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Background: Adverse non-motor outcomes are common after acute stroke and likely to substantially affect quality of life, yet few studies have comprehensively assessed their prevalence, patterns, and predictors across multiple health domains. Aims: We aimed to identify the prevalence, patterns, and the factors associated with non-motor outcomes 30 days after stroke. Methods: This prospective observational hospital cohort study—Stroke Investigation in North and Central London (SIGNAL)—identified patients with acute ischemic stroke or intracerebral hemorrhage (ICH) admitted to the Hyperacute Stroke Unit (HASU) at University College Hospital (UCH), London, between August 1, 2018 and August 31, 2019. We assessed non-motor outcomes (anxiety, depression, fatigue, sleep, participation in social roles and activities, pain, bowel function, and bladder function) at 30-day follow-up using the Patient-Reported Outcome Measurement Information System-Version 29 (PROMIS-29) scale and Barthel Index scale. Results: We obtained follow-up data for 605/719 (84.1%) eligible patients (mean age 72.0 years; 48.3% female; 521 with ischemic stroke, 84 with ICH). Anxiety (57.0%), fatigue (52.7%), bladder dysfunction (50.2%), reduced social participation (49.2%), and pain (47.9%) were the commonest adverse non-motor outcomes. The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2 and ⩾ 3 domains were 89%, 66.3%, and 45.8%, respectively; in adjusted analyses, stroke due to ICH (compared to ischemic stroke) and admission stroke severity were the strongest and most consistent predictors. There were significant correlations between bowel dysfunction and bladder dysfunction (κ = 0.908); reduced social participation and bladder dysfunction (κ = 0.844); and anxiety and fatigue (κ = 0.613). We did not identify correlations for other pairs of non-motor domains. Conclusion: Adverse non-motor outcomes were very common at 30 days after stroke, affecting nearly 90% of evaluated patients in at least one health domain, about two-thirds in two or more domains, and almost 50% in three or more domains. Stroke due to ICH and admission stroke severity were the strongest and most consistent predictors. Adverse outcomes occurred in pairs of domains, such as with anxiety and fatigue. Our findings emphasize the importance of a multi-domain approach to effectively identify adverse non-motor outcomes after stroke to inform the development of more holistic patient care pathways after stroke. [ABSTRACT FROM AUTHOR]

Background: Epidemiological evidence suggests an association between low ambient temperature and stroke risk, but available data are limited particularly on associations with different stroke subtypes. Aims: The aim of this study is to estimate the relationship between cold spells and stroke admissions, including the effect of cold spells on different stroke subtypes (ischemic stroke and intracerebral hemorrhage (ICH)). Methods: A total of 144,405 stroke admissions from the Tianjin Centre for Health and Meteorology Multidisciplinary Innovation in China, covering the period from January 2016 to December 2020, were studied, as well as meteorological and air pollutant data. A generalized additive model with a distributed lag nonlinear model was employed to assess the relationship, considering 12 different definitions of a cold spell based on various temperature thresholds and durations. The analysis controlled for lagged and nonlinear effects of temperature. Analyses were performed on all strokes as well as ischemic stroke and ICH. Results: There was a significant increase in stroke admissions during cold spells. Generally, the increased risk during cold spells increased as the temperature threshold decreased, but was not significantly affected by the duration. The optimal model was obtained using the cold-spell definition based on an average daily temperature below the 10th percentile (0.11°C) for 2 or more consecutive days. According to this model, the effect of cold spells on ischemic stroke admissions had a significant lag effect and was long-lasting, with a single-day effect occurring on lag 7d, peaking on lag 13d (relative risk (RR) = 1.05; 95% confidence interval (CI) = 1.02 to 1.09), and lasting until lag 20d. In contrast, the effect on ICH was immediate and short-lived, with the most significant single-day effect occurring on the current day (RR = 1.17; 95% CI = 1.06 to 1.29) and limited within 3 days. 14.15% of stroke cases could be attributed to cold spells, with ICH exhibiting a higher burden than ischemic stroke except for strict temperature threshold definitions. Conclusion: Cold spells are associated with an increased stroke risk. Different patterns of association were seen for different stroke subtypes. The effect on ischemic stroke had a lag effect and a longer duration, whereas the effect on ICH had an immediate effect and a shorter duration. These findings support the development and improvement of stroke cold-spell early warning systems and highlight the importance of public health interventions to mitigate the adverse health impacts of cold spells. [ABSTRACT FROM AUTHOR]

The article discusses the role of chronic inflammation in stroke and the potential for anti-inflammatory drugs to reduce stroke risk. It highlights the complexity of the field, as inflammation may play different roles in different types of stroke. The article also explores the impact of inflammation on other subtypes of stroke, such as cerebral small vessel disease. It mentions the use of canakinumab and colchicine as anti-inflammatory agents for vascular prevention. Additionally, the article addresses the non-motor symptoms of stroke, including anxiety, fatigue, and impaired bladder function, which can have a significant impact on quality of life. It emphasizes the need for further research in these areas. The article also discusses the association between stroke and cancer, particularly in cases of cryptogenic stroke, and the potential use of cerebral microinfarcts as a marker for brain ischemia and stroke risk in cancer patients. Finally, the article provides information on the risk of recurrence after cervical artery dissection. [Extracted from the article]

Background and purpose: Poststroke fatigue (PSF) is a common complication after stroke. However, information on the global prevalence of PSF and how this varies geographically and by population is lacking. Our aim was to examine the global prevalence of PSF and identify sources of heterogeneity in the published literature. Methods: Four medical databases (PubMed, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews) were searched from their inception to 28 February 2022. The Joanna Briggs Institute Critical Appraisal Instrument for studies reporting prevalence data (JBI) was used to assess the risk of bias (ROB) of the included studies. The primary outcome was the prevalence of PSF determined using a random-effects model. Subgroup analysis and meta-regression models were used to define the source of heterogeneity. Results: In all, 66 studies with 11,697 patients were included in this meta-analysis. The overall quality of the included studies was medium. The global pooled prevalence of PSF in stroke survivors was 46.79% (95% confidence interval (CI), 43.41–50.18%). The prevalence estimates of PSF based on the Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory-20 (MFI-20), and Fatigue Assessment Scale (FAS) were 47.44% (95% CI, 43.20–51.67%), 51.69% (95% CI, 44.54–58.83%), and 36.13% (95% CI, 23.07–49.18%), respectively. Prevalence rates of PSF were higher in females (53.19%; 95% CI, 46.46–59.92%), in hemorrhagic stroke (57.54%; 95% CI, 40.55–74.53%), in those with a college degree or higher (53.18%; 95% CI, 42.82–63.54%), and in those with unmarried or divorced status (59.78%; 95% CI, 44.72–74.83%). Conclusions: The prevalence of PSF in stroke survivors is high, affecting almost half of all stroke sufferers. PSF rates were higher with female gender, being unmarried or divorced, having a higher educational level, and being hemorrhagic compared to ischemic stroke. Trial registration: PROSPERO (CRD42021269441). [ABSTRACT FROM AUTHOR]

Background: Although men have a higher rate of stroke than women, it is not clear whether women have a worse outcome after adjusting for confounders such as vascular risk factors, age, stroke severity, and reperfusion therapy. We evaluated sex differences on 90-day functional outcomes after stroke in a multicenter study in Vietnam. Methods: We recruited patients presenting with ischemic or hemorrhagic stroke at 10 stroke centers in Vietnam for a period of 1 month from 1 August 2022 to 31 August 2022. We reviewed the patient's clinical demographics, time from symptom onset to hospital admission, stroke classification, stroke subtype, stroke severity, characteristics of reperfusion therapy, and 90-day clinical outcome. We compared functional outcomes and predisposing factors at day 90 between men and women after an ischemic and hemorrhagic stroke. Poor outcome was defined as modified Rankin Scale 3–6. Results: There were 2300 stroke patients included. Men accounted for 61.3% (1410) of participants. Compared to men, women were older (67.7 ± 13.9 vs 63.7 ± 13.3, P < 0.001), had a higher rate of diabetes mellitus (21.1% vs 15.3%, P < 0.001), a lower rate of tobacco use (1.0 % vs 23.6%, P < 0.001), and a lower body mass index (21.4 ± 2.70 vs 22.0 ± 2.72, P < 0.001). There was a higher rate of intracranial hemorrhage (ICH) in men (21.3% vs 15.6%, P = 0.001), whereas the rate of subarachnoid hemorrhage was higher in women (6.2% vs 3.0%, P < 0.001). For ischemic stroke, door-to-needle time (36.9 ± 17.6 vs 47.8 ± 35.2 min, P = 0.04) and door-to-recanalization time (113.6 ± 51.1 vs 134.2 ± 48.2, P = 0.03) were shorter in women. There was no difference in 90-day functional outcomes between sexes. Factors associated with poor outcomes included age ⩾50 years (adjusted odds ratio (aOR): 1.75; 95% confidence interval (CI): 1.16–2.66), history of stroke (aOR: 1.50; 95% CI: 1.15–1.96), large artery atherosclerosis (aOR: 5.19; 95% CI: 3.90–6.90), and cardioembolism (aOR: 3.21; 95% CI: 1.68–6.16). Factors associated with mortality in patients with acute ischemic stroke included a history of coronary artery disease (aOR: 3.04; 95% CI: 1.03–8.92), large artery atherosclerosis (aOR: 3.37; 95% CI: 2.11–5.37), and cardioembolism (aOR: 3.15; 95% CI: 1.20–8.27). Conclusion: There were no sex differences in the clinical outcome of stroke and ischemic stroke in this prospective cohort of hospitalized Vietnamese patients. [ABSTRACT FROM AUTHOR]

Background and aim: There are few data on the influence of lupus flare on stroke risk in systemic lupus erythematosus (SLE). In this study, we examined whether a severe lupus flare further increases the risk of stroke among SLE patients. Methods: Using the Taiwan's National Health Insurance Research Database, we conducted a retrospective population-based cohort study from 2000 to 2016. Each patient with SLE was matched to a non-SLE subject in age, sex, and index date. A severe flare of lupus was identified when an SLE patient was admitted for pulse therapy with intravenous methylprednisolone greater than 250 mg in a single hospitalization. SLE patients were divided into severe flare and non-severe flare groups. Results: In total, 334 of 10,006 patients with SLE had a severe lupus flare, and the remaining 9672 patients were assigned to the non-severe flare group. Ischemic stroke occurred in 29 (8.7%), 485 (5%), and 384 (3.8%) of the patients in the severe flare, non-severe flare, and control groups, respectively. Hemorrhagic stroke occurred in 9 (2.7%), 123 (1.3%), and 37 (0.4%) of patients in the severe flare, non-severe flare, and control groups, respectively. Compared with patients in the non-severe flare group, patients with severe flare had a significantly higher risk of ischemic stroke (adjusted hazard ratio (aHR) = 7.44, 95% confidence interval (CI): 4.93–11.25 vs aHR = 1.52, 95% CI: 1.26–1.83) and hemorrhagic stroke (aHR = 22.49, 95% CI: 10.09–50.12 vs aHR = 4.47, 95% CI: 2.90–6.90). Conclusion: Severe lupus flare is associated with a much higher risk of ischemic and hemorrhagic strokes among SLE patients. [ABSTRACT FROM AUTHOR]

Rationale: The optimal duration of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin for the large artery atherosclerotic (LAA) stroke subtype has been debated. Aims: To determine whether the 1-year risk of recurrent vascular events could be reduced by a longer duration of DAPT in patients with the LAA stroke subtype. Methods and study design: A total of 4806 participants will be recruited to detect a statistically significant relative risk reduction of 22% with 80% power and a two-sided alpha error of 0.05, including a 10% loss to follow-up. This is a registry-based, multicenter, prospective, randomized, open-label, blinded end point study designed to evaluate the efficacy and safety of a 12-month duration of DAPT compared with a 3-month duration of DAPT in the LAA stroke subtype. Patients will be randomized (1:1) to either DAPT for 12 months or DAPT for 3 months, followed by monotherapy (either aspirin or clopidogrel) for the remaining 9 months. Study outcomes: The primary efficacy outcome of the study is a composite of stroke (ischemic or hemorrhagic), myocardial infarction, and all-cause mortality for 1 year after the index stroke. The secondary efficacy outcomes are (1) stroke, (2) ischemic stroke or transient ischemic attack, (3) hemorrhagic stroke, and (4) all-cause mortality. The primary safety outcome is major bleeding. Discussion: This study will help stroke physicians determine the appropriate duration of dual therapy with clopidogrel-aspirin for patients with the LAA stroke subtype. Trial registration: URL: https://cris.nih.go.kr/cris. CRIS Registration Number: KCT0004407 [ABSTRACT FROM AUTHOR]

Background: The absolute burden of stroke in Korea is ever growing. Many studies have explored the outcomes of mortality, quality of life (QOL), and/or economic burden with limited periods of observation. Relatively few have addressed the lifetime outcomes that are estimated beyond the limited observation period of study samples. Aims: By combining QOL and the survival functions over a lifetime horizon, our aims were to estimate the quality-adjusted life expectancy (QALE) and loss-of-QALE of patients with ischemic and hemorrhagic stroke in South Korea, and to compare them between genders. Methods: The survival function of stroke patients (n = 13,994) was estimated by the Kaplan–Meier's method from the National Health Insurance Service-National Sample Cohort of Korea (2002–2015), and then extrapolated to lifetime through a rolling-over algorithm. The QOL measurements, assessed by EuroQol 5-dimension (EQ-5D) questionnaire, of stroke patients (n = 474) were extracted from the Korea Health Panel (KHP, 2008–2018) to estimate the QALE. All stroke patients were categorized by sex and two types of stroke: ischemic and hemorrhagic. Age-, sex-, and calendar year-matched referents were simulated from the Korean life tables to be integrated with the general population's QOL from the KHP to estimate the QALE of the referents. We calculated the loss-of-QALE by comparing the above two sets of QALE. Results: The QALE and loss-of-QALE for ischemic stroke were 10.8 and 6.1 QALYs (quality-adjusted life years), respectively, and 14.0 and 9.0 QALYs for hemorrhagic stroke. The loss-of-QALE in men was 3.0 QALYs larger than that of women with hemorrhagic stroke (p < 0.05), while the difference for ischemic stroke was much smaller and statistically insignificant at 0.6 QALYs. Conclusions: The lifetime impact of stroke in Korea is large, especially for males who survived hemorrhagic stroke. Future studies assessing the lifetime needs for long-term care of stroke patients are warranted to quantify the burden of stroke from the societal perspective. [ABSTRACT FROM AUTHOR]

Rationale: The evidence base for acute post-stroke rehabilitation is inadequate and global guideline recommendations vary. Aim: To define optimal early mobility intervention regimens for ischemic stroke patients of mild and moderate severity. Hypotheses: Compared with a prespecified reference arm, the optimal dose regimen(s) will result in more participants experiencing little or no disability (mRS 0–2) at 3 months post-stroke (primary), fewer deaths at 3 months, fewer and less severe complications during the intervention period, faster recovery of unassisted walking, and better quality of life at 3 months (secondary). We also hypothesize that these regimens will be more cost-effective. Sample size estimates: For the primary outcome, recruitment of 1300 mild and 1400 moderate participants will yield 80% power to detect a 10% risk difference. Methods and design: Multi-arm multi-stage covariate-adjusted response-adaptive randomized trial of mobility training commenced within 48 h of stroke in mild (NIHSS < 7) and moderate (NIHSS 8–16) stroke patient strata, with analysis of blinded outcomes at 3 (primary) and 6 months. Eligibility criteria are broad, while excluding those with severe premorbid disability (mRS > 2) and hemorrhagic stroke. With four arms per stratum (reference arm retained throughout), only the single treatment arm demonstrating the highest proportion of favorable outcomes at the first stage will proceed to the second stage in each stratum, resulting in a final comparison with the reference arm. Three prognostic covariates of age, geographic region and reperfusion interventions, as well as previously observed mRS 0–2 responses inform the adaptive randomization procedure. Participants randomized receive prespecified mobility training regimens (functional task-specific), provided by physiotherapists/nurses until discharge or 14 days. Interventions replace usual mobility training. Fifty hospitals in seven countries (Australia, Malaysia, United Kingdom, Ireland, India, Brazil, Singapore) are expected to participate. Summary: Our novel adaptive trial design will evaluate a wider variety of mobility regimes than a traditional two-arm design. The data-driven adaptions during the trial will enable a more efficient evaluation to determine the optimal early mobility intervention for patients with mild and moderate ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. Aims: To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). Summary of review: Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. Conclusion: The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation. [ABSTRACT FROM AUTHOR]

Background: Research investigating differences in the overall stroke risk between individuals with and without immune thrombocytopenia (ITP) is lacking. Methods: This real-world study used the National Health Insurance Research Database (NHIRD). Risk of stroke was compared between 13,085 individuals with ITP enrolled between 1 January 2000 and 31 December 2015 and a control cohort of 52,340 individuals without ITP (1:4 ratio propensity score–matched by age, sex, index year, relevant comorbidities, and medications). Sub-distribution hazards models were used to estimate adjusted sub-distribution hazard ratio (SHR) and 95% confidence intervals (CIs), with the non-ITP group as the control group. Results: Of the 65,425 participants, 13,085 had ITP, 63.3% were women, and the mean age was 52.59 years. The risk of both ischemic and hemorrhagic stroke was 1.14 times (adjusted SHR 1.14, 95% CI, 1.07–1.22) and 1.93 times (adjusted SHR 1.93, 95% CI, 1.70–2.20) higher in the ITP group than in controls. Patients with ITP in the 20- to 29-year subgroup had a higher risk of new-onset stroke (adjusted SHR, 4.06 (95% CI, 2.72–6.07), p value for interaction <0.01) than those aged 20–29 years without ITP. Individuals with severe ITP with splenectomy had a 1.79 times higher overall stroke risk than those without. Conclusions: ITP is associated with increased risk of both ischemic and hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Background: Having a stroke at a young age has a huge socioeconomic impact. Data on the trends of stroke incidence in young adults from prospective population-based studies are scarce. Aims: The aim of this study was to analyze the trends in stroke incidence in 15- to 54-year-old residents of Tartu, Estonia from 1991 to 2017. Methods: Three population-based studies with identical study protocols determining the incidence of first-ever stroke have previously been conducted in Tartu, Estonia (1991–1993, 2001–2003, and 2013–2017). All residents of Tartu with first-ever stroke (ischemic stroke, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage) who were hospitalized to the Department of Neurology, Tartu University Hospital in respective study periods were included prospectively. Overlapping data sources for case ascertainment were used to include both hospitalized and non-hospitalized cases. Trends in first-ever stroke incidence in 15- to 54-year-old residents of Tartu were calculated and compared using rate ratio (RR). Results: Altogether 259 strokes were identified. From 1991 to 2017, the proportion of women increased from 38.3% to 43.6%. Mean age at onset in women decreased from 46.9 (standard deviation (SD): 7.3) to 42.6 (SD: 8.9). Overall crude incidence rates per 100,000 decreased significantly from 1991 to 2003 (from 57.2 (95% confidence interval (CI): 46.9–69.1) to 35.7 (95% CI: 25.7–48.3)); RR: 0.62 (95% CI: 0.44–0.89). While also present in women, the decrease was most notable in 45- to 54-year-old men (RR: 0.55 (95% CI: 0.30–0.99)). In 35- to 44-year-old men, the incidence rates decreased significantly from 2001 to 2017 (RR: 0.37 (95% CI: 0.14–0.99)). Conclusion: The overall first-ever stroke incidence rates decreased from 1991 to 2003 and remained stable thereafter. [ABSTRACT FROM AUTHOR]

Cerebral small vessel disease (SVD) causes lacunar stroke and intracerebral hemorrhage, and is the most common pathology underlying vascular cognitive impairment. Increasingly, the importance of other clinical features of SVD is being recognized including motor impairment, (vascular) parkinsonism, impaired balance, falls, and behavioral symptoms, such as depression, apathy, and personality change. Epidemiological data show a high prevalence of the characteristic magnetic resonance imaging (MRI) features of white matter hyperintensities and lacunar infarcts in community studies, and recent data suggest that it is also a major health burden in low- and middle-income countries. In this review, we cover advances in diagnosis, imaging, clinical presentations, pathogenesis, and treatment. The two most common pathologies underlying SVD are arteriolosclerosis caused by aging, hypertension, and other conventional vascular risk factors, and cerebral amyloid angiopathy (CAA) caused by vascular deposition of β-amyloid. We discuss the revised Boston criteria of CAA based on MRI features, which have been recently validated. Imaging is providing important insights into pathogenesis, including improved detection of tissue damage using diffusion tensor imaging (DTI) leading to its use to monitor progression and surrogate endpoints in clinical trials. Advanced MRI techniques can demonstrate functional or dynamic abnormalities of the blood vessels, while the high spatial resolution provided by ultrahigh field MRI at 7 T allows imaging of individual perforating arteries for the first time, and the measurement of flow velocity and pulsatility within these arteries. DTI and structural network analysis have highlighted the importance of network disruption in mediating the effect of different SVD pathologies in causing a number of symptoms, including cognitive impairment, apathy, and gait disturbance. Despite the public health importance of SVD, there are few proven treatments. We review the evidence for primary prevention, and recent data showing how intensive blood pressure lowering reduces white matter hyperintensities (WMH) progression and delays the onset of cognitive impairment. There are few treatments for secondary prevention, but a number of trials are currently evaluating novel treatment approaches. Recent advances have implicated molecular processes related to endothelial dysfunction, nitric oxide synthesis, blood–brain barrier integrity, maintenance and repair of the extracellular matrix, and inflammation. Novel treatment approaches are being developed to a number of these targets. Finally, we highlight the importance of large International collaborative initiatives in SVD to address important research questions and cover a number which have recently been established. [ABSTRACT FROM AUTHOR]

Background: Preventive screening for intracranial aneurysms is effective in persons with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH), but for many relatives of aSAH patients, it can be difficult to assess whether their relative had an aSAH or another type of stroke. Aim: We aimed to develop a family history questionnaire for people in the population who believe they have a first-degree relative who had a stroke and to assess its accuracy to identify relatives of aSAH patients. Methods: A questionnaire to distinguish between aSAH and other stroke types (ischemic stroke and intracerebral hemorrhage) was developed by a team of clinicians and consumers. The level of agreement between the questionnaire outcome and medical diagnosis was pilot tested in 30 previously admitted aSAH patients. Next, the sensitivity and specificity of the questionnaire were assessed in 91 first-degree relatives (siblings/children) of previously admitted stroke patients. Results: All 30 aSAH patients were identified by the questionnaire in the pilot study; 29 of 30 first-degree relatives of aSAH patients were correctly identified. The questionnaire had a sensitivity of 97% (95% confidence interval (CI) = 83–100%) and a specificity of 93% (95% CI = 84–98%) when tested in the first-degree relatives of stroke patients. Conclusion: Our questionnaire can help persons to discriminate an aSAH from other types of stroke in their affected relative. This family history questionnaire is developed in the Netherlands but could also be used in other countries after validation. [ABSTRACT FROM AUTHOR]

Objective: Based on the few population-based studies that have been conducted in the Middle East, we determined the incidence of stroke in Qom, one of the central provinces of Iran. Methods: The Qom province includes an estimated at-risk population of about 1 million. During a 12-month period (November 2018–November 2019), all first-ever strokes occurring in the target population were registered. Hospitalized cases were ascertained by discharge codes. Out-of-hospital cases were ascertained by a prospective screening of emergency medical services, emergency departments, ambulances records, primary care clinics, rural and urban public health centers, primary care physician offices, and neurologists' offices. Crude and age-adjusted incidence rates (per 100,000 person-years) were calculated. Results: During the study period, 1462 first-ever strokes occurred with a mean age of 68.1 (17–103) years; of these 45.2% were females (661 cases). The crude annual incidence rate per 100,000 at-risk populations was 145.4 (95% confidence interval, 138.1–153.0) for all types of stroke (156.5 for males and 134.3 for females), 26.4 (95% confidence interval, 23.5–29.8) for hemorrhagic stroke, and 114 (95% confidence interval, 105–121) for ischemic stroke. The incidence rate adjusted to the world population was 201.4 (95% confidence interval, 193–210) per 100,000 at-risk populations (adj incidence, 218.5 for males vs 187.4 for females). The total fatality rate during the first 28 days was 19.6%. Conclusion: This study states that in this region there is a high incidence of stroke, which occurs at a younger age than the global average. There was a high prevalence of underlying stroke risk factors. [ABSTRACT FROM AUTHOR]

Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking.To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3–11.2%), whereas LAPSS missed the most (25.5%).Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment. [ABSTRACT FROM AUTHOR]

Keywords: Stroke; guidelines; global; clinical trials; intracerebral hemorrhage; thrombectomy; endoscopic surgery; pediatric stroke; dementia; Twitter EN Stroke guidelines global clinical trials intracerebral hemorrhage thrombectomy endoscopic surgery pediatric stroke dementia Twitter 496 498 3 05/22/23 20230601 NES 230601 Guidelines are very useful in guiding our everyday practice. Stroke, guidelines, clinical trials, intracerebral hemorrhage, thrombectomy, endoscopic surgery, global, pediatric stroke, dementia, Twitter For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. [Extracted from the article]

Introduction: Intracerebral hemorrhage is the deadliest form of stroke. Hematoma expansion, growth of the hematoma between the baseline computed tomography scan and a follow-up computed tomography scan at 24 ± 6 h, predicts long-term disability or death. Recombinant factor VIIa (rFVIIa) has reduced hematoma expansion in previous clinical trials with a variable effect on clinical outcomes, with the greatest impact on hematoma expansion and potential benefit when administered within 2 h of symptom onset. Methods: Factor VIIa for Hemorrhagic Stroke Treatment at Earliest Possible Time (FASTEST, NCT03496883) is a randomized controlled trial that will enroll 860 patients at ∼100 emergency departments and mobile stroke units in five countries. Patients are eligible for enrollment if they have acute intracerebral hemorrhage within 2 h of symptom onset confirmed by computed tomography, a hematoma volume of 2 to 60 mL, no or small volumes of intraventricular hemorrhage, do not take anticoagulant medications or concurrent heparin/heparinoids (antiplatelet medications are permissible), and are not deeply comatose. Enrolled patients will receive rFVIIa 80 µg/kg or placebo intravenously over 2 min. The primary outcome measure is the distribution of the ordinal modified Rankin Scale at 180 days. FASTEST is monitored by a Data Safety Monitoring Board. Safety endpoints include thrombotic events (e.g. myocardial infarction). Human subjects research is monitored by an external Institutional Review Board in participating countries. Discussion: In the US, FASTEST will be first NIH StrokeNet Trial with an Exception from Informed Consent which allows enrollment of non-communicative patients without an immediately identifiable proxy. [ABSTRACT FROM AUTHOR]

Objective: Many epidemiological studies have observed the association of air pollutant exposure with the onset, progression, and mortality of stroke. The aim of this study was to investigate the associations of air pollutants, including SO2, NO2, O3, CO, and PM10, with stroke according to exposure duration. Methods: Data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 were obtained. The 21,240 patients who were admitted for or died due to stroke were 1:4 matched for age, sex, income, and region of residence with 84,960 control participants. The meteorological factors of mean, highest, and lowest temperatures; relative humidity; ambient atmospheric pressure; and air pollutant concentrations (SO2, NO2, O3, CO, and PM10) were analyzed to determine their associations with stroke. The odds ratios for stroke after exposure to each meteorological factor and air pollutant at 7 and 30 days were calculated in the stroke and control groups. Subgroup analyses were conducted according to age, sex, income, and region of residence. Results: The odds ratio associated with seven days of exposure to CO was 1.16 (95% CI = 1.04–1.31) in stroke patients. For 30 days of exposure, the odds ratio associated with CO was 1.16 (95% CI = 1.02–1.32) in stroke patients. Seven and 30 days of NO2 exposure were inversely associated with stroke. The odds ratio associated with seven days of exposure to O3 was 1.16 (95% CI = 1.01–1.32) in ischemic stroke patients. Both ischemic and hemorrhagic stroke had negative associations with 7 and 30 days of NO2 exposure. Conclusion: Both short- and long-term exposure to CO were related to stroke. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular events occur more often in winter than in summer; however, the dependence of strokes on various meteorological factors remains unclear. Aims: The purpose of this meta-analysis was to determine the dependence of the circannual dynamics of hospitalizations for hemorrhagic stroke and ischemic stroke on seasonal fluctuations in meteorological factors. Summary of review and conclusions: For our meta-analysis, we selected 20 and 26 publications examining the seasonal dynamics of hemorrhagic stroke and ischemic stroke, respectively. The meta-analysis showed that hemorrhagic stroke is less likely to occur in summer than in other seasons and does not depend on a region's climate. The seasonal dynamics of ischemic stroke are not clearly expressed and are determined by the characteristics of a region's climate. In a climate without pronounced seasonal dynamics of atmospheric pressure and in wet winters, the vector of ischemic stroke incidents will not be expressed or slightly shifted toward winter. Low atmospheric pressure in summer is associated with an increased likelihood of ischemic stroke during this season compared to winter. There was also a relation between ischemic stroke risk with high relative humidity and a significant decrease in ρO2 in summer, but there is not enough evidence regarding this association. We did not reveal dependence of the seasonal dynamics of strokes on the amplitude of annual fluctuations in air temperature. [ABSTRACT FROM AUTHOR]

Background: The burden of stroke is high in sub-Saharan Africa; however, few data are available on long-term mortality. Objective: To estimate over one-month stroke case fatality in sub-Saharan Africa. Methods: A systematic review and meta-analysis were performed according to meta-analysis of observational studies in epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42020192439), on five electronic databases (PubMed, Science direct, AJOL, EMBASE, and Web of Sciences). We searched all studies on stroke case fatality over one month in sub-Saharan Africa published between 1st January 2000 and 31st December 2019. Results:We included 91 studies with a total of 34,362 stroke cases. The one-month pooled stroke case-fatality rate was 24.1% [95% CI: 21.5-27.0] and 33.2% [95% CI: 23.6-44.5] at one year. At three and five years, the case-fatality rates were respectively 40.1% [95% CI: 20.8-63.0] and 39.4% [95% CI: 14.3-71.5] with high heterogeneity. Hemorrhagic stroke was associated with a higher risk of mortality at one month, but ischemic stroke increased the risk of mortality over six months. Diabetes was associated with poor prognosis at 6 and 12 months with odds ratios of 1.64 [95% CI: 1.22-2.20] and 1.85 [1.25-2.75], respectively. Conclusion: The stroke case fatality over one month was very high, compared to case fatalities reported in Western countries and can be explained by a weak healthcare systems and vascular risk factors. [ABSTRACT FROM AUTHOR]

Background and aims: As moyamoya disease in pregnancy is clinically rare, it is poorly understood. We therefore analyzed our experiences of moyamoya disease pregnancies and deliveries over three decades. Methods: The clinical data of 78 pregnancies and 77 deliveries among 62 moyamoya disease cases at Tokyo Medical and Dental University Hospital from 1991 to 2019 were retrospectively reviewed. Results: There were six, 17 and 55 pregnancies in the first, second, and last decades, respectively. The mean patient age at delivery was 29.3 ± 5.0 years. The primary symptoms of moyamoya disease at diagnosis were ischemia in 50 cases (64.1%) and intracranial hemorrhage in eight cases (10.2%). Cesarean section was performed in 75 cases (96.2%). Fifteen pregnancies (19.2%) developed hypertensive disorders of pregnancy; of these, 13 (86.7%) developed hypertensive disorders of pregnancy after 34 weeks of gestation and 9 (60%) required emergency cesarean section because of a sudden increase in blood pressure. Four (5.1%) women experienced renal artery stenosis complications and three of them developed hypertension during pregnancy. Two (2.6%) experienced cerebral infarctions several days after delivery, both of whom had no subsequent aftereffects. No cases of hemorrhagic stroke were reported in the peripartum period. Conclusions: To date, this is the largest single-center analysis. It showed the number of moyamoya disease pregnancies has risen rapidly over the last decade. The hypertensive disorders of pregnancy and emergency cesarean section rates were high among moyamoya disease patients. Minor ischemic stroke was observed, but its prevalence was low. Therefore, pregnant women with moyamoya disease should be managed with the understanding that hypertensive disorders of pregnancy is a common complication. [ABSTRACT FROM AUTHOR]

Background: Increased aortic stiffness, assessed as carotid-femoral pulse wave velocity (cfPWV), contributes to cerebrovascular damage and is predictive of cerebrovascular events. Aims and methods: We sought to examine the association between estimated pulse wave velocity (ePWV), a proxy of carotid-femoral pulse wave velocity, and stroke and its subtypes (ischemic and hemorrhagic) in a prospective cohort of 2666 men (aged mean 53.1, range 42–61 years) enrolled in the Kuopio Ischemic Heart Disease cohort study. Results: During a median 28-year follow-up, 471 incident stroke (397 ischemic and 94 hemorrhagic) events occurred. After adjusting for several established and emerging risk factors including age and pulse pressure, comparing the p versus bottom quartiles of ePWV, there was an increased risk of stroke (hazard ratio [HR] 2.37, 95% Confidence Interval [CI]: 1.57–3.58), ischemic stroke (HR 2.23, 95% CI, 1.42–3.50), and hemorrhagic stroke (HR 3.57, 95% CI, 1.45–8.76). Conclusion: These findings demonstrate that ePWV is independently associated with the risk of stroke in middle-aged men. [ABSTRACT FROM AUTHOR]

Background: COVID-19-related strokes are increasingly being diagnosed across the world. Knowledge about the clinical profile, imaging findings, and outcomes is still evolving. Here we describe the characteristics of a cohort of 62 COVID-19-related stroke patients from 13 hospitals, from Bangalore city, south India. Objective: To describe the clinical profile, neuroimaging findings, interventions, and outcomes in COVID-19-related stroke patients. Methods: This is a multicenter retrospective study of all COVID-19-related stroke patients from 13 hospitals from south India; 1st June 2020–31st August 2020. The demographic, clinical, laboratory, and neuroimaging data were collected along with treatment administered and outcomes. SARS–CoV-2 infection was confirmed in all cases by RT-PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis. Results: During the three-month period, we had 62 COVID-19-related stroke patients, across 13 centers; 60 (97%) had ischemic strokes, while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ± 13.20 years, with 34 (77.4%) males. Twenty-six percent (16/62) of patients did not have any conventional risk factors for stroke. Diabetes mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8%, and atrial fibrillation in 4.8%. Baseline National Institutes of Health Stroke Scale score was 12.7 ± 6.44. Stroke severity was moderate (National Institutes of Health Stroke Scale 5–15) in 27 (61.3%) patients, moderate to severe (National Institutes of Health Stroke Scale 16–20) in 13 (20.9%) patients and severe (National Institutes of Health Stroke Scale 21–42) in 11 (17.7%) patients. According to TOAST classification, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion, and 5% had cardioembolic strokes. Three (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/kg and 3 (5%) underwent mechanical thrombectomy, two endovascular and one surgical. Duration of hospital stay was 16.16 ± 6.39 days; 21% (13/62) died in hospital, while 37 (59.7%) had a modified Rankin score of 3–5 at discharge. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality. A comparison to 111 historical controls during the non-COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality, and higher morbidity in COVID-19-related stroke patients. Conclusion: COVID-19-related strokes are increasingly being recognized in developing countries, like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of COVID-19-related strokes. COVID-19-related strokes were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation, and higher baseline National Institutes of Health Stroke Scale scores were associated with increased mortality. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear. Aims: We aimed to characterize the incidence, risk factors, clinical–radiological manifestations, and outcome of COVID-19-associated stroke. Methods: Three medical databases were systematically reviewed for published articles on acute cerebrovascular diseases in COVID-19 (December 2019–September 2020). The review protocol was previously registered (PROSPERO ID = CRD42020185476). Data were extracted from articles reporting ≥5 stroke cases in COVID-19. We complied with the PRISMA guidelines and used the Newcastle–Ottawa Scale to assess data quality. Data were pooled using a random-effect model. Summary of review: Of 2277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0–1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral hemorrhage was less common (11.6%). Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not, were older (pooled median difference = 4.8 years; 95%CI: 1.7–22.4), more likely to have hypertension (OR = 7.35; 95%CI: 1.94–27.87), diabetes mellitus (OR = 5.56; 95%CI: 3.34–9.24), coronary artery disease (OR = 3.12; 95%CI: 1.61–6.02), and severe infection (OR = 5.10; 95%CI: 2.72–9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference = −6.0 years; 95%CI: −12.3 to −1.4), had higher NIHSS (pooled median difference = 5; 95%CI: 3–9), higher frequency of large vessel occlusion (OR = 2.73; 95%CI: 1.63–4.57), and higher in-hospital mortality rate (OR = 5.21; 95%CI: 3.43–7.90). Conclusions: Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease. [ABSTRACT FROM AUTHOR]

Keywords: Stroke; global; epidemiology; disparities; Africa; South America; Japan; New Zealand; lacunar; small vessel disease; Angels Initiative EN Stroke global epidemiology disparities Africa South America Japan New Zealand lacunar small vessel disease Angels Initiative 632 633 2 07/03/23 20230701 NES 230701 Stroke remains an enormous global burden for us all regardless of geographical location or ethnicity. The Angels Initiative has supported over 1700 hospitals (>1000 in low- and middle-income countries (LMICs)) that did not previously treat stroke patients to become "stroke ready." Importantly, they report that disparities in care and outcomes following stroke were independent of traditional risk factors, suggesting they may be attributable to differences in stroke service delivery rather than patient factors. [Extracted from the article]

Background and methods: Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. Results: Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0–2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. Conclusions: Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized. [ABSTRACT FROM AUTHOR]

Background and methods: Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results: Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00–18:45), a median of NIHSS 6 (3–14), and a median age of 66 (56–76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. Conclusions: MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries. [ABSTRACT FROM AUTHOR]

Background Retrospective data indicate increased stroke incidence in Aboriginal/Torres Strait Islander (Indigenous) Australians, possibly with poorer outcomes. We present the first prospective population-based stroke incidence study in Indigenous Australians. Methods We pooled data from ASCEND and SEARCH, two prospective “ideal” South Australian stroke incidence studies, ASCEND conducted in urban Northwestern Adelaide (2009–2010) and SEARCH in five South Australian rural centers (2009–2011). We calculated age-standardized incidence for Aboriginal and non-Aboriginal people. Results The study population comprised 261,403 inhabitants. Among 432 first-ever strokes, 13 were in Aboriginal people (median age 51 vs. 78 years for non-Aboriginal people, p < 0.001). Age-standardized stroke incidence per 100,000 in Aboriginal patients (116, 95% CI: 95–137) was nearly two-fold that of non-Aboriginal patients (67, 95% CI: 51–84). Age-stratified excess incidence in Aboriginal people was restricted to those aged < 55 years (incidence rate ratio (IRR) 3.5, 95% CI: 2–7), particularly for intracerebral hemorrhage (IRR: 16, 95% CI: 4–61). Conclusion The excess stroke incidence in Aboriginal South Australians appears substantial, especially in those aged <55 years. Further work is required to delineate and address disparities. [ABSTRACT FROM AUTHOR]

Although thrombectomy can transform outcome in stroke patients, not all patients benefit and there is great interest in identifying potentially reversible modifying factors. Intracranial vertebral disease was more common than extracranial disease in the Chinese population, while patients with combined intracranial disease were more likely to have hypertension. They studied 151 patients with acute BAO, of which 112 patients (74%) underwent endovascular treatment. [Extracted from the article]

Background and purpose: Moyamoya vasculopathy, a rare steno-occlusive progressive cerebrovascular disorder, has not been thoroughly studied in Caucasian populations. We established a registry of Finnish patients treated at the Helsinki University Hospital, to collect and report demographic and clinical data. Methods:We collected data both retrospectively and prospectively from all the patients with a moyamoya vasculopathy referred to our hospital between January 1987 and December 2014. All patients underwent a neurological outpatient clinic visit. Results: We diagnosed 61 patients (50 females, 10 children) with moyamoya vasculopathy. The mean age at the disease-onset was 31.5±17.9 years. The two most common presenting symptoms were ischemic stroke (n=31) and hemorrhage (n=8). Forty-four percent underwent revascularization surgery, and 70% were prescribed antithrombotic treatment. Conclusions: The results support in part the Western phenotype of the disease considering the later presentation and larger female predominance compared to the Asian moyamoya vasculopathy reports. However, the proportion of ischemic strokes and hemorrhagic strokes is closer to Japanese population than German population. The absence of familial cases points to a different genetic profile in the Finnish patients. [ABSTRACT FROM AUTHOR]

Background: Hematoma expansion is a major predictor of morbidity and mortality after intracerebral hemorrhage (ICH). Both baseline hematoma volume and the CT-angiogram (CTA) spot sign predict hematoma expansion. Because the CTA spot sign may represent foci of active hemorrhage, we hypothesized that patients with smaller baseline hematoma volumes are less likely to be spot sign positive, and therefore less likely to expand. Aim: We sought to validate our prior finding that small hematomas are unlikely to expand, and to determine the relationship between baseline hematoma volume, spot sign status, and risk of hematoma expansion. Methods: Data were from the prospective PREDICT ICH study. Patients presenting within 6 h of symptom onset with completed baseline CT, CTA, and follow-up CT were included. Baseline hematoma volume was categorized a priori (<3 mL, 3-10 mL, 10-20 mL, >20 mL). The primary outcome was significant hematoma expansion (2:6 mL, 2:12.5 mL or 2:33%) and secondary outcomes were early neurological worsening, good clinical outcome (modified Rankin Scale 0-3), and mortality at 90 days. Results: Among 315 patients meeting the inclusion criteria, baseline hematoma volume category predicted absolute hematoma expansion (p < 0.001), spot sign prevalence (p < 0.001), early neurologic worsening (p = 0.002), clinical outcome (p < 0.001), and mortality (p < 0.001). Very small hematomas (<3 mL) were unlikely to be spot positive (7.7%), unlikely to expand (2.6%), and were associated with a 73% chance of good clinical outcome. Spot sign appeared to be most predictive of expansion in the 3-10 mL baseline hematoma volume category. Conclusion: Very small hematomas are unlikely to expand and have a low spot sign prevalence. Hemostatic therapy trials may be best targeted at hemorrhages >3 mL in volume. [ABSTRACT FROM AUTHOR]

The corrected figure is provided below: Graph The online and print versions have been updated to reflect the correct name, "Khan F.A., 2005". Dependence of seasonal dynamics of hemorrhagic and ischemic strokes on the climate of a region: A meta-analysis. [Extracted from the article]

This study reviews available data on stroke epidemiology in Italy. Data were identified through Medline/PubMed, Embase, and from reference lists, related articles, and citation lists of each of the retrieved papers. Nineteen papers were considered, referring to selected stroke-registers performed in seven different geographical areas: Acquaviva-Casamassima county, Aeolian Islands, Aosta district, Belluno district, L'Aquila district, Trasimeno area, and Vibo Valentia district. Registers covered a total population of 2 262 940 people, with a hospitalization rate from 82% to 98%. The mean age at stroke onset was 74·6 ± 1·1 years, 72·3 years in men and 76·6 years in women. Among all strokes: Annual incidence rates standardized to the Italian population ranged from 175/1 00 000 to 360/1 00 000 in men and from 130/1 00 000 to 273/1 00 000 in women. Thirty-day case-fatality rates for all strokes ranged from 18·1% to 33·0% while one-year case-fatality rates ranged from 37·9% to 40·2%. Data from selected Italian registers on stroke incidence and case-fatality indicate the great burden of the disease on our national healthcare system. The continuous implementation of preventive strategies, either population-based or addressed to the single patient at a high risk of stroke, is important to reduce the burden of the disease. [ABSTRACT FROM AUTHOR]

The impact of acute therapy for intracerebral hemorrhage is far behind that for acute ischemic stroke. Potential breakthroughs in the management of acute intracerebral hemorrhage are presented. To prevent early hematoma growth, acute blood pressure lowering, emergent hemostatic therapy, and minimally invasive surgery with topical thrombolysis have been attempted. Anti-inflammatory and neuroprotective pharmacotherapies may attenuate perihematomal edema as a surrogate marker for the inflammatory response and improve clinical outcomes after intracerebral hemorrhage. Hyperacute modification of vital parameters, early seizure control, early rehabilitation, and neuroregenerative therapy are other promising strategies in the foreseeable future. [ABSTRACT FROM AUTHOR]