Pub Date : 2026-01-16DOI: 10.1016/j.jstrokecerebrovasdis.2026.108562
Yang Dong MD , Cong Lu MD , Tiantian Luo PhD , Hao Huang MD , Yan Xiong MD , Jie Zeng MD
Background
There is lacking of robust clinical evidence comparing transcatheter closure with antithrombotic therapy in elderly patent foramen ovale (PFO) patients with cryptogenic stroke.
Methods
The Pubmed, Embase, Web of Science, clinicaltrials.gov and Cochrane Library databases were systematically searched. Studies comparing transcatheter closure therapy with antithrombotic drug therapy in PFO patients in older age (≥55 years old) were included. The number of patients with and without events in both experimental group and control group were extracted. There were three study endpoints: composite endpoint of recurrent ischemic stroke and transient ischemic attack (TIA); all-cause death; new-onset atrial fibrillation. A random-effect model was performed. Heterogeneity among selected publications was assessed using Q-test based on a χ² test. I2>50% was defined as high heterogeneity. P < 0.05 was considered statistically significant.
Results
Nine studies of 7275 elderly PFO patients with cryptogenic stroke were included. Patients undergoing PFO closure had significantly lower risk of a composite endpoint of recurrent stroke and TIA (4.74% versus 8.08%, OR=0.517, 95% CI:0.325-0.821) and all-cause death (1.17% versus 1.24%, OR=0.531, 95% CI: 0.317-0.891). There was no significant different occurrence of new-onset atrial fibrillation between the two groups (3.81% versus 2.82%, OR=1.218, 95% CI: 0.826-1.798). None of the studies measuring the three endpoints manifested high heterogeneity.
Conclusions
PFO closure might reduce the risk of composite endpoint of recurrent stroke and TIA and all-cause death, while not increase the risk of new-onset atrial fibrillation comparing with medication therapy in elderly PFO patients with cryptogenic stroke. PFO closure should be considered part of a comprehensive secondary prevention strategy in elderly patients.
背景：对于老年隐源性脑卒中卵圆孔未闭（PFO）患者，比较经导管闭合与抗血栓治疗缺乏强有力的临床证据。方法：系统检索Pubmed、Embase、Web of Science、clinicaltrials.gov和Cochrane Library数据库。比较高龄PFO患者（≥55岁）经导管闭合治疗与抗血栓药物治疗的研究。提取实验组和对照组发生和未发生事件的患者数量。研究有三个终点：复发性脑卒中和短暂性脑缺血发作（TIA）的复合终点；全因死亡;新发心房颤动。采用随机效应模型。采用基于χ 2检验的q检验评估所选出版物的异质性。I2>50%定义为高异质性。P < 0.05为差异有统计学意义。结果：9项研究纳入7275例老年PFO伴隐源性卒中患者。接受PFO闭合的患者卒中和TIA复发的复合终点（4.74%对8.08%，OR=0.517, 95% CI: 0.25 -0.821）和全因死亡（1.17%对1.24%，OR=0.531, 95% CI: 0.317-0.891）的风险显著降低。两组间新发房颤发生率无显著差异（3.81% vs 2.82%， OR=1.218, 95% CI: 0.826-1.798）。测量这三个终点的研究均未显示出高度异质性。结论：与药物治疗相比，PFO关闭可降低老年PFO隐源性卒中合并TIA复合终点复发风险和全因死亡风险，但不会增加新发房颤的风险。PFO闭合应被视为老年患者综合二级预防策略的一部分。
{"title":"Transcatheter closure versus antithrombotic therapy for cryptogenic stroke in elderly patients with patent foramen ovale: a systematic review and meta-analysis of non-randomized studies","authors":"Yang Dong MD , Cong Lu MD , Tiantian Luo PhD , Hao Huang MD , Yan Xiong MD , Jie Zeng MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108562","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108562","url":null,"abstract":"<div><h3>Background</h3><div>There is lacking of robust clinical evidence comparing transcatheter closure with antithrombotic therapy in elderly patent foramen ovale (PFO) patients with cryptogenic stroke.</div></div><div><h3>Methods</h3><div>The Pubmed, Embase, Web of Science, clinicaltrials.gov and Cochrane Library databases were systematically searched. Studies comparing transcatheter closure therapy with antithrombotic drug therapy in PFO patients in older age (≥55 years old) were included. The number of patients with and without events in both experimental group and control group were extracted. There were three study endpoints: composite endpoint of recurrent ischemic stroke and transient ischemic attack (TIA); all-cause death; new-onset atrial fibrillation. A random-effect model was performed. Heterogeneity among selected publications was assessed using Q-test based on a χ² test. I<sup>2</sup>>50% was defined as high heterogeneity. P < 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Nine studies of 7275 elderly PFO patients with cryptogenic stroke were included. Patients undergoing PFO closure had significantly lower risk of a composite endpoint of recurrent stroke and TIA (4.74% versus 8.08%, OR=0.517, 95% CI:0.325-0.821) and all-cause death (1.17% versus 1.24%, OR=0.531, 95% CI: 0.317-0.891). There was no significant different occurrence of new-onset atrial fibrillation between the two groups (3.81% versus 2.82%, OR=1.218, 95% CI: 0.826-1.798). None of the studies measuring the three endpoints manifested high heterogeneity.</div></div><div><h3>Conclusions</h3><div>PFO closure might reduce the risk of composite endpoint of recurrent stroke and TIA and all-cause death, while not increase the risk of new-onset atrial fibrillation comparing with medication therapy in elderly PFO patients with cryptogenic stroke. PFO closure should be considered part of a comprehensive secondary prevention strategy in elderly patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108562"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infectious intracranial aneurysms (IIAs) are generally thought to develop de novo as a consequence of septic embolization during infective endocarditis (IE). Rapid infection-related enlargement of a pre-existing unruptured aneurysm during IE has not been previously documented. We report a case in which a small middle cerebral artery (MCA) aneurysm, previously identified on imaging, enlarged rapidly in the course of IE.
Case Description
A 67-year-old woman with a history of mitral valve repair presented with progressive general malaise and mild left hemiparesis. MRI demonstrated acute infarctions in the right caudate nucleus and putamen, and MRA showed occlusion of the right M2 superior branch. A previously identified 2.2-mm right MCA bifurcation aneurysm was not visualized on admission MRA. Infective endocarditis was subsequently diagnosed, and the aneurysm reappeared on day 9 at 5.5 mm and enlarged further to 9.5 mm by day 15. Endovascular coil embolization was performed on day 16, achieving complete aneurysm occlusion. The patient later underwent mitral valve surgery without complications.
Conclusion
This case demonstrates infection-related enlargement of a pre-existing intracranial aneurysm during IE, documented chronologically with serial MRA. These findings highlight the need for careful interval imaging in patients with IE and known aneurysms, and rapid morphological change should prompt urgent aneurysm treatment.
{"title":"Rapid enlargement of a pre-existing intracranial aneurysm during infective endocarditis: a case report","authors":"Mamoru Ishida MD, PhD, Ryosuke Nishiwaki MD, Hisashi Mizutani MD, Yuichi Kawasaki MD, Takahiro Oyama MD, Mitsuhiro Yoshida MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108561","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108561","url":null,"abstract":"<div><h3>Background</h3><div>Infectious intracranial aneurysms (IIAs) are generally thought to develop de novo as a consequence of septic embolization during infective endocarditis (IE). Rapid infection-related enlargement of a pre-existing unruptured aneurysm during IE has not been previously documented. We report a case in which a small middle cerebral artery (MCA) aneurysm, previously identified on imaging, enlarged rapidly in the course of IE.</div></div><div><h3>Case Description</h3><div>A 67-year-old woman with a history of mitral valve repair presented with progressive general malaise and mild left hemiparesis. MRI demonstrated acute infarctions in the right caudate nucleus and putamen, and MRA showed occlusion of the right M2 superior branch. A previously identified 2.2-mm right MCA bifurcation aneurysm was not visualized on admission MRA. Infective endocarditis was subsequently diagnosed, and the aneurysm reappeared on day 9 at 5.5 mm and enlarged further to 9.5 mm by day 15. Endovascular coil embolization was performed on day 16, achieving complete aneurysm occlusion. The patient later underwent mitral valve surgery without complications.</div></div><div><h3>Conclusion</h3><div>This case demonstrates infection-related enlargement of a pre-existing intracranial aneurysm during IE, documented chronologically with serial MRA. These findings highlight the need for careful interval imaging in patients with IE and known aneurysms, and rapid morphological change should prompt urgent aneurysm treatment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108561"},"PeriodicalIF":1.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.jstrokecerebrovasdis.2026.108559
Hojin Ju MD , Won Kee Chang MD, MS , Hee-Mun Cho MD , Hyo Jong Kim MD , Miji Kang RN , Yun-Sun Jung MPH, PhD , Nam-Jong Paik MD, PhD , Won-Seok Kim MD, PhD
Background
Health-related quality of life (HRQoL) is a key outcome in stroke survivors, but evidence on distinct physical and mental recovery trajectories is limited. EuroQoL 5-dimension 3-level (EQ-5D-3L) is widely used but prone to ceiling effects and cannot separate physical (PH) and mental health (MH). We administered Patient-Reported Outcomes Measurement Information System 10-item short form (PROMIS-10) at 3 and 12 months post-stroke, identified discharge-related predictors of PROMIS-10 PH and MH to distinguish their recovery trajectories, and compared their discriminatory capacity with that of EQ-5D-3L.
Methods
We analyzed PROMIS-10 and EQ-5D-3L scores in a retrospective cohort of 741 stroke survivors discharged from a tertiary center and followed at 3 and 12 months. Discriminatory capacity across modified Rankin Scale (mRS) groups was assessed using effect sizes. Linear regression identified demographic and clinical predictors of PROMIS-10 PH and MH at 3 and 12 months.
Results
At 3 months, EQ-5D-3L demonstrated greater discriminatory capacity across mRS groups. At 12 months, PH exhibited better discriminatory capacity than EQ-5D-3L for mild disability (mRS 0–1 vs. 2), consistent with ceiling effects reducing EQ-5D-3L sensitivity in the mild impairment group. Discharge ambulation consistently predicted both PH and MH at 3 and 12 months. Comorbidity burden, employment status, respondent type (proxy vs. patient), and discharge destination were associated with PROMIS-10, particularly in 12-month MH.
Conclusion
Predictors and trajectories differed between PH and MH groups, supporting separate assessment. PROMIS-10 exhibited better discriminatory capacity of milder disability at 12 months by distinguishing physical and mental dimensions, supporting tailored care basis.
{"title":"Longitudinal comparison of health-related quality of life at 3 and 12 months post-stroke using patient-reported outcome measures","authors":"Hojin Ju MD , Won Kee Chang MD, MS , Hee-Mun Cho MD , Hyo Jong Kim MD , Miji Kang RN , Yun-Sun Jung MPH, PhD , Nam-Jong Paik MD, PhD , Won-Seok Kim MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108559","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108559","url":null,"abstract":"<div><h3>Background</h3><div>Health-related quality of life (HRQoL) is a key outcome in stroke survivors, but evidence on distinct physical and mental recovery trajectories is limited. EuroQoL 5-dimension 3-level (EQ-5D-3L) is widely used but prone to ceiling effects and cannot separate physical (PH) and mental health (MH). We administered Patient-Reported Outcomes Measurement Information System 10-item short form (PROMIS-10) at 3 and 12 months post-stroke, identified discharge-related predictors of PROMIS-10 PH and MH to distinguish their recovery trajectories, and compared their discriminatory capacity with that of EQ-5D-3L.</div></div><div><h3>Methods</h3><div>We analyzed PROMIS-10 and EQ-5D-3L scores in a retrospective cohort of 741 stroke survivors discharged from a tertiary center and followed at 3 and 12 months. Discriminatory capacity across modified Rankin Scale (mRS) groups was assessed using effect sizes. Linear regression identified demographic and clinical predictors of PROMIS-10 PH and MH at 3 and 12 months.</div></div><div><h3>Results</h3><div>At 3 months, EQ-5D-3L demonstrated greater discriminatory capacity across mRS groups. At 12 months, PH exhibited better discriminatory capacity than EQ-5D-3L for mild disability (mRS 0–1 vs. 2), consistent with ceiling effects reducing EQ-5D-3L sensitivity in the mild impairment group. Discharge ambulation consistently predicted both PH and MH at 3 and 12 months. Comorbidity burden, employment status, respondent type (proxy vs. patient), and discharge destination were associated with PROMIS-10, particularly in 12-month MH.</div></div><div><h3>Conclusion</h3><div>Predictors and trajectories differed between PH and MH groups, supporting separate assessment. PROMIS-10 exhibited better discriminatory capacity of milder disability at 12 months by distinguishing physical and mental dimensions, supporting tailored care basis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108559"},"PeriodicalIF":1.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.jstrokecerebrovasdis.2026.108560
Rui Mao, Xin Tan, Rong Li, Zhiyong Yang, Hua Liu
Background
To explore the mechanism by which RAF kinase inhibitory protein (RKIP) alleviates neuroinflammatory damage in male rats with ischemic stroke (IS).
Methods
Male rats were subjected to middle cerebral artery occlusion (MCAO) to establish an IS model. Two weeks before MCAO, a single tail-vein injection of lentivirus or an equivalent volume of normal saline was administered to rats. The neurological deficit scores, infarct volume fractions, and pathological changes of the ischemic penumbra were evaluated in the rats. Immunohistochemstry, double-labeled immunofluorescence, ELISA, and Western blot were performed to assess microglial polarization, neuroinflammation and ERK/MAPK-related protein expressions.
Results
IS rats exhibited elevated neurological deficit scores and enlarged infarct volume fractions, accompanied by aggravated histopathological damage in the ischemic penumbra. Microglial M1 polarization was enhanced, meanwhile, IL-6 and TNF-α were up-regulated, whereas the anti-inflammatory mediator IL-10 was down-regulated, indicating a pronounced neuroinflammatory response. In particular, Western blot results showed that the ischemic penumbra expression of RKIP in IS rats was markedly lower in IS group than that in Control group. After achieving RKIP overexpression via lentivirus mediation, the polarization direction of microglia in the ischemic penumbra of IS rats shifted toward the M2 phenotype. This was specifically manifested by a significant decrease in the proportion of iNOS⁺/Iba1⁺ double-positive microglia, while the proportion of Arg-1⁺/Iba1⁺ double-positive microglia was significantly increased, and the neuroinflammatory response was alleviated. Moreover, its overexpression significantly reduced the expressions of p-ERK1/2 and p-p38 MAPK in ischemic penumbra. Interestingly, rmEGF-activated ERK elevated the protein levels of p-ERK1/2 and p-p38 MAPK in ischemic penumbra without altering RKIP expression itself. Consequently, the proportion of iNOS⁺/Iba1⁺ double-positive microglia rebounded, while that of Arg-1⁺/Iba1⁺ double-positive microglia decreased . Finally, functional experiments demonstrated that ERK partially reversed the neuroinflammatory protection conferred by RKIP overexpression in IS rats.
Conclusion
Overexpression of RKIP may alleviate the neuroinflammatory damage in IS rats by inhibiting ERK/MAPK pathway, thereby improving neurological function.
{"title":"RKIP regulates the ERK/MAPK signaling pathway to improve neuroinflammatory injury in male rats with ischemic stroke","authors":"Rui Mao, Xin Tan, Rong Li, Zhiyong Yang, Hua Liu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108560","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108560","url":null,"abstract":"<div><h3>Background</h3><div>To explore the mechanism by which RAF kinase inhibitory protein (RKIP) alleviates neuroinflammatory damage in male rats with ischemic stroke (IS).</div></div><div><h3>Methods</h3><div>Male rats were subjected to middle cerebral artery occlusion (MCAO) to establish an IS model. Two weeks before MCAO, a single tail-vein injection of lentivirus or an equivalent volume of normal saline was administered to rats. The neurological deficit scores, infarct volume fractions, and pathological changes of the ischemic penumbra were evaluated in the rats. Immunohistochemstry, double-labeled immunofluorescence, ELISA, and Western blot were performed to assess microglial polarization, neuroinflammation and ERK/MAPK-related protein expressions.</div></div><div><h3>Results</h3><div>IS rats exhibited elevated neurological deficit scores and enlarged infarct volume fractions, accompanied by aggravated histopathological damage in the ischemic penumbra. Microglial M1 polarization was enhanced, meanwhile, IL-6 and TNF-α were up-regulated, whereas the anti-inflammatory mediator IL-10 was down-regulated, indicating a pronounced neuroinflammatory response. In particular, Western blot results showed that the ischemic penumbra expression of RKIP in IS rats was markedly lower in IS group than that in Control group. After achieving RKIP overexpression via lentivirus mediation, the polarization direction of microglia in the ischemic penumbra of IS rats shifted toward the M2 phenotype. This was specifically manifested by a significant decrease in the proportion of iNOS⁺/Iba1⁺ double-positive microglia, while the proportion of Arg-1⁺/Iba1⁺ double-positive microglia was significantly increased, and the neuroinflammatory response was alleviated. Moreover, its overexpression significantly reduced the expressions of p-ERK1/2 and p-p38 MAPK in ischemic penumbra. Interestingly, rmEGF-activated ERK elevated the protein levels of p-ERK1/2 and p-p38 MAPK in ischemic penumbra without altering RKIP expression itself. Consequently, the proportion of iNOS⁺/Iba1⁺ double-positive microglia rebounded, while that of Arg-1⁺/Iba1⁺ double-positive microglia decreased . Finally, functional experiments demonstrated that ERK partially reversed the neuroinflammatory protection conferred by RKIP overexpression in IS rats.</div></div><div><h3>Conclusion</h3><div>Overexpression of RKIP may alleviate the neuroinflammatory damage in IS rats by inhibiting ERK/MAPK pathway, thereby improving neurological function.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108560"},"PeriodicalIF":1.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.jstrokecerebrovasdis.2026.108558
Andrea Loggini MD MPH MBA , Victor J. Del Brutto MD , Faddi G. Saleh Velez MD , Jonatan Hornik MD , Awni D. Shahait MD , Denise Battaglini MD PhD , Shawn S. Wallery MD , Alejandro Hornik MD , Christos Lazaridis MD , Adnan I. Qureshi MD
{"title":"Methodological contextualization and interpretation of early gastrostomy timing in nontraumatic intracerebral hemorrhage","authors":"Andrea Loggini MD MPH MBA , Victor J. Del Brutto MD , Faddi G. Saleh Velez MD , Jonatan Hornik MD , Awni D. Shahait MD , Denise Battaglini MD PhD , Shawn S. Wallery MD , Alejandro Hornik MD , Christos Lazaridis MD , Adnan I. Qureshi MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108558","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108558","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108558"},"PeriodicalIF":1.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.jstrokecerebrovasdis.2026.108557
Regina Isemann MD , Florian Wild MD , Paul Bronzlik MD , Joachim K. Krauss MD , Thomas Stüber MD , Kurt-Wolfram Sühs MD
Background
Malignant middle cerebral artery (MCA) infarction is a serious condition for which hemicraniectomy can improve survival and outcome. However, it remains unclear to what extent other perioperative factors contribute to the outcome.
Methods
This monocentric, retrospective observational study included patients with MCA infarction and subsequent hemicraniectomy. Perioperative parameters were collected from 68 patients between 01/2012 and 12/2020. Logistic regression analysis was performed to establish determinants for the outcome measured by the Modified Rankin Scale (mRS) (dichotomized in mRS 0-3: favorable outcome, mRS 4-6: poor outcome) 12 months after stroke.
Results
Before event, most patients had no impairment (mRS 0, 75 %) or mild impairment (mRS 1-3, 23.5 %). 12 months after stroke, 18 patients (32 %) had favorable outcome (mRS 0-3). In univariable analysis, age (OR[95 %CI]: 1.124[1.045,1.208], p = 0.002) and the pre-existing conditions diabetes (OR[95 %CI]: 10.625[1.279,88.293], p = 0.029) and hypertension (OR[95 %CI]: 3.875[1.159,12.961], p = 0.028) were associated with poor outcome, as were more points of effort for intensive care complex treatment in the Simplified Acute Physiology Score (SAPS) in the first two days after stroke (ORday1[95 %CIday1]: 1.109[1.023,1.203], pday1 = 0.012) (ORday2[95 %CIday2]: 1.209[1.078,1.355], pday2 = 0.001). All other collected periinterventional parameters (i.e. sedation, fever) did not influence the outcome. In multivariable analysis, older age (OR[95 %CI]: 1.107[1.029,1.190], p = 0.006) was found to be an independent predictor of higher mRS (4-6). For age, our ROC analysis showed a cut-off point of 57 years.
Conclusion
Our data provide information about changes in the degree of impairment and its improvement over time beyond the acute phase of stroke. Of all included parameters, age emerged as the most important prognostic factor.
{"title":"Assessment of perioperative outcome factors after hemicraniectomy confirms age as the prognostic factor in patients with middle cerebral artery infarction: Evidence from real-world data","authors":"Regina Isemann MD , Florian Wild MD , Paul Bronzlik MD , Joachim K. Krauss MD , Thomas Stüber MD , Kurt-Wolfram Sühs MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108557","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108557","url":null,"abstract":"<div><h3>Background</h3><div>Malignant middle cerebral artery (MCA) infarction is a serious condition for which hemicraniectomy can improve survival and outcome. However, it remains unclear to what extent other perioperative factors contribute to the outcome.</div></div><div><h3>Methods</h3><div>This monocentric, retrospective observational study included patients with MCA infarction and subsequent hemicraniectomy. Perioperative parameters were collected from 68 patients between 01/2012 and 12/2020. Logistic regression analysis was performed to establish determinants for the outcome measured by the Modified Rankin Scale (mRS) (dichotomized in mRS 0-3: favorable outcome, mRS 4-6: poor outcome) 12 months after stroke.</div></div><div><h3>Results</h3><div>Before event, most patients had no impairment (mRS 0, 75 %) or mild impairment (mRS 1-3, 23.5 %). 12 months after stroke, 18 patients (32 %) had favorable outcome (mRS 0-3). In univariable analysis, age (OR[95 %CI]: 1.124[1.045,1.208], p = 0.002) and the pre-existing conditions diabetes (OR[95 %CI]: 10.625[1.279,88.293], p = 0.029) and hypertension (OR[95 %CI]: 3.875[1.159,12.961], p = 0.028) were associated with poor outcome, as were more points of effort for intensive care complex treatment in the Simplified Acute Physiology Score (SAPS) in the first two days after stroke (OR<sub>day1</sub>[95 %CI<sub>day1</sub>]: 1.109[1.023,1.203], p<sub>day1</sub> = 0.012) (OR<sub>day2</sub>[95 %CI<sub>day2</sub>]: 1.209[1.078,1.355], p<sub>day2</sub> = 0.001). All other collected periinterventional parameters (i.e. sedation, fever) did not influence the outcome. In multivariable analysis, older age (OR[95 %CI]: 1.107[1.029,1.190], p = 0.006) was found to be an independent predictor of higher mRS (4-6). For age, our ROC analysis showed a cut-off point of 57 years.</div></div><div><h3>Conclusion</h3><div>Our data provide information about changes in the degree of impairment and its improvement over time beyond the acute phase of stroke. Of all included parameters, age emerged as the most important prognostic factor.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108557"},"PeriodicalIF":1.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunoglobulin G4–related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disease. Histopathology is the key to diagnosis. Although aortitis/periaortitis is a phenotype of IgG4-related disease, the relationship between cerebrovascular disease and IgG4-related disease remains unclear.
Methods
We report a 60-year-old man with recurrent stroke induced by IgG4-related arteritis and present the pathological findings of the patient's superficial temporal artery and middle cerebral artery.
Results
Immunohistochemistry demonstrated scattered plasma cells in the intima and adventitia of the superficial temporal artery, with a small number of IgG4-positive cells observed (10–15 cells per high-power field).
Conclusions
Case reports and studies examining the association between IgG4-related neurological arteritis and stroke are limited. Although a definitive link between IgG4-related arteritis (IgG4-RA) and stroke has not been established, IgG4-related arteritis should be considered as an etiology in patients with recurrent idiopathic stroke.
{"title":"The association of recurrent stroke and immunoglobulin G4-related arteritis in the central nervous system: a case report","authors":"Qi Huang , Hongjian Shen , Pengfei Xing, Yi Jiang, Xiaolong Xu, Qiang Li, Yongwei Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2026.108556","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108556","url":null,"abstract":"<div><h3>Background</h3><div>Immunoglobulin G4–related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory disease. Histopathology is the key to diagnosis. Although aortitis/periaortitis is a phenotype of IgG4-related disease, the relationship between cerebrovascular disease and IgG4-related disease remains unclear.</div></div><div><h3>Methods</h3><div>We report a 60-year-old man with recurrent stroke induced by IgG4-related arteritis and present the pathological findings of the patient's superficial temporal artery and middle cerebral artery.</div></div><div><h3>Results</h3><div>Immunohistochemistry demonstrated scattered plasma cells in the intima and adventitia of the superficial temporal artery, with a small number of IgG4-positive cells observed (10–15 cells per high-power field).</div></div><div><h3>Conclusions</h3><div>Case reports and studies examining the association between IgG4-related neurological arteritis and stroke are limited. Although a definitive link between IgG4-related arteritis (IgG4-RA) and stroke has not been established, IgG4-related arteritis should be considered as an etiology in patients with recurrent idiopathic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108556"},"PeriodicalIF":1.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.jstrokecerebrovasdis.2026.108553
Wang Rong MD , Zhanlan Zhu MD , Dongji Wang MD , Wenbin Shang MD
Background
Metabolic syndrome (MetS) contributes to cerebrovascular disease in older adults. Traditional binary diagnostic criteria may not fully capture metabolic dysfunction or its impact on stroke risk.
Objective
This study explores the relationship between MetS severity and stroke risk.
Methods
Data were derived from the China Health and Retirement Longitudinal Study (2011–2018). MetS severity was quantified using a validated scoring algorithm, and a cumulative severity score was calculated as the average of MetS scores at waves 1 and 3, weighted by the interval between waves. Cox proportional hazards models evaluated the relationship between baseline MetS severity and stroke events, while logistic regression assessed cumulative score in relation to incident stroke occurring after wave 3. Restricted cubic spline (RCS) functions were applied to explore nonlinear associations. Subgroup and interaction analyses were performed, and sensitivity analyses excluded participants receiving metabolic-related medications or with stroke occurring within two years prior to follow-up.
Results
During a median follow-up of 7 years, 459 stroke cases were documented (7.04%). Each interquartile increase in baseline MetS score was associated with a 33.4% higher stroke risk (HR = 1.334; 95% CI 1.239–1.436). Stroke risk increased significantly across quartiles (P for trend < 0.0001), with the highest quartile exhibiting nearly a threefold greater risk compared with the lowest (HR = 2.923; 95% CI 2.208–3.871). Cumulative MetS score was also positively associated with stroke (OR = 1.034; 95% CI 1.025–1.043), with the highest quartile showing significantly elevated odds (OR = 1.069; 95% CI 1.049–1.092). RCS analyses demonstrated significant nonlinear associations between baseline and cumulative MetS scores and stroke risk in the overall population, whereas linear associations were observed in stratified analyses according to MetS status. Additional analyses assessing changes in MetS score between waves 1 and 3 showed no significant association with stroke risk.
Conclusion
Greater MetS severity is independently associated with increased stroke risk among middle-aged and older Chinese adults. These findings highlight the need for continuous surveillance of MetS severity and timely intervention to mitigate stroke burden in aging populations.
背景：代谢综合征（MetS）与老年人脑血管疾病有关。传统的二元诊断标准可能不能完全捕获代谢功能障碍或其对卒中风险的影响。目的：探讨MetS严重程度与卒中风险的关系。方法：数据来源于中国健康与退休纵向研究（2011-2018）。使用经过验证的评分算法对MetS的严重程度进行量化，并计算累积严重性评分为第1和第3波MetS评分的平均值，并按波之间的间隔加权。Cox比例风险模型评估基线MetS严重程度与卒中事件之间的关系，而逻辑回归评估累积评分与第3波后发生的卒中事件的关系。利用限制三次样条函数（RCS）来研究非线性关联。进行了亚组分析和相互作用分析，敏感性分析排除了接受代谢相关药物治疗或随访前两年内发生中风的参与者。结果：在中位随访7年期间，记录了459例卒中病例（7.04%）。基线met评分每增加四分位数，卒中风险增加33.4% （HR = 1.334;95% CI 1.239-1.436）。卒中风险在四分位数中显著增加（P < 0.0001），最高四分位数的风险比最低四分位数的风险高出近三倍（HR = 2.923;95% CI 2.208-3.871）。累积MetS评分也与卒中呈正相关（OR = 1.034;95% CI 1.025-1.043），最高的四分位数显示显著升高的几率（OR = 1.069;95% CI 1.049-1.092）。RCS分析显示，基线和累积MetS评分与总体人群卒中风险之间存在显著的非线性关联，而根据MetS状态进行分层分析则观察到线性关联。额外的分析评估了第1波和第3波之间MetS评分的变化，显示与卒中风险没有显著关联。结论：在中国中老年人群中，较大的MetS严重程度与卒中风险增加独立相关。这些发现强调了持续监测MetS严重程度和及时干预以减轻老年人群卒中负担的必要性。
{"title":"Metabolic syndrome severity and stroke risk: a longitudinal analysis in middle-aged and older chinese adults","authors":"Wang Rong MD , Zhanlan Zhu MD , Dongji Wang MD , Wenbin Shang MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108553","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108553","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic syndrome (MetS) contributes to cerebrovascular disease in older adults. Traditional binary diagnostic criteria may not fully capture metabolic dysfunction or its impact on stroke risk.</div></div><div><h3>Objective</h3><div>This study explores the relationship between MetS severity and stroke risk.</div></div><div><h3>Methods</h3><div>Data were derived from the China Health and Retirement Longitudinal Study (2011–2018). MetS severity was quantified using a validated scoring algorithm, and a cumulative severity score was calculated as the average of MetS scores at waves 1 and 3, weighted by the interval between waves. Cox proportional hazards models evaluated the relationship between baseline MetS severity and stroke events, while logistic regression assessed cumulative score in relation to incident stroke occurring after wave 3. Restricted cubic spline (RCS) functions were applied to explore nonlinear associations. Subgroup and interaction analyses were performed, and sensitivity analyses excluded participants receiving metabolic-related medications or with stroke occurring within two years prior to follow-up.</div></div><div><h3>Results</h3><div>During a median follow-up of 7 years, 459 stroke cases were documented (7.04%). Each interquartile increase in baseline MetS score was associated with a 33.4% higher stroke risk (HR = 1.334; 95% CI 1.239–1.436). Stroke risk increased significantly across quartiles (P for trend < 0.0001), with the highest quartile exhibiting nearly a threefold greater risk compared with the lowest (HR = 2.923; 95% CI 2.208–3.871). Cumulative MetS score was also positively associated with stroke (OR = 1.034; 95% CI 1.025–1.043), with the highest quartile showing significantly elevated odds (OR = 1.069; 95% CI 1.049–1.092). RCS analyses demonstrated significant nonlinear associations between baseline and cumulative MetS scores and stroke risk in the overall population, whereas linear associations were observed in stratified analyses according to MetS status. Additional analyses assessing changes in MetS score between waves 1 and 3 showed no significant association with stroke risk.</div></div><div><h3>Conclusion</h3><div>Greater MetS severity is independently associated with increased stroke risk among middle-aged and older Chinese adults. These findings highlight the need for continuous surveillance of MetS severity and timely intervention to mitigate stroke burden in aging populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108553"},"PeriodicalIF":1.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.jstrokecerebrovasdis.2026.108554
Jianfeng Qi , Zhimin Zhang , Jixiang Yin , Xuhui Yuan , Xu Wang , Zexiang Liu , Yuhang Liu , Jianjun Wang
Background
Pdcd4 is a potential target for intracerebral hemorrhage (ICH) treatment. This research intended to elucidate the mechanism by which Pdcd4 regulates ICH progression.
Methods
Male mice were infected with sh-Pdcd4 lentivirus, followed by injection of bacterial collagenase to establish an ICH model. Subsequent experiments, including brain water content assessment, neurological injury scoring, brain hematoma volume measurement, ELISA, HE staining, immunohistochemistry, Evans blue extravasation assay, and Western blot, were conducted to analyze the role of Pdcd4 in ICH. PI3K inhibitor LY294002 was employed to further investigate the potential mechanisms in vivo. bEnd.3 cells were infected with sh-Pdcd4 in the presence or absence of tunicamycin (an ER stress inducer), followed by hemoglobin treatment to mimic ICH in vitro. The effects of Pdcd4 on endoplasmic reticulum (ER) stress in ICH were evaluated through CCK-8, ELISA, and Western blot assays.
Results
Pdcd4 was upregulated in ICH mice, with the highest levels observed at 24 h. Pdcd4 knockdown markedly alleviated brain injury and neuroinflammation, inhibited ER stress, and upregulated PI3K/AKT pathway in ICH mice. These changes were partially reversed by LY294002. In bEnd.3 cells, Pdcd4 levels were significantly increased after hemoglobin treatment. Additionally, Pdcd4 knockdown significantly increased cell viability and inhibited inflammatory factor secretion and ER stress in the ICH group. This phenomenon was partially counteracted by tunicamycin. Furthermore, Pdcd4 knockdown markedly activated the PI3K/AKT pathway in the ICH group.
Conclusion
Pdcd4 knockdown alleviates ICH through PI3K/AKT pathway-mediated ER stress.
{"title":"Knockdown of programmed cell death 4 inhibits endoplasmic reticulum stress in male mice with intracerebral hemorrhage through the phosphoinositide 3-kinase/protein kinase B pathway","authors":"Jianfeng Qi , Zhimin Zhang , Jixiang Yin , Xuhui Yuan , Xu Wang , Zexiang Liu , Yuhang Liu , Jianjun Wang","doi":"10.1016/j.jstrokecerebrovasdis.2026.108554","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108554","url":null,"abstract":"<div><h3>Background</h3><div>Pdcd4 is a potential target for intracerebral hemorrhage (ICH) treatment. This research intended to elucidate the mechanism by which Pdcd4 regulates ICH progression.</div></div><div><h3>Methods</h3><div>Male mice were infected with sh-<em>Pdcd4</em> lentivirus, followed by injection of bacterial collagenase to establish an ICH model. Subsequent experiments, including brain water content assessment, neurological injury scoring, brain hematoma volume measurement, ELISA, HE staining, immunohistochemistry, Evans blue extravasation assay, and Western blot, were conducted to analyze the role of Pdcd4 in ICH. PI3K inhibitor LY294002 was employed to further investigate the potential mechanisms <em>in vivo</em>. bEnd.3 cells were infected with sh-<em>Pdcd4</em> in the presence or absence of tunicamycin (an ER stress inducer), followed by hemoglobin treatment to mimic ICH <em>in vitro</em>. The effects of Pdcd4 on endoplasmic reticulum (ER) stress in ICH were evaluated through CCK-8, ELISA, and Western blot assays.</div></div><div><h3>Results</h3><div>Pdcd4 was upregulated in ICH mice, with the highest levels observed at 24 h. <em>Pdcd4</em> knockdown markedly alleviated brain injury and neuroinflammation, inhibited ER stress, and upregulated PI3K/AKT pathway in ICH mice. These changes were partially reversed by LY294002. In bEnd.3 cells, Pdcd4 levels were significantly increased after hemoglobin treatment. Additionally, <em>Pdcd4</em> knockdown significantly increased cell viability and inhibited inflammatory factor secretion and ER stress in the ICH group. This phenomenon was partially counteracted by tunicamycin. Furthermore, <em>Pdcd4</em> knockdown markedly activated the PI3K/AKT pathway in the ICH group.</div></div><div><h3>Conclusion</h3><div><em>Pdcd4</em> knockdown alleviates ICH through PI3K/AKT pathway-mediated ER stress.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108554"},"PeriodicalIF":1.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.jstrokecerebrovasdis.2026.108552
Oladotun V. Olalusi , Tobi Olajide , Akintomiwa I. Makanjuola , Joseph Yaria , Rufus O. Akinyemi , Mayowa O. Owolabi , Adesola Ogunniyi
As health systems globally grapple with increasing stroke burden, physician shortage and fragile healthcare infrastructure, an understudied and yet underrecognized phenomenon is gaining attention. Just as the more widely described neurophobia, gaps within the stroke educational and training ecosystem lead to strokophobia - a phenomenon that describes fear or hesitation among health care providers and trainees with diagnosing and managing patients with stroke. It often stems from lack of interest, perceived difficulty/complexity, low confidence and inadequate knowledge of stroke neurology or unfamiliarity with stroke care protocols. This fuels prognostic pessimism which may lead to poor outcome. Gaps in stroke neurology education and ensuing strokophobia have implications across all strata of the stroke care continuum, from early-career practitioners (medical students/residents and other health-care trainees) to advanced-career practitioners (clinicians and stroke-support staff) and the community (caregivers, policy makers and payers). This review explores strokophobia, highlights the burden and implications for stroke care globally, while proposing a three-tier strategy to addressing the problem with the aim of improving confidence and clinical outcomes. Specifically, we describe targeted educational strategies that should be implemented across the stroke care continuum from the student/trainee level to clinicians as well as care givers and policy makers, with the aim of building a robust stroke care ecosystem. Tailored stroke education should be designed to the specific context and target population to improve usable knowledge, boost bedside clinical confidence and competence, increase interest and ultimately improve clinical outcomes.
{"title":"Strokophobia in the stroke care continuum: An under-recognized global phenomenon with profound implications","authors":"Oladotun V. Olalusi , Tobi Olajide , Akintomiwa I. Makanjuola , Joseph Yaria , Rufus O. Akinyemi , Mayowa O. Owolabi , Adesola Ogunniyi","doi":"10.1016/j.jstrokecerebrovasdis.2026.108552","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108552","url":null,"abstract":"<div><div>As health systems globally grapple with increasing stroke burden, physician shortage and fragile healthcare infrastructure, an understudied and yet underrecognized phenomenon is gaining attention. Just as the more widely described neurophobia, gaps within the stroke educational and training ecosystem lead to strokophobia - a phenomenon that describes fear or hesitation among health care providers and trainees with diagnosing and managing patients with stroke. It often stems from lack of interest, perceived difficulty/complexity, low confidence and inadequate knowledge of stroke neurology or unfamiliarity with stroke care protocols. This fuels prognostic pessimism which may lead to poor outcome. Gaps in stroke neurology education and ensuing strokophobia have implications across all strata of the stroke care continuum, from early-career practitioners (medical students/residents and other health-care trainees) to advanced-career practitioners (clinicians and stroke-support staff) and the community (caregivers, policy makers and payers). This review explores strokophobia, highlights the burden and implications for stroke care globally, while proposing a three-tier strategy to addressing the problem with the aim of improving confidence and clinical outcomes. Specifically, we describe targeted educational strategies that should be implemented across the stroke care continuum from the student/trainee level to clinicians as well as care givers and policy makers, with the aim of building a robust stroke care ecosystem. Tailored stroke education should be designed to the specific context and target population to improve usable knowledge, boost bedside clinical confidence and competence, increase interest and ultimately improve clinical outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108552"},"PeriodicalIF":1.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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