Pub Date : 2026-02-01Epub Date: 2025-12-29DOI: 10.1016/j.jstrokecerebrovasdis.2025.108539
Milan Sivakumar BS , Nathan Degen BS , Thomas C. Varkey MD, MBA, MEd , Judy Dawod MD , Andrei V. Alexandrov MD , Savdeep Singh MD
Introduction
Prospective applicants for neurology stroke fellowship programs often rely on online resources to make informed decisions. Access to comprehensive and accurate program information is essential for making application and attendance decisions. This study aimed to assess the availability of critical application and program information on websites of neurology stroke fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and participating in the National Residency Matching Program (NRMP).
Methods
Using the Electronic Residency Application Services (ERAS), a list of websites for 112 ACGME-accredited neurology stroke fellowship programs was compiled. Each website was evaluated for 7 components of application information, including deadlines and contact details, and 17 components of program information, such as compensation, rotation schedule, and faculty listings.
Results
Of the 112 programs, only 5.1% of websites contained all 7 components of application information, while none (0%) provided all 17 components of program information. This gap in online data availability suggests that prospective fellows may struggle to find essential information to guide their application process.
Conclusion
The lack of comprehensive online information poses a challenge for applicants and may hinder the recruitment of qualified candidates. Improving the accessibility and completeness of information on neurology stroke fellowship websites could facilitate better decision-making and ultimately enhance program participation.
{"title":"An evaluation of Stroke Neurology fellowship websites: Incomplete and inconsistent information","authors":"Milan Sivakumar BS , Nathan Degen BS , Thomas C. Varkey MD, MBA, MEd , Judy Dawod MD , Andrei V. Alexandrov MD , Savdeep Singh MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108539","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108539","url":null,"abstract":"<div><h3>Introduction</h3><div>Prospective applicants for neurology stroke fellowship programs often rely on online resources to make informed decisions. Access to comprehensive and accurate program information is essential for making application and attendance decisions. This study aimed to assess the availability of critical application and program information on websites of neurology stroke fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and participating in the National Residency Matching Program (NRMP).</div></div><div><h3>Methods</h3><div>Using the Electronic Residency Application Services (ERAS), a list of websites for 112 ACGME-accredited neurology stroke fellowship programs was compiled. Each website was evaluated for 7 components of application information, including deadlines and contact details, and 17 components of program information, such as compensation, rotation schedule, and faculty listings.</div></div><div><h3>Results</h3><div>Of the 112 programs, only 5.1% of websites contained all 7 components of application information, while none (0%) provided all 17 components of program information. This gap in online data availability suggests that prospective fellows may struggle to find essential information to guide their application process.</div></div><div><h3>Conclusion</h3><div>The lack of comprehensive online information poses a challenge for applicants and may hinder the recruitment of qualified candidates. Improving the accessibility and completeness of information on neurology stroke fellowship websites could facilitate better decision-making and ultimately enhance program participation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108539"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879784","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 : 2026-02-01Epub Date: 2025-12-20DOI: 10.1016/j.jstrokecerebrovasdis.2025.108533
Jeffrey J. Wing , Helen C.S. Meier , Jenna I. Rajczyk , Gia E. Barboza-Salerno , Jonathan R. Powell , Bernadette Boden-Albala
Background and Purpose
The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study found that a skills-based intervention on systolic blood pressure (SBP) reduction in a cohort of mild/moderate strokes/transient ischemic attacks (TIA) was only effective at reducing SBP among Hispanics. We sought to better understand the differential ethnic success of DESERVE and determine if the efficacy of the intervention varied by longitudinal mortgage lending discrimination, measured by where they lived and home lending practices.
Methods
We conducted a post hoc analysis using DESERVE, which randomized 552 stroke/TIA survivors to skills-based intervention or usual care for secondary stroke prevention. We geocoded participant addresses to census tract-level historic and present-day lending discrimination. We used a four-level neighborhood longitudinal lending discrimination variable from Home Owners’ Loan Corporation redlining data and 2018 Home Mortgage Disclosure Act reports: no discrimination, growing investment, declining investment, and persistent discrimination. We modeled change in SBP by intervention status stratified by longitudinal lending discrimination category linearly with generalized estimating equations, clustering by site with inverse probability weights.
Results
In unweighted models, the intervention was most efficacious in growing investment areas (8.65 mmHg reduction; 95 % CI: 0.48, 16.82) vs. usual care and least efficacious in declining investment areas (9.69 mmHg increase; 95 % CI:15.04, -4.34). After weighting to account for selection biases and duration of time lived in the community, conclusions were unchanged.
Conclusion
The intervention efficacy was impacted by underlying systems of persistent disadvantage, emphasizing the need for contextual factor consideration when designing stroke recovery trials.
{"title":"Trajectory of longitudinal lending discrimination modifies the efficacy of a skills-based intervention in stroke survivors","authors":"Jeffrey J. Wing , Helen C.S. Meier , Jenna I. Rajczyk , Gia E. Barboza-Salerno , Jonathan R. Powell , Bernadette Boden-Albala","doi":"10.1016/j.jstrokecerebrovasdis.2025.108533","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108533","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study found that a skills-based intervention on systolic blood pressure (SBP) reduction in a cohort of mild/moderate strokes/transient ischemic attacks (TIA) was only effective at reducing SBP among Hispanics. We sought to better understand the differential ethnic success of DESERVE and determine if the efficacy of the intervention varied by longitudinal mortgage lending discrimination, measured by where they lived and home lending practices.</div></div><div><h3>Methods</h3><div>We conducted a post hoc analysis using DESERVE, which randomized 552 stroke/TIA survivors to skills-based intervention or usual care for secondary stroke prevention. We geocoded participant addresses to census tract-level historic and present-day lending discrimination. We used a four-level neighborhood longitudinal lending discrimination variable from Home Owners’ Loan Corporation redlining data and 2018 Home Mortgage Disclosure Act reports: no discrimination, growing investment, declining investment, and persistent discrimination. We modeled change in SBP by intervention status stratified by longitudinal lending discrimination category linearly with generalized estimating equations, clustering by site with inverse probability weights.</div></div><div><h3>Results</h3><div>In unweighted models, the intervention was most efficacious in growing investment areas (8.65 mmHg reduction; 95 % CI: 0.48, 16.82) vs. usual care and least efficacious in declining investment areas (9.69 mmHg increase; 95 % CI:15.04, -4.34). After weighting to account for selection biases and duration of time lived in the community, conclusions were unchanged.</div></div><div><h3>Conclusion</h3><div>The intervention efficacy was impacted by underlying systems of persistent disadvantage, emphasizing the need for contextual factor consideration when designing stroke recovery trials.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108533"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812677","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 : 2026-02-01Epub Date: 2026-01-05DOI: 10.1016/j.jstrokecerebrovasdis.2026.108550
Hameer Ali , Rida Shehzad , Usama Ahmed , Yahya Abualown , Wajida Perveen , Junaid Gulzar , Saad Azam , Zain ul Abideen , Shah e Zaman , Umair Hayat , Uzair Jafar , Muhammad Ehsan , Bilawal Nadeem , Ankit Agrawal , Raheel Ahmed
Introduction and Objective
Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases, posing a substantial burden on public health systems and individuals. Tirofiban and eptifibatide are used alongside intravenous thrombolysis (IVT) in patients with AIS, as they are believed to improve clinical outcomes. We aimed to investigate the efficacy and safety of IV tirofiban or eptifibatide as adjunctive therapy versus using IVT alone in patients with AIS.
Methods
We conducted a systematic search using PubMed, Embase, and Clinicaltrials.gov to retrieve randomized controlled trials and observational studies comparing adjunctive tirofiban or eptifibatide to IVT alone in patients with AIS. The quality of included RCTs and observational studies was assessed using the revised Cochrane “Risk of Bias” tool (RoB 2.0) and Newcastle– Ottawa Scale (NOS), respectively. All statistical analyses were performed using RevMan 5.4, using the random effects model with Risk Ratio (RR) and Mean difference (MD) as effect measures.
Results
Our meta-analysis included eleven studies, including seven RCTs and four observational studies, involving 1,796 patients. Our results showed that the number of patients with functional independence in the adjunctive therapy group (mRS score 0–2 at 90 days) was comparable to IVT alone (11 studies; n = 1686; RR 1.10; 95% CI, 0.90 - 1.36). There was no evidence of publication bias. Sensitivity analysis with evidence from RCTs showed that adjunctive Tirofiban may improve functional independence at 90 days. The incidence of symptomatic intracranial hemorrhage (ICH) (8 studies; n = 1234; RR 0.74; 95% CI, 0.37 - 1.48) and mortality (11 studies; n = 1686; RR=1.18; 95% CI, 0.82-1.70) was also found to be comparable between the two groups. There was no significant difference between the two groups when assessing the risk of any ICH, asymptomatic ICH, major hemorrhage or systemic bleeding, and fatal ICH. The incidence of early neurologic deterioration and mean change in mRS score remained comparable between the two groups.
Conclusion
Our meta-analysis suggests that while adjunctive tirofiban or eptifibatide with IVT do not yield benefits in terms of reducing mortality or improving functional independence at 90 days in AIS, emerging evidence from RCTs indicates that tirofiban may offer functional benefits, though this remains uncertain. Importantly, adjunctive therapy did not demonstrate a significant increase in bleeding risk in the analyzed studies. . These findings support the need for further large-scale, high-quality randomized controlled trials to explain the role of tirofiban in the management of AIS.
{"title":"Safety and efficacy of adjunctive tirofiban and eptifibatide in acute ischemic stroke: A systematic review and meta-analysis","authors":"Hameer Ali , Rida Shehzad , Usama Ahmed , Yahya Abualown , Wajida Perveen , Junaid Gulzar , Saad Azam , Zain ul Abideen , Shah e Zaman , Umair Hayat , Uzair Jafar , Muhammad Ehsan , Bilawal Nadeem , Ankit Agrawal , Raheel Ahmed","doi":"10.1016/j.jstrokecerebrovasdis.2026.108550","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108550","url":null,"abstract":"<div><h3>Introduction and Objective</h3><div>Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases, posing a substantial burden on public health systems and individuals. Tirofiban and eptifibatide are used alongside intravenous thrombolysis (IVT) in patients with AIS, as they are believed to improve clinical outcomes. We aimed to investigate the efficacy and safety of IV tirofiban or eptifibatide as adjunctive therapy versus using IVT alone in patients with AIS.</div></div><div><h3>Methods</h3><div>We conducted a systematic search using PubMed, Embase, and Clinicaltrials.gov to retrieve randomized controlled trials and observational studies comparing adjunctive tirofiban or eptifibatide to IVT alone in patients with AIS. The quality of included RCTs and observational studies was assessed using the revised Cochrane “Risk of Bias” tool (RoB 2.0) and Newcastle– Ottawa Scale (NOS), respectively. All statistical analyses were performed using RevMan 5.4, using the random effects model with Risk Ratio (RR) and Mean difference (MD) as effect measures.</div></div><div><h3>Results</h3><div>Our meta-analysis included eleven studies, including seven RCTs and four observational studies, involving 1,796 patients. Our results showed that the number of patients with functional independence in the adjunctive therapy group (mRS score 0–2 at 90 days) was comparable to IVT alone (11 studies; <em>n</em> = 1686; RR 1.10; 95% CI, 0.90 - 1.36). There was no evidence of publication bias. Sensitivity analysis with evidence from RCTs showed that adjunctive Tirofiban may improve functional independence at 90 days. The incidence of symptomatic intracranial hemorrhage (ICH) (8 studies; <em>n</em> = 1234; RR 0.74; 95% CI, 0.37 - 1.48) and mortality (11 studies; <em>n</em> = 1686; RR=1.18; 95% CI, 0.82-1.70) was also found to be comparable between the two groups. There was no significant difference between the two groups when assessing the risk of any ICH, asymptomatic ICH, major hemorrhage or systemic bleeding, and fatal ICH. The incidence of early neurologic deterioration and mean change in mRS score remained comparable between the two groups.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis suggests that while adjunctive tirofiban or eptifibatide with IVT do not yield benefits in terms of reducing mortality or improving functional independence at 90 days in AIS, emerging evidence from RCTs indicates that tirofiban may offer functional benefits, though this remains uncertain. Importantly, adjunctive therapy did not demonstrate a significant increase in bleeding risk in the analyzed studies. . These findings support the need for further large-scale, high-quality randomized controlled trials to explain the role of tirofiban in the management of AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108550"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919286","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 : 2026-02-01Epub Date: 2025-12-23DOI: 10.1016/j.jstrokecerebrovasdis.2025.108536
Andrea Loggini MD, 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 , Amber Schwertman MD , Alejandro Hornik MD , Christos Lazaridis MD , Adnan I. Qureshi MD
Purpose
We investigated the trends and outcomes of early gastrostomy tube placement in patients with nontraumatic intracerebral hemorrhage (ICH).
Methods
We analyzed the National Inpatient Sample (NIS) database from 2002 to 2022 for adult hospitalized ICH patients who underwent gastrostomy. Variables included age, sex, race, income, hospital location and region, comorbidities, ICH severity indicators (coma, cerebral edema, brain compression, hydrocephalus), neurosurgical procedures, in-hospital complications (deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury, aspiration pneumonia), and in-hospital outcomes (length of stay, cost, medical complications, and discharge disposition). Early gastrostomy (EG) was defined as below the 25th percentile of median time interval from admission to gastrostomy (< 7 days). Trends were assessed using linear regression of log-transformed yearly proportions. Propensity-score matching (PSM) was applied to balance comorbidities and severity between EG and nEG groups. Binary logistic regression was used to analyze in-hospital outcomes. Subgroups analyses were conducted for medically and surgically managed ICHs.
Results
Of 36776 ICH patients who received gastrostomy, 9484 (26%) underwent EG. The rate of EG increased significantly from 23.6% in 2002 to 29.5% in 2022 (β:0.004, p = 0.002). The increase was consistent across sex, ages ≥60 years, and racial groups, greater among Asians (β:0.007, p = 0.008) and patients aged ≥80 years (β:0.006, p = 0.002). Regional analyses showed the fastest growth in the Northeast (β:0.010, p < 0.001). However, overall median time to gastrostomy did not significantly change during the study period (β:0.013, p = 0.495). EG placement occurred more frequently in older patients IQR (71 [59-81] vs. 66 [55-76]), women (47.7% vs. 44.3%), and Whites (57.6% vs. 50.6%). EG was associated with lower rate of in-hospital complications, including DVT/PE (6.6% vs. 11.4%), acute kidney injury (22.6% vs. 28.3%), and aspiration pneumonia (21.4% vs. 28.8%), p < 0.001 for all. After 1:1 PSM, EG was independently associated with decreased odds of greater length of hospitalization (OR:0.388, 95%CI: 0.357-0.421, p < 0.001) and reduced hospitalization costs (OR:0.583, 95%CI:0.538-0.631, p < 0.001).
Conclusions
EG placement among ICH patients has increased over the past two decades. Notable variability in these trends exists across age, racial groups, and geographical regions. Consistent with this trend, EG is associated with lower in-hospital complications, and more efficient healthcare resource utilization.
{"title":"Early gastrostomy is associated with more efficient healthcare resource utilization in nontraumatic intracerebral hemorrhage patients","authors":"Andrea Loggini MD, 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 , Amber Schwertman MD , Alejandro Hornik MD , Christos Lazaridis MD , Adnan I. Qureshi MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108536","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108536","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the trends and outcomes of early gastrostomy tube placement in patients with nontraumatic intracerebral hemorrhage (ICH).</div></div><div><h3>Methods</h3><div>We analyzed the National Inpatient Sample (NIS) database from 2002 to 2022 for adult hospitalized ICH patients who underwent gastrostomy. Variables included age, sex, race, income, hospital location and region, comorbidities, ICH severity indicators (coma, cerebral edema, brain compression, hydrocephalus), neurosurgical procedures, in-hospital complications (deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury, aspiration pneumonia), and in-hospital outcomes (length of stay, cost, medical complications, and discharge disposition). Early gastrostomy (EG) was defined as below the 25th percentile of median time interval from admission to gastrostomy (< 7 days). Trends were assessed using linear regression of log-transformed yearly proportions. Propensity-score matching (PSM) was applied to balance comorbidities and severity between EG and nEG groups. Binary logistic regression was used to analyze in-hospital outcomes. Subgroups analyses were conducted for medically and surgically managed ICHs.</div></div><div><h3>Results</h3><div>Of 36776 ICH patients who received gastrostomy, 9484 (26%) underwent EG. The rate of EG increased significantly from 23.6% in 2002 to 29.5% in 2022 (β:0.004, <em>p</em> = 0.002). The increase was consistent across sex, ages ≥60 years, and racial groups, greater among Asians (β:0.007, <em>p</em> = 0.008) and patients aged ≥80 years (β:0.006, <em>p</em> = 0.002). Regional analyses showed the fastest growth in the Northeast (β:0.010, <em>p</em> < 0.001). However, overall median time to gastrostomy did not significantly change during the study period (β:0.013, <em>p</em> = 0.495). EG placement occurred more frequently in older patients IQR (71 [59-81] vs. 66 [55-76]), women (47.7% vs. 44.3%), and Whites (57.6% vs. 50.6%). EG was associated with lower rate of in-hospital complications, including DVT/PE (6.6% vs. 11.4%), acute kidney injury (22.6% vs. 28.3%), and aspiration pneumonia (21.4% vs. 28.8%), <em>p</em> < 0.001 for all. After 1:1 PSM, EG was independently associated with decreased odds of greater length of hospitalization (OR:0.388, 95%CI: 0.357-0.421, <em>p</em> < 0.001) and reduced hospitalization costs (OR:0.583, 95%CI:0.538-0.631, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>EG placement among ICH patients has increased over the past two decades. Notable variability in these trends exists across age, racial groups, and geographical regions. Consistent with this trend, EG is associated with lower in-hospital complications, and more efficient healthcare resource utilization.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108536"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835828","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 : 2026-02-01Epub 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.jstrokecerebrovasdis.2025.108528
Ji Li , Yongjie Zhu , Jing Han , Zhenshan Wang , Hongbo Xue , Meili Zhai , Chong Liu
Background
With global population aging, the incidence of ischemic stroke is rising annually. However, its underlying mechanisms and effective clinical preventive and therapeutic measures remain elusive. This study investigated inflammatory mechanisms and therapeutic targets using a rat cerebral ischemia-reperfusion injury (CIRI) model, focusing on endoplasmic reticulum stress (ERS)-mediated inflammation.
Methods
A rat CIRI model was established. Neurological assessments were performed 24 h post-modeling. Histopathological analysis evaluated inflammatory cytokines (IL-1β, TNF-α) and NF-κB p65 nuclear translocation in the ischemic penumbra. Molecular profiling assessed activation of endoplasmic reticulum stress (ERS) markers (GRP78, p-PERK, p-eIF2α) and the ERS-associated transcription factor Glutamine-rich protein 1 (QRICH1). Pharmacological induction of ERS and treatment with berberine (BBR) were employed, with mechanistic studies including PERK inhibition.
Results
Neurological assessments revealed significant CIRI-induced neural deficits. Histopathology demonstrated upregulated IL-1β/TNF-α and NF-κB p65 nuclear translocation. Molecular profiling identified activation of ERS markers (GRP78, p-PERK, p-eIF2α) and a time-dependent elevation of QRICH1 post-CIRI. Pharmacological ERS induction confirmed QRICH1/PERK/NF-κB pathway activation. BBR administration significantly attenuated IL-1β/TNF-α levels, suppressed IκB-α degradation, and inhibited NF-κB nuclear translocation. Mechanistically, BBR downregulated QRICH1 upregulation and suppressed agonist-induced ERS-inflammatory cascades; these therapeutic effects were partially reversed by PERK inhibitor.
Conclusion
These findings propose modulation of the QRICH1-ERS pathway as a promising therapeutic target for CIRI management, with BBR conferring protection by partially suppressing this axis.
{"title":"Role of Qrich1-mediated endoplasmic reticulum stress pathway in Berberine inhibition of NF-κB activation induced by cerebral ischemia-reperfusion injury","authors":"Ji Li , Yongjie Zhu , Jing Han , Zhenshan Wang , Hongbo Xue , Meili Zhai , Chong Liu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108528","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108528","url":null,"abstract":"<div><h3>Background</h3><div>With global population aging, the incidence of ischemic stroke is rising annually. However, its underlying mechanisms and effective clinical preventive and therapeutic measures remain elusive. This study investigated inflammatory mechanisms and therapeutic targets using a rat cerebral ischemia-reperfusion injury (CIRI) model, focusing on endoplasmic reticulum stress (ERS)-mediated inflammation.</div></div><div><h3>Methods</h3><div>A rat CIRI model was established. Neurological assessments were performed 24 h post-modeling. Histopathological analysis evaluated inflammatory cytokines (IL-1β, TNF-α) and NF-κB p65 nuclear translocation in the ischemic penumbra. Molecular profiling assessed activation of endoplasmic reticulum stress (ERS) markers (GRP78, p-PERK, p-eIF2α) and the ERS-associated transcription factor Glutamine-rich protein 1 (QRICH1). Pharmacological induction of ERS and treatment with berberine (BBR) were employed, with mechanistic studies including PERK inhibition.</div></div><div><h3>Results</h3><div>Neurological assessments revealed significant CIRI-induced neural deficits. Histopathology demonstrated upregulated IL-1β/TNF-α and NF-κB p65 nuclear translocation. Molecular profiling identified activation of ERS markers (GRP78, p-PERK, p-eIF2α) and a time-dependent elevation of QRICH1 post-CIRI. Pharmacological ERS induction confirmed QRICH1/PERK/NF-κB pathway activation. BBR administration significantly attenuated IL-1β/TNF-α levels, suppressed IκB-α degradation, and inhibited NF-κB nuclear translocation. Mechanistically, BBR downregulated QRICH1 upregulation and suppressed agonist-induced ERS-inflammatory cascades; these therapeutic effects were partially reversed by PERK inhibitor.</div></div><div><h3>Conclusion</h3><div>These findings propose modulation of the QRICH1-ERS pathway as a promising therapeutic target for CIRI management, with BBR conferring protection by partially suppressing this axis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108528"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784145","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 : 2026-02-01Epub Date: 2025-12-11DOI: 10.1016/j.jstrokecerebrovasdis.2025.108521
Jiawen Wei, Yan Shen
Background
Physical activity (PA) and sleep reduce the risk of dementia and mortality, but evidence among older stroke survivors in China is limited.
Objective
To investigate the impact of PA on dementia and all-cause mortality risks in this population and analyze its joint effect with sleep.
Methods
Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we analyzed the correlation of PA with dementia and mortality in elderly stroke survivors and explored the mediating role of dementia in the PA–mortality relationship. Joint variables of PA and sleep were constructed to assess their combined effects on dementia and mortality.
Results
Older stroke survivors engaging in regular PA had a 38 % reduced risk of dementia [Odds Ratio (OR) =0.62, 95 % Confidence Interval (CI): 0.56-0.69, P < 0.001] and a 44 % lower risk of mortality [Hazard Ratio (HR) =0.56, 95 % CI: 0.52-0.59, P < 0.001]. Additional protective factors against dementia included pet ownership, social activity, and reading, whereas television viewing and radio listening were linked to an increased risk of dementia. Raising domestic animals/pets, participating in outdoor activities, and performing housework were associated with a lower mortality risk (P < 0.05). Dementia mediated 5.9 % of PA–mortality risk relationship. The joint analysis highlighted that coupling regular PA with sleep exceeding 9 h was associated with a 42 % decrease in dementia risk, whereas pairing it with 9 h or less of sleep yielded a 60 % decrease in mortality risk.
Conclusion
For elderly stroke survivors, PA confers protective effects against both dementia and all-cause mortality. This association is partially mediated by the reduced risk of dementia. Furthermore, the beneficial impact of regular PA on these outcomes is moderated by sleep duration, underscoring the necessity of a joint consideration of both factors in prognostic assessments. This study underscores the importance of adopting an integrative perspective to assess exercise, daily activities, and sleep in stroke survivor prognosis. Our findings provide critical evidence for developing individualized, non-pharmacological, comprehensive management strategies and indicate future directions for interventional research.
{"title":"Synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in Chinese older stroke survivors","authors":"Jiawen Wei, Yan Shen","doi":"10.1016/j.jstrokecerebrovasdis.2025.108521","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108521","url":null,"abstract":"<div><h3>Background</h3><div>Physical activity (PA) and sleep reduce the risk of dementia and mortality, but evidence among older stroke survivors in China is limited.</div></div><div><h3>Objective</h3><div>To investigate the impact of PA on dementia and all-cause mortality risks in this population and analyze its joint effect with sleep.</div></div><div><h3>Methods</h3><div>Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we analyzed the correlation of PA with dementia and mortality in elderly stroke survivors and explored the mediating role of dementia in the PA–mortality relationship. Joint variables of PA and sleep were constructed to assess their combined effects on dementia and mortality.</div></div><div><h3>Results</h3><div>Older stroke survivors engaging in regular PA had a 38 % reduced risk of dementia [Odds Ratio (OR) =0.62, 95 % Confidence Interval (CI): 0.56-0.69, <em>P</em> < 0.001] and a 44 % lower risk of mortality [Hazard Ratio (HR) =0.56, 95 % CI: 0.52-0.59, <em>P</em> < 0.001]. Additional protective factors against dementia included pet ownership, social activity, and reading, whereas television viewing and radio listening were linked to an increased risk of dementia. Raising domestic animals/pets, participating in outdoor activities, and performing housework were associated with a lower mortality risk (<em>P</em> < 0.05). Dementia mediated 5.9 % of PA–mortality risk relationship. The joint analysis highlighted that coupling regular PA with sleep exceeding 9 h was associated with a 42 % decrease in dementia risk, whereas pairing it with 9 h or less of sleep yielded a 60 % decrease in mortality risk.</div></div><div><h3>Conclusion</h3><div>For elderly stroke survivors, PA confers protective effects against both dementia and all-cause mortality. This association is partially mediated by the reduced risk of dementia. Furthermore, the beneficial impact of regular PA on these outcomes is moderated by sleep duration, underscoring the necessity of a joint consideration of both factors in prognostic assessments. This study underscores the importance of adopting an integrative perspective to assess exercise, daily activities, and sleep in stroke survivor prognosis. Our findings provide critical evidence for developing individualized, non-pharmacological, comprehensive management strategies and indicate future directions for interventional research.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108521"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746501","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 : 2026-02-01Epub Date: 2025-12-10DOI: 10.1016/j.jstrokecerebrovasdis.2025.108520
Wei Li, Lei Shi
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Pub Date : 2026-01-01Epub Date: 2025-11-19DOI: 10.1016/j.jstrokecerebrovasdis.2025.108498
Hanna Schenck M.D., M.sc. , Sander M.J. van Kuijk Ph.D. , Hans Vink Ph.D. , Erik Gommer Ph.D. , Werner Mess Ph.D. , Inger R. de Ridder Ph.D. , Govert Hoogland Ph.D. , Onno Teernstra Ph.D. , Jim Dings Ph.D. , Marcel Aries Ph.D. , Yasin Temel Ph.D. , Roel Haeren Ph.D.
Objective
Microcirculatory changes contribute to delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), but bedside assessment remains challenging. Sidestream darkfield imaging (SDF) enables direct visualization but may be difficult in critically ill patients. The objective was to evaluate the feasibility of repeated sublingual and conjunctival SDF imaging in aSAH patients and to compare microcirculatory changes at both sites.
Methods
SDF imaging was performed sublingually and conjunctivally at six timepoints after aSAH. Feasibility was assessed by completion rate, patient experience, and acquisition time. Logistic mixed models identified factors influencing completion and microvascular outcomes. Agreement between sites was assessed with Bland-Altman plot and Spearman correlation.
Results
Thirty patients were included. Sublingual and conjunctival imaging completion rates were 89% and 70% respectively, with the latter declining over time. Positive patient experience increased success (OR 16, 95% 3.46-74.17), while longer acquisition time reduced success (OR 0.89, 95% CI 0.80-0.98). Discomfort was the main cause of conjunctival imaging failure. Sublingual and conjunctival parameters showed distinct trajectories during follow-up.
Conclusion
Sublingual SDF imaging is a feasible, well-tolerated method for serial microcirculatory assessment in aSAH patients. Conjunctival imaging is less tolerated and may be less suitable for repeated measurements. Microcirculatory changes differ between sites and cannot be used interchangeably.
目的：微循环改变有助于动脉瘤性蛛网膜下腔出血（aSAH）后延迟性脑缺血（DCI），但床边评估仍然具有挑战性。侧流暗场成像（SDF）可以实现直接可视化，但在危重患者中可能比较困难。目的是评估aSAH患者重复舌下和结膜SDF成像的可行性，并比较两个部位的微循环变化。方法：在aSAH后的6个时间点进行舌下和结膜SDF成像。可行性通过完成率、患者经验和获取时间进行评估。Logistic混合模型确定了影响完井和微血管预后的因素。用Bland-Altman图和Spearman相关评价各站点间的一致性。结果：纳入30例患者。舌下和结膜成像完成率分别为89%和70%，后者随着时间的推移而下降。积极的患者体验增加了成功率（OR 16, 95% 3.46-74.17），而较长的获取时间降低了成功率（OR 0.89, 95% CI 0.80-0.98）。不适是结膜成像失败的主要原因。舌下和结膜参数在随访中表现出明显的变化轨迹。结论：舌下SDF成像是一种可行且耐受性良好的aSAH患者系列微循环评估方法。结膜成像的耐受性较差，可能不太适合重复测量。不同部位的微循环变化不同，不能互换使用。
{"title":"Feasibility of sidestream darkfield imaging of the sublingual and conjunctival microcirculation in aneurysmal subarachnoid haemorrhage patients: A technical report","authors":"Hanna Schenck M.D., M.sc. , Sander M.J. van Kuijk Ph.D. , Hans Vink Ph.D. , Erik Gommer Ph.D. , Werner Mess Ph.D. , Inger R. de Ridder Ph.D. , Govert Hoogland Ph.D. , Onno Teernstra Ph.D. , Jim Dings Ph.D. , Marcel Aries Ph.D. , Yasin Temel Ph.D. , Roel Haeren Ph.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108498","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108498","url":null,"abstract":"<div><h3>Objective</h3><div>Microcirculatory changes contribute to delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), but bedside assessment remains challenging. Sidestream darkfield imaging (SDF) enables direct visualization but may be difficult in critically ill patients. The objective was to evaluate the feasibility of repeated sublingual and conjunctival SDF imaging in aSAH patients and to compare microcirculatory changes at both sites.</div></div><div><h3>Methods</h3><div>SDF imaging was performed sublingually and conjunctivally at six timepoints after aSAH. Feasibility was assessed by completion rate, patient experience, and acquisition time. Logistic mixed models identified factors influencing completion and microvascular outcomes. Agreement between sites was assessed with Bland-Altman plot and Spearman correlation.</div></div><div><h3>Results</h3><div>Thirty patients were included. Sublingual and conjunctival imaging completion rates were 89% and 70% respectively, with the latter declining over time. Positive patient experience increased success (OR 16, 95% 3.46-74.17), while longer acquisition time reduced success (OR 0.89, 95% CI 0.80-0.98). Discomfort was the main cause of conjunctival imaging failure. Sublingual and conjunctival parameters showed distinct trajectories during follow-up.</div></div><div><h3>Conclusion</h3><div>Sublingual SDF imaging is a feasible, well-tolerated method for serial microcirculatory assessment in aSAH patients. Conjunctival imaging is less tolerated and may be less suitable for repeated measurements. Microcirculatory changes differ between sites and cannot be used interchangeably.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108498"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575184","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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