Cerebrovascular Diseases最新文献

Background: Admission hyperglycemia (glucose > 140 mg/dL) after ischemic stroke is associated with poor clinical outcomes, including cognitive impairment. Although hyperglycemia is commonly observed following intracerebral hemorrhage (ICH), it remains unclear whether its presence is also associated with reduced cognitive performance.

Methods: In this post hoc analysis of the ICH Deferoxamine Trial, admission hyperglycemia and other baseline characteristics were compared between patients with and without cognitive impairment (90-day Montreal Cognitive Assessment score < 26) using univariable and multivariable models.

Results: Among 293 patients with spontaneous, supratentorial ICH (aged 60±12 years, 38% female), 132 had hyperglycemia and 134 met criteria for cognitive impairment. Patients with cognitive impairment were older (61±12 vs. 57±11 years, p = 0.02), more likely to be female (46% vs. 28%, p = 0.02), had less coronary artery disease (6% vs. 16%, p = 0.06), higher hemorrhage volumes (19.5 mL [IQR 9.3-32.7] vs. 12.2 mL [IQR 6.1-18.3], p < 0.01), and more lobar hemorrhages (25% vs. 13%, p = 0.05). When these variables were entered into a multivariable logistic regression model, age (aOR 1.04, 95% CI [1.01-1.07]), coronary artery disease (aOR 0.33, 95% CI [0.11-0.97]), hyperglycemia (aOR 2.03, 95% CI [1.03-3.97]), and ICH volume (aOR 1.03, 95% CI [1.01-1.06]) were independently associated with impaired cognition.

Conclusion: The association between admission hyperglycemia and cognition indicates that acute hyperglycemia may identify patients at heightened risk of cognitive decline, underscoring the need for further studies to determine whether aggressive glycemic control mitigates post-ICH cognitive impairment.

Background: Hemodynamic management after endovascular thrombectomy (EVT) for patients with acute ischemic stroke from large-vessel occlusions is a critical and unsolved challenge: four major randomized controlled trials that applied fixed systolic blood pressure targets yielded neutral or harmful results, and the 2026 American Heart Association guideline cautions against aggressive systolic blood pressure reduction below 140 mmHg in the early post-EVT period. Independent physiological data demonstrate that cerebral autoregulation is profoundly and heterogeneously impaired after LVO stroke, suggesting that population-level fixed thresholds may be intrinsically mismatched to the biological diversity of autoregulatory states across individual patients.

Summary: Continuous, personalized monitoring of cerebral autoregulation offers a precise alternative to uniform blood pressure targets. Current post-EVT hemodynamic management is reactive: blood pressure is measured intermittently, population-level thresholds are applied regardless of individual physiology, and clinical deterioration is often recognized only after secondary injury has occurred. Near-infrared spectroscopy-based computation of the cerebral oximetry index enables real-time derivation of each patient's optimal mean arterial pressure and autoregulatory limits, but current monitoring platforms remain confined to specialized research settings. This review examines how recent advances in wearable ultrasound engineering, including conformal transcranial patches, wireless integrated systems, and low-cost disposable devices, create the technical foundation for portable, scalable cerebral hemodynamic monitoring with the potential to extend personalized autoregulation-guided care from specialized academic centers to community hospitals and broader stroke networks.

Background: Symptomatic intracranial hemorrhage (sICH) remains a devastating complication undermining reperfusion therapy in acute ischemic stroke (AIS). Current prediction models rely on static baseline parameters, neglecting dynamic post-treatment physiological changes. We aimed to develop and validate a dynamic, explainable risk prediction framework integrating high-resolution temporal data.

Methods: In this prospective multicenter study, 2,341 AIS patients with anterior circulation large vessel occlusion receiving reperfusion therapy were consecutively enrolled (January 2023-June 2024). High-frequency vital signs and serial laboratory tests were collected over 72 hours post-treatment. Time-series features (trend, volatility, stability) were engineered, and XGBoost-based dynamic models were constructed at five timepoints (6, 12, 24, 48, 72 hours). Performance was evaluated in a held-out validation cohort (n=576) against a static baseline model. SHAP was applied for interpretability.

Results: Of 2,158 analyzed patients, 218 (10.1%) developed sICH. The dynamic model consistently outperformed the static model across all timepoints (AUC 0.83-0.90 vs. 0.71-0.75; all P<0.001). SHAP identified three core risk drivers: hemodynamic volatility (24-hour SBP standard deviation ranked highest), metabolic-inflammatory trajectories, and early tissue injury markers. Unsupervised clustering revealed three risk phenotypes: persistent low-risk (71.5%, sICH 0.8%), early rapid-riser (18.2%, 52.3%), and delayed-riser (10.3%, 38.1%).

Conclusion: This dynamic, explainable framework shifts sICH risk prediction from static snapshots to continuous, interpretable monitoring. Hemodynamic volatility emerged as the strongest modifiable predictor, offering clinically actionable insights for personalized post-procedural care in AIS.

Background: Although obesity is associated with cerebral small vessel disease (CSVD), the extent to which hypertension (HTN) and diabetes mellitus (DM) statistically account for this association in Asian populations remains unclear.

Methods: We analyzed asymptomatic Japanese adults enrolled in a Japanese Brain Dock registry between 2018 and 2024. The primary outcome was high CSVD burden, defined as a composite score ≥2 on a 0-4 scale based on the STandards for ReportIng Vascular changes on nEuroimaging criteria and incorporating moderate-to-severe white matter hyperintensities, lacunes, cerebral microbleeds, and pathologic basal ganglia perivascular spaces. Obesity was defined as a body mass index ≥25 kg/m² according to Asian-specific criteria. We performed multivariable logistic regression, parametric mediation-decomposition analyses with bootstrap-derived 95% confidence intervals (CIs), and Karlson-Holm-Breen (KHB) decomposition.

Results: Among 84,204 participants (45.7% women; median age, 50 years), obesity was associated with high CSVD burden (adjusted odds ratio [OR] 1.51 [95% CI 1.32-1.71]); this association attenuated to 1.24 (1.09-1.41) after adjustment for HTN and 1.21 (1.07-1.38) after additional adjustment for DM. In KHB decomposition, HTN and DM jointly accounted for 49.4% of the association (HTN, 91.9%; DM, 8.1%). The natural indirect effect was significant for HTN (1.27 [1.20-1.36]) but not for DM (1.00 [0.99-1.01]). A significant obesity × DM interaction was observed (p <0.05).

Conclusion: In this large Japanese brain-screening cohort, approximately half of the association between obesity and high subclinical CSVD burden was statistically apportioned to HTN and DM, predominantly through HTN. These cross-sectional decomposition findings should be interpreted as statistical, not mechanistic, mediation and support prioritizing blood-pressure assessment in obese adults undergoing brain screening.

Objectives: To develop an evidence-based, contextually relevant clinical practice guideline (CPG) for motor rehabilitation across the stroke continuum in India, identify priority recommendations for implementation, and evaluate the feasibility of its implementation.

Design: A three-phase mixed-methods study integrating a scoping review, focus group discussions, and systematic guideline synthesis.

Setting: India, across tertiary, secondary, and community-based rehabilitation settings.

Participants: Rehabilitation professionals (neurologists, physiatrists, physiotherapists, occupational therapists, nurses, social workers) with ≥10 years' experience, persons with lived experience of stroke, and stakeholders including policymakers, researchers, and administrators.

Main outcome measures: Development of contextually relevant CPG recommendations and their classification based on the strength of evidence and implementation feasibility.

Results: Rehabilitation pathways were fragmented, with limited access post-discharge and no standardized referral systems. Sixty clinical questions were refined into nine PICO questions and two practice points. A total of 84 recommendations were synthesized from high-quality international guidelines (AGREE-II/REX ≥60%). Using a modified Alper tool, 50 recommendations supported interventions, 13 advised against routine use, and others had limited or unclear evidence. Feasibility assessment using the Adopt-Contextualize-Adapt (ACA) framework showed 39 recommendations suitable for adoption, 32 requiring contextualization, and 13 requiring adaptation. Key domains included motor recovery, activities of daily living, quality of life, complication prevention, therapy dosage, and caregiver involvement.

Conclusions: This study developed a stakeholder-informed, contextually adapted stroke rehabilitation CPG for India. The guideline provides a scalable framework to improve rehabilitation quality and access, with potential applicability to other low- and middle-income countries.

Introduction: Cerebral infarction (CI) represents a central nervous system vascular disorder characterized by high risks of disability and fatality. Quercetagetin (RG, 6-Hydroxyquercetin), a flavonoid isolated from Carthami Flos, has therapeutic potential against cerebral infarction. This research investigates its action mechanisms.

Methods: Human astrocytes (HAs) subjected to oxygen-glucose deprivation/reperfusion (OGD/R) and the middle cerebral artery occlusion-induced CI mice model were employed to investigate the protective effect of RG. By means of network pharmacology, AKT1 was identified as a potential CI-related target of RG in CI treatment. By predicting the ENCORI/starBase database and analyzing the GSE86291 dataset, miR-30d-5p was screened as a promising AKT1 regulator. Their regulatory relationship was verified through a dual-luciferase reporter experiment, and their expression was examined using the RT-qPCR or western blot technique. Furthermore, cell viability was detected using the CCK-8 assay, and cell apoptosis was evaluated via flow cytometry analysis. Additionally, Rotarod and Morris water maze tests were applied for the behavioral assessment of mice.

Results: RG exhibited a concentration-dependent protective effect by restoring cell viability and reducing apoptosis in OGD/R-treated HAs. MiRNA-30d-5p downregulated AKT1 expression by targeting its mRNA. Upregulation of miR-30d-5p exacerbated HA cell damage induced by OGD/R, and this damage was alleviated by AKT1 overexpression. miR-30d-5p agomir weakened RG's protective effect on OGD/R-treated HAs, and this suppression was reversed by the co-transfection of the AKT1 overexpression vector. RG downregulated the miR-30d-5p level while upregulating AKT1 expression in OGD/R-treated HAs and CI mice. Meanwhile, the motor coordination and learning/memory abilities of CI mice were enhanced.

Conclusion: RG exerted a protective effect on HAs against OGD/R-induced impairment via the miR-30d-5p/AKT1 mechanism.

Background: Diagnosing transient ischemic attacks (TIAs) remains challenging, particularly in primary care and emergency department settings where specialist neurologist consultation may be limited. Recently developed Explicit Diagnostic Criteria for TIA (EDCT) aim to guide diagnosis, while artificial intelligence (AI)-based diagnostic tools have also emerged, but their comparative effectiveness in clinical practice is uncertain.

Methods: We conducted a prospective study of 127 patients referred to a specialist stroke service from an emergency department between June 2023 and February 2024 with suspected TIA. The diagnostic performance of three EDCT versions was compared against an advanced AI model (OpenAI O3-mini-high) using real-world clinical data. Final diagnoses by stroke neurologists served as the reference standard.

Results: Of 127 patients, 67 (52.8%) had a final diagnosis of TIA or minor stroke. EDCT Versions 1, 2, and 3 demonstrated sensitivities of 95.5%, 91.0%, and 91.0% respectively, and specificities of 23.3%, 43.3%, and 46.7%. The AI model had a sensitivity of 98.5% but a very low specificity (11.7%; 95% CI 5.8-22.2). Steering improved AI specificity slightly (18.3%) but at the cost of decreased sensitivity.

Conclusion: Structured clinical criteria (EDCT) outperformed an advanced AI model in distinguishing TIA from mimics in an emergency setting. AI classified almost all patients (119 out of 127) as having had a TIA, resulting in high sensitivity but very poor specificity, highlighting significant limitations when applied to real-world clinical scenarios. Future development of AI diagnostic tools should include rigorous validation against structured clinical standards.

Ischaemic injury occurring in association with acute intracerebral haemorrhage (ICH) is increasingly recognised, most commonly as remote diffusion-weighted imaging (DWI) lesions. The mechanisms, timing, and clinical significance of these lesions remain incompletely defined. This narrative review evaluates whether current research supports serum biomarker testing as part of the acute work-up for ischaemic lesions occurring in the context of acute ICH. We distinguish diagnostic utility (identifying or predicting lesions) from prognostic utility (predicting outcomes). Candidate biomarkers are narratively appraised by assessing: (i) evidence linking circulating levels to magnetic resonance imaging (MRI)-defined remote DWI lesions, (ii) mechanistic alignment with post-ICH microvascular injury, and (iii) limitations of the available clinical evidence. Across astrocytic and neuronal injury markers (glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), neurofilament light chain (NfL)) and systemic inflammatory indices (C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR)), the prevailing signal reflects global injury burden or the differentiation between haemorrhagic and ischaemic stroke subtypes rather than lesion-specific detection. Lactate dehydrogenase (LDH) has demonstrated direct association with remote lesions in a retrospective ICH cohort but lacks brain specificity and is vulnerable to extracranial confounding. Prognostic biomarkers (inflammatory, oxidative, and haemostasis-related) predict general ICH outcomes but are yet to be validated for risk stratification specifically in patients with secondary DWI lesions. Overall, no single serum biomarker currently justifies routine clinical testing to detect or guide management of remote DWI lesions after ICH. Future work should prioritise temporally resolved, multi-marker panels validated against serial MRI-defined lesion phenotypes to characterise the ischaemic phenotype and support precision haemodynamic and anti-inflammatory strategies.

Background Intracerebral haemorrhage (ICH) is associated with significant long-term disability. Precise ICH location is readily available from routine diagnostic imaging and may thus enhance prognostic models. We have previously shown that involvement of motor pathways in the haematoma is highly predictive of poor outcome. However, ICH patients suffer many other impairments, and this is largely governed by ICH location. To better understand the potential prognostic significance of ICH location and guide further research, our aim was to investigate the associations between specific domains of neurological impairment and 1-year functional outcome after ICH and how these association change over time. Methods Data were pooled from 2 ICH trials: CLEAR-III and MISTIE-III. National Institutes of Health Stroke Scale and Stroke Impact Scale-3 subscores from day 30, 180 and 365 were used to construct eight neurological domains: consciousness, language, motor, sensory, vision, ataxia, memory & thinking, and emotions. The primary outcome was 1-year mRS in ICH survivors, dichotomised into good (0-3) or poor (4-5) outcome. Multivariable logistic regression models were used to investigate the association between impairments at days 30, 180, and 365 and good 1-year mRS, adjusting for baseline confounders (age, premorbid mRS, ICH and intraventricular volume on stability CT scans) and treatment group (intervention vs control). Results 736 patients were included in the analysis. Motor (OR 0.937; 95%CI:0.925-0.950) and vision (OR 0.991; 95%CI:0.983-0.999) impairment at day 30 were associated with poor 1-year mRS. At day 180, motor (OR 0.891; 95%CI:0.874-0.908) and memory & thinking (OR 0.987; 95%CI:0.975-0.998) impairment were associated with poor 1-year mRS. At day 365, motor (OR 0.876; 95%CI:0.856-0.897) impairment was significantly associated with poor 1-year mRS, along with memory & thinking (OR 0.982; 95%CI:0.971-0.994) and language (OR 0.982; 95%CI:0.966-0.999) impairment. Conclusion In our secondary analysis of this ICH cohort, motor impairment within the first year after ICH is consistently and strongly associated with 1-year mRS after ICH at all time points. Although the associations are weaker, memory and thinking at days 180 & 365 was also associated with 1-year mRS. Of the other domains, only vision showed a weak association at a single time point (day 30). Our exploratory study suggests that lesion locations impacting on motor function and memory and thinking may worsen functional recovery in ICH patients.

Introduction: Timely identification and transfer of patients with large vessel occlusion (LVO) to thrombectomy-capable stroke centers (TSCs) for endovascular thrombectomy (EVT) remains a major challenge in prehospital stroke care. This study evaluated the clinimetric performance of the Cincinnati Prehospital Stroke Scale (CPSS), the Maria Prehospital Stroke Scale (MPSS) and novel LVO screening scales created by integrating four LVO-related items into these established prehospital assessments.

Methods: Using prehospital electronic records linked with hospital data across Kawasaki City from April 2023 to March 2024, we retrospectively analyzed whether the addition of aphasia, unilateral spatial neglect, conjugate eye deviation, and atrial fibrillation (via ambulance ECG) improved prehospital LVO detection. These items were incorporated into the MPSS (MPSS+4 scale) and CPSS (CPSS+4 scale), and the predictive performance of four tools: CPSS, CPSS+4 scale, MPSS, and MPSS+4 scale was compared.

Results: Among 1,653 transported patients, 207 (12.5%) had LVO. MPSS+4 scale demonstrated the highest predictive performance for LVO (AUROC 0.768). The addition of the four LVO-related items significantly improved LVO prediction for both MPSS and CPSS (p < 0.001 for each). Higher MPSS+4 scale scores were strongly and progressively associated with the likelihood of receiving EVT after hospital arrival. Adjusted odds ratios increased from 2.97 to 100.59 for scores 2-9 compared with a score of 1.

Conclusion: Incorporating LVO-related items into prehospital stroke assessment substantially improved diagnostic precision for LVO, with MPSS+4 scale outperforming all other tools. The strong association between MPSS+4 scale scores and subsequent EVT implementation suggests that MPSS+4 scale may serve as a practical, clinically meaningful instrument for emergency medical technicians in prehospital triage of suspected acute stroke and identification of EVT candidates.