly pediatric (2.5-52 years). Presentations frequently included seizures (n = 21), TIAs (n = 8), hemiparesis (n = 7), cognitive impairment (n = 8), and headaches (n = 3); in many, growth failure predated neurological events. Height deficits ranged from -2.13 to -23.7 SDS. Endocrine involvement was common: growth hormone deficiency (n ≈ 6), delayed bone age (n = 3), and other pituitary-thyroid-gonadal disturbances; a rare pituitary stalk duplication was reported. Management varied. Indirect revascularization in selected cases reduced recurrent ischemia; growth hormone therapy improved height velocity. Antiplatelets were commonly used; anticoagulation occasionally led to complications. Outcomes were heterogeneous; four deaths occurred, typically in patients with severe multisystem disease. Conclusion: Growth retardation in MMD is generally a manifestation of hypothalamic-pituitary dysfunction, chronic cerebral hypoxia, or genetic syndromes. The observations in the present study suggest that MMD may be part of a more generalized multisystemic disorder in some patients and needs multisystemic assessment and management.

Background: Hypertension is the most common cause of intracerebral hemorrhage (ICH). The presentation, etiology, and outcome of ICH among young adults may vary compared to other age groups. The prior literature from our region has described a variety of etiologies with an inconsistent relationship to hypertension, which is the commonest cause of primary ICH in adults overall. Objective: We aimed to determine the demographic pattern, clinical presentation, underlying etiology, radiological characteristics, and outcome of ICH among young adults in our population. Methods: This was an IRB-approved chart review that included patients from January 2016 to December 2020. Descriptive young adults were defined as people between 15 and 45 years and arbitrarily divided into threee further age groups. A variety of demographic, clinical, and radiological features were compared among the subgroups and presented as descriptive and comparative analyses. Results: A total of 120 patients were included; 110 (91.7%) were males. The mean age was 26.8 ± 7.4 years. Majority, 86 (73.5%), presented with loss of consciousness; 22 (18.8%) had seizures, 14 (13.2%) had headaches, and 13 (11.9%) had vomiting. Traditional vascular risk factors, hypertension (5.8%) and diabetes mellitus (2.5%) were uncommon. Mean GCS was 7 ± 4. The commonest cause was trauma in 101 (84.2%) patients. Lobar hemorrhage was the commonest, 99 (83.2%); 92 (81.4%) had ICH volume < 30 mL, and ventricular involvement was seen in 43 (36.1%). Median ICH score was 2. Higher odds of mortality were observed among the oldest age group (OR 4.30, 95% CI 1.23-14.98, p = 0.022), higher ICH scores (OR 3.37, 95% CI 1.86-6.09, p < 0.001), ICH volume > 30 mL (OR 16.40, 95% CI 5.35-50.26, p < 0.001), ventricular extension (OR 5.60, 95% CI 2.14-14.68, p < 0.001), and nontraumatic ICH etiology (OR 3.59, 95% CI 1.26-10.26, p = 0.017). Conclusions: In our cohort, ICH was more common in young males; trauma being the leading cause of ICH. ICH resulted in significant morbidity and mortality in this population. Larger hemorrhages, ventricular involvement, and relatively older age were poor prognostic factors.

Background and Aims: Histological analysis of thrombi can enhance the understanding of pathophysiology. We aimed to analyze EVT-retrieved thrombi in cerebral venous thrombosis (CVT), compare them with acute ischemic stroke (AIS) thrombi, and correlate their composition with CT density. Methods: Retrospective case-series, including five CVT and 10 AIS cases treated with EVT. Thrombus sections were stained with hematoxylin and eosin; Picro Mallory for RBCs, fibrin, and collagen; and Prussian Blue for iron plus immunohistochemical staining with anti-CD61 (platelets), anti-MPO (neutrophils), anti-CD3 (T-cells), anti-CD20 (B-cells), anti-CD34 (endothelial cells), anti-CD68 (macrophages), and anti-citH3 (NETs). Thrombus components were quantified (Orbit) and expressed as a percentage of total area. The CVT-thrombus relative density (rHU) was calculated as HU thrombus/HU contralateral. Results: All CVT cases showed extensive thrombosis. Four patients had prior anticoagulation, and four had rHU > 1.00 with CT hyperdensity. The etiologies were heterogeneous. CVT thrombi were rich in red blood cells and displayed variable histological features, including signs of early organization. Compared to arterial thrombi, venous thrombi exhibited larger size (surface area 185.6 mm² [IQR 83.0-237.9] vs. 21.8 mm² [IQR 8.8-77.8]; p = 0.028) and lower fibrin content (16.6% [IQR 13.9-31.5] vs. 46.5% [IQR 25.1-49.5]; p = 0.036), with no other significant differences in composition. Low fibrin content and high RBC-to-fibrin ratio (R -0.9 and R 0.9, respectively; p = 0.047 for both) showed a significant correlation with rHU. Conclusion: Our exploratory study first shows that CVT thrombi are larger than AIS thrombi, with higher RBC content and lower fibrin, matching CT density. These findings enhance the understanding of CVT pathophysiology but need validation.

Background: Cognitive impairments and depression are common after stroke. Noninvasive treatments like transcranial direct current stimulation (tDCS) and mindfulness-based interventions have shown potential for improving these outcomes, though their effects on stroke survivors remain unclear. This study is aimed at evaluating the efficacy of mindfulness and tDCS in enhancing cognitive function and alleviating depression in stroke survivors. Methods: This randomized controlled trial, conducted from July 2021 to July 2022, included 30 stroke survivors divided into three groups: mindfulness (n = 5), tDCS (n = 14), and control (n = 11). Cognitive function was measured using Addenbrooke's Cognitive Examination-III (ACE-III), and depression was assessed using the Beck Depression Inventory-II (BDI-II) before and after interventions. The tDCS group received 10 sessions of anodal stimulation, and the mindfulness group underwent eight weekly sessions of mindfulness-based stress reduction. Data were analyzed using paired t-tests for within-group comparisons and ANOVA for between-group differences. Results: The tDCS group showed significant improvement in cognitive function, with ACE-III scores increasing by 9.14 ± 8.24 points (p = 0.02). Fluency and orientation scores also improved significantly in this group (p < 0.001 and p = 0.01, respectively). No significant cognitive changes were observed in the mindfulness group. Depression scores (BDI-II) did not change significantly in any group. Conclusions: tDCS significantly improved cognitive performance, particularly in fluency and orientation, while mindfulness showed no significant cognitive or depression-related effects. Future studies should explore the long-term impact of these interventions in stroke rehabilitation. Trial Registration: ClinicalTrials.gov identifier: IRCT20090716002195N3.

Background: Calcified cerebral emboli (CCEs) represent a rare cause of acute ischemic stroke and can pose technical challenges for neurointerventionalists. The few studies on endovascular thrombectomy (EVT) of CCE to date show poor recanalization rates and unfavorable outcomes. Objective: This study is aimed at investigating the technical and clinical results concerning EVT of CCE compared with noncalcified cerebral emboli (NCCEs). Methods: All cases of EVT for acute stroke from January 2014 to December 2021 from a single center were analyzed retrospectively. Emboli with a maximum density of ≥ 130 Hounsfield units on preinterventional CT scans were considered calcified. Propensity score matching was performed to compare technical and clinical results between patients with CCE and NCCE. Results: CCEs were present in 26 of 1004 cases (2.6%). Successful recanalization (mTICI ≥ 2b) was achieved less frequently in CCE (CCE: 62%, NCCE: 92%, p = 0.009). Also, first-pass reperfusion was less common in CCE (CCE: 12%, NCCE: 46%, p = 0.006). In CCE, infarct growth was more frequent (CCE: 81%, NCCE: 42%, p = 0.004) and more severe (p = 0.005). National Institutes of Health Stroke Scale improvement after EVT was lower in CCE patients (CCE: median 2, range -23 to 20, interquartile range (IQR) 2.75; NCCE: median 5, range -8 to 17, IQR 11, p = 0.008). Conclusion: First-pass reperfusion is less common in EVT of CCE. Also, there is a more frequent and severe infarct growth in CCE patients after EVT, which helps to understand the poorer clinical results. Thrombectomy devices optimized for CCE are desirable to improve outcomes in this subgroup of stroke patients.

Poststroke cognitive impairment (PSCI) refers to any level of cognitive decline occurring after a stroke, ranging from mild to severe impairments, while PSCI with dementia describes a more severe form where the cognitive decline significantly affects daily functioning and meets the clinical criteria for dementia. PSCI occurs in more than half of individuals who have had a stroke. Despite its high prevalence, the pharmacotherapeutic options for PSCI are limited. Several pharmacotherapeutic options like cholinesterase inhibitors (e.g., donepezil, galantamine, and rivastigmine) and N-methyl-d-aspartate receptor antagonists (e.g., memantine) have shown potential in improving cognitive functions. However, their overall effectiveness remains inconsistent across different studies and patient populations. Newer drugs such as citicoline, cilostazol, and antidepressants have shown promise, but further research is needed to validate their efficacy and safety specifically for PSCI management.