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<p>Introduction: In Vietnam, the incidence of transient ischemic attack (TIA) or ischemic stroke has increased in recent years due to lifestyle changes. Carotid stenosis is a common cause of TIA/ischemic stroke. This study aimed to determine the prevalence and identify risk factors for ipsilateral internal carotid artery (ICA) stenosis in patients with TIA or ischemic stroke. We recruited consecutive patients admitted to Bach Mai hospital from June/2021 to June/2022 with the diagnosis of TIA/ischemic stroke. The primary outcome was the presence of significant ipsilateral carotid stenosis (&#x2265;50%) by using carotid imaging modalities (duplex ultrasonography, computed tomography angiography, or magnetic resonance angiography). Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with 50-99% ICA stenosis. In total, 1,191 consecutive patients with TIA/ischemic stroke were included. Of these, 62 (5.2%, 95% confidence interval [CI]: 4.0-6.6) had 50-99% ipsilateral ICA stenosis. Patients with significant ICA stenosis were more likely to have advanced age, male sex, and prior stroke. In multivariable logistic regression, advanced age (OR 1.49 per 10-year increment; 95% CI: 1.17-1.90, p = 0.001), male sex (OR 4.94; 95% CI: 2.15-11.38, p < 0.001), and prior stroke (OR 2.01; 95% CI: 1.12-3.62, p = 0.02) were risk factors for ICA stenosis. The observed prevalence of extracranial ICA stenosis in TIA/ischemic stroke patients in Vietnam appears to be lower compared to Western nations, yet it is relatively comparable to that of other Asian countries. Male sex, prior stroke, and advanced age constitute significant risk factors for symptomatic ICA stenosis. </p>.

The blood brain barrier (BBB) is an endothelial-derived structure which restricts the movement of certain molecules between the general somatic circulatory system to the central nervous system (CNS). While the BBB maintains homeostasis by regulating the molecular environment induced by cerebrovascular perfusion, it also presents significant challenges in developing therapeutics intended to act on CNS targets. Many drug development practices rely partly on extensive cell and animal models to predict, to an extent, whether prospective therapeutic molecules can cross the BBB. In interest to reduce costs and improve prediction accuracy, many propose using advanced computational modeling of BBB permeability profiles leveraging empirical data. Given the scale of growth in machine learning and deep learning, we review the most recent machine learning approaches in predicting BBB permeability.

Cerebrovascular radiation-related vasculopathies can involve vessels of all sizes. Of these, extracranial carotid and vertebral artery (VA) radiation-induced atherosclerosis are the most commonly encountered radiation vasculopathy in Asia. This is because of the high incidence of oro-nasopharyngeal cancers in this region, where radiation therapy (RT) is the mainstay treatment. Radiation exposure induces the early and rapid development of atherosclerosis in the extracranial arteries. In retrospective studies, significant changes were demonstrated as early as 1 year after RT, using carotid intima media thickness measurements. Plaque development continued at an accelerated rate, with a four times increased risk compared to those without radiation exposure, and regardless of the presence or absence of traditional risk factors. In addition, radiation-induced plaques were often extensive, involving all cranial arteries exposed to radiation. They often have high-risk features, which included echolucent plaques with ulcerations, mobile components, and/or intraplaque hypoechoic foci. The risk of both ischaemic and haemorrhagic strokes are increased, with the highest risk seen in patients younger than 40 years old. Carotid blowout is a rare and potentially deadly complication, which could involve the common, internal or external carotid arteries. Both carotid endarterectomy and carotid artery stenting have been performed, but there is a preference for stenting because of a "hostile neck," from underlying radiation dermopathy and fibrosis, or scarring from prior surgeries, both contributing to poor wound healing and difficult CEA. Favourable outcomes have been reported with transcarotid artery revascularisation, compared against CEA. Other radiation-related vasculopathies, intracranial aneurysms, intracranial disease or moyamoya syndrome, cavernomas, and microbleeds were less common and rarely encountered in Asian populations. Of this, radiation-related intracranial aneurysm has been described in <1% of Chinese patients who had head and neck radiation, with a long latency periods after radiation exposure, ranging from median lag time of 6-20 years. Cerebrovascular radiation vasculopathies have a diverse phenotypic range, from small vessel to large vessel involvement, from extracranial to intracranial disease, intracranial aneurysms, cavernomas and microbleeds. In Asia, extracranial carotid and VA radiation-induced atherosclerosis was most commonly encountered and reported, due to the prevalence of oro-nasopharyngeal cancers in many parts of this region. Complications include atherosclerosis, stroke, and increased risk of carotid blowout syndrome.

Takayasu arteritis is a large-vessel vasculitis with polymorphic clinical presentation and outcomes. In this large multi-ethnic Takayasu cohort, we aimed to determine how factors present at diagnosis cluster together and impact prognosis. International multicentre retrospective cohort of consecutive patients with Takayasu arteritis fulfilling international criteria at tertiary referral centres. Clinical features, laboratory and radiological data at diagnosis were collected, as well as outcomes. A step-wise unsupervised approach was used for exploratory analyses, including principal component analysis (PCA) and hierarchical clustering on principal components. Survival curves were calculated using the Kaplan-Meier estimator. 852 patients were included (81.5% women; median age 30.6 years). After imputation of missing data, three clusters were unraveled with a progressively lower age at diagnosis from cluster 1 to 3, named 'supra-aortic', 'abdominal' and 'diffuse', respectively. 'Supra-aortic' cluster mainly presented with supra-aortic trunks' involvement (96.6%) and significantly higher rates of cerebrovascular events (16.7%). 'Abdominal' cluster presented a marked involvement of abdominal aorta (72.1%) and renal arteries (64.6%). 'Diffuse' cluster had widespread arterial involvement and significantly more extra-vascular symptoms. Elevated acute phase reactants were seen in 49.8%, 65.8% and 98.0% of patients within 'supra-aortic', 'abdominal' and 'diffuse' clusters, respectively. Compared to the 'supra-aortic' cluster, 'abdominal' patients had the highest risk of vascular complications (HR&#xa0;=&#xa0;1.79, 95%CI 1.12-2.87), and 'diffuse' ones the greatest risk of future relapses (HR&#xa0;=&#xa0;2.31, 95%CI 1.81-2.95). The heterogeneous demographic, clinical, laboratory and radiological features at diagnosis split patients with Takayasu arteritis into three clusters, with prognostic implications over time.

Rheumatoid arthritis (RA) is associated with a wide spectrum of comorbidities that substantially influence quality of life and long-term outcomes. These include extra-articular manifestations, cardiovascular disease, cerebrovascular accidents, dementia, malignancy, infection, mental health disorders and osteoporosis. Patterns of comorbidity in RA have evolved over the past three decades, with declining prevalence of some complications alongside persistently high or increasing burdens of interstitial lung disease, anxiety and depression. Shifts in the comorbidity landscape probably reflect advances in RA management, including the expanded use of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) and a widespread adoption of treat-to-target strategies. Consideration of comorbidity-specific epidemiology, the potential effect of DMARDs on comorbidity risk and opportunities to address both RA and comorbid disease are increasingly relevant in clinical care. Preventive strategies, including selected enhanced screening approaches such as those for cervical cancer, interstitial lung disease, cardiovascular disease and osteoporosis, form an important component of comprehensive RA management. Awareness of the changing comorbidity landscape could support more integrated and individualized care for people with RA.

Genetic deficiency of factor XI is associated with a reduced risk of ischemic stroke. Asundexian is a direct inhibitor of activated factor XIa (FXIa) with a low risk of bleeding in early trials. We seek to determine its efficacy and safety combined with antiplatelet therapy for prevention of ischemic stroke. Oral faCtor Eleven A iNhibitor asundexian as novel antithrombotiC (OCEANIC-STROKE) is a placebo-controlled, double-blind, event-driven randomised trial including participants with stroke (NIHSS &#x2264;&#x2009;15) or high-risk TIA (ABCD2 6 or 7) within 72&#xa0;h of onset. Participants had at least one of the following: atherosclerosis of extra- or intracranial vessels, a medical history of atherosclerosis or an imaged acute non-lacunar infarct. We excluded sources of stroke requiring anticoagulation and active non-trivial bleeding other than hemorrhagic infarction (HI 1 or 2). Participants received asundexian 50&#xa0;mg daily or placebo stratified by planned concurrent antiplatelet therapy (single vs dual). The primary endpoint is time to ischemic stroke. We present baseline characteristics as of 5 June 2025. Between January 2023 and February 2025, we randomised 12,327 participants. Participants were 67% male with a mean (SD) age of 68 (11) years. Ischemic stroke was the index event for 95% of whom 27.4% had thrombolysis and/or mechanical thrombectomy. By TOAST classification, 43% of index strokes were LAA, 22% small vessel disease, 30% undetermined and 2% cardioembolic. Dual antiplatelets were planned in 63% as standard initial treatment. Trial completion is anticipated in October 2025. OCEANIC-STROKE will be the first completed trial of FXIa inhibition for prevention of stroke after non-cardioembolic stroke or TIA. ClinicalTrials.gov (NCT05686070).

Introduction Despite the established benefit of Mechanical Thrombectomy (MT), data on the incidence, risk factors, and longer-term outcomes of Stroke-Associated Infections (SAIs) in this population remain limited. This retrospective, single-centre cohort study evaluated the frequency of SAI, associated variables, and longer-term mortality post-MT. Methods Data for acute ischaemic stroke patients undergoing MT at Manchester Centre for Clinical Neurosciences, were extracted from the Sentinel Stroke National Audit Programme (April 2016-March 2024) and linked to Electronic Patient Records. Routinely collected admission and procedural variables were analysed. Primary outcome measures were proportion developing SAI and subtypes of SAI post-MT. Multifactorial regression analysis was performed to evaluate associations between clinical variables and SAI, and also between SAI and 1-year mortality. Results Of 589 patients, 179 (30%) developed SAI. Stroke-associated pneumonia (SAP) accounted for 73% of SAI (131 cases, 22% of patients); urinary tract infections comprised 9%. Admission NIHSS, dysphagia, C-reactive protein (CRP), neutrophil-lymphocyte ratio, and premorbid mRS were independently associated with SAI (p<0.05). Similar associations were observed for SAP, though CRP association was attenuated. Crude 1-year mortality was higher in patients with SAI (34%, 60/179), including those with SAP (36%, 47/131), compared with 12% (49/410) in non-SAI patients. However, multivariable regression did not reach statistical significance. Conclusions SAI occurred in nearly one-third of patients post-MT, predominantly as SAP. While crude mortality was increased with SAI, adjusted analyses were non-significant. Several variables were independently associated with SAI, enabling opportunities for identification of high-risk patients for enhanced monitoring or preventive strategies.

Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center. This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease. We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men. Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.

Perioperative stroke constitutes a major subset of in-hospital stroke. Evidence is lacking on whether procedure-specific risk profiles exist and how they influence functional recovery. We aimed to identify distinct clinical features and procedure-specific risk factors associated with perioperative stroke. We retrospectively analyzed a 4-year cohort of patients with in-hospital stroke from 5 tertiary hospitals across China. Clinical data were systematically extracted through electronic medical record review. Ninety-day functional outcomes were assessed. Multivariate linear regression was performed to identify factors associated with 90-day outcomes in perioperative stroke. Out of 1,048,566 hospitalized patients, 166 (0.02%) patients developed in-hospital stroke. Among them, 158 patients completed the 90-day follow-up, with 100 males (63.29%) and a median age of 69 years (IQR: 61-76). Sixty-three (39.87%) had perioperative stroke, with the highest proportion (13.92%) occurring in the cardiology/cardiothoracic surgery departments. Delayed recognition (4 h [IQR: 1.58-24.00] vs. 2 h [IQR: 1.00-5.50], p = 0.020), higher NIHSS scores (12 [IQR: 5-30] vs. 9 [IQR: 4-16], p = 0.045), and lower proportion of reperfusion therapy (5.56% vs. 28.21%, p = 0.003) were observed in patients with perioperative ischemic stroke compared to those with non-perioperative stroke. In subgroup analysis, cardiovascular surgery-related ischemic stroke patients had higher NIHSS scores (20 [IQR: 8-35] vs. 8 [IQR: 5-20], p = 0.035) and 90-day modified Rankin scale scores (4 [IQR: 2-6] vs. 2 [IQR: 1-4], p = 0.039) than those non-cardiovascular surgical counterparts. Additionally, they exhibited a trend toward a higher 90-day mortality rate (33.33% vs. 10.71%; OR, 4.17 [95% CI: 1.07 to 20.83]; p = 0.052). Perioperative in-hospital stroke exhibits distinct clinical characteristics. Cardiovascular-related surgery is associated with worse functional outcomes.

Hypertension-induced alterations in hemodynamics and wave dynamics are important pathological mechanisms for cerebrovascular diseases, vascular cognitive impairment and dementia. However, fundamental understanding of hemodynamics and wave dynamics in hypertension remains limited due to the restricted temporal and spatial resolution of current medical devices. To address the gap, this study developed a closed-loop multiscale computational modeling framework for the entire cardiovascular system. A novel "parameter assignment method" designed for diverse 0D peripheral vascular bed models across the entire cardiovascular system was proposed. Additionally, a mathematical modeling strategy was introduced to characterize cardiovascular parameters associated with hypertension across varying degrees of severity. Key findings from model-based studies indicated that in hypertension, there was early arrival and increased magnitudes of forward compression wave intensity and power (FCWI and FCWP), forward expansion wave intensity and power (FEWI and FEWP), and back compression wave intensity and power (BCWI and BCWP) in extra-intracranial cerebral arteries. The proximal aorta, however, exhibited delayed arrival of FCWI and FCWP but early arrival of BCWI and BCWP, along with negligible change in FCWI magnitudes and slightly increased BCWI magnitudes, significantly increased FEWI, FCWP, FEWP and BCWP magnitudes. Moreover, parametric studies demonstrated that progressively enlarging central large elastic arteries, increasing passive myocardial stiffness, and raising peripheral vascular resistance led to reduced magnitudes of FCWI, BCWI, FCWP and BCWP in cerebral arteries. Conversely, stiffening of central large elastic arteries and increasing myocardial contractility had opposite effects. The proposed computational modeling framework will serve as a powerful tool for elucidating the complex mechanisms underlying hypertension-associated hemodynamics and wave dynamics.

This study aimed to explore the relationship between serum inflammatory biomarkers and the carotid atherosclerotic plaque characteristics, given prior evidence suggesting a key role of inflammation in the development of atherosclerosis. In this prospective study, patients with carotid atherosclerotic plaque were recruited. Serum high-sensitivity CRP (Hs-CRP), homocysteine (Hcy) concentrations, and neutrophil-to-lymphocyte ratio (NLR) were obtained for all enrolled patients. Carotid atherosclerosis characteristics (such as intraplaque hemorrhage [IPH] and lipid-rich necrotic core [LRNC]) were determined by three-dimensional high-resolution vessel wall imaging. The associations between Hs-CRP, Hcy, NLR, and plaque characteristics were assessed. In total, 128 patients (84.4% men; mean age, 58.0 &#xb1; 8.7 years) were included. Multivariate logistic regression indicated that increased Hs-CRP levels were associated with the presence of LRNC (OR = 1.23, 95% CI: 1.07-1.40, p = 0.003) and IPH (OR = 1.26, 95% CI: 1.10-1.45, p = 0.001). Multivariate linear regression confirmed a significant correlation between Hs-CRP level (&#x3b2; = 3.24, 95% CI: 0.66-5.81, p = 0.014) and the IPH volume. For plaque burden, higher Hs-CRP levels were associated with larger max normalized wall index (NWI) (&#x3b2; = 0.01, 95% CI: 0.00-0.02, p = 0.005) and larger Max wall thickness (&#x3b2; = 0.08, 95% CI: 0.02-0.14, p = 0.006). NLR and Hcy levels did not show significant associations with the carotid plaque characteristics. Elevated Hs-CRP levels were found to be closely associated with plaque burden and vulnerable plaque characteristics. The relationship between the elevated Hs-CRP and plaque vulnerability highlights its potential role in risk stratification and early intervention strategies. Further validation in larger, multicenter population studies is required to confirm these associations.

Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Traditional vascular risk factors and the degree of the stenosis play an important role in predicting stroke occurrence. In East Asia, non-atherosclerotic vasculopathies are also often observed in ischemic stroke patients caused by large artery disease, highlighting the importance of identifying the specific etiologies of intracranial artery stenosis. Advances in diagnostic neuroimaging, such as high-resolution MRI (HR-MRI), can be helpful in distinguishing between them. For stroke prevention in patients with both asymptomatic and symptomatic ICAS, intensive management, including strict control of modifiable risk factors and appropriate antiplatelet therapies, is essential. There are no clear guidelines regarding the duration and combination of antiplatelet therapies. However, current recommendations suggest short-term dual antiplatelet therapies for 90 days to reduce the recurrence of stroke in symptomatic severe ICAS (70-99%). Cilostazol is also proposed as a good second-line treatment option, following clopidogrel, which remains the most widely used. In addition, endovascular or surgical interventions could be considered alternatives for a limited subset of symptomatic severe ICAS cases that are hemodynamically unstable. The key messages are as follows: (1) ICAS is a major cause of ischemic stroke, especially in Asian populations. Its distinct pathophysiology, compared to ECAS, requires different treatment strategies for secondary prevention; (2) differentiation of intracranial artery stenosis etiology is essential, and HR-MRI would be a valuable diagnostic tool; (3) stroke prevention includes strict vascular risk factor control and the use of antiplatelet therapies, with short-term DAPT recommended for symptomatic severe ICAS; (4) cilostazol may serve as an effective second-line option for preventing ischemic stroke, while endovascular or surgical interventions may be limited to hemodynamically unstable cases. Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Traditional vascular risk factors and the degree of the stenosis play an important role in predicting stroke occurrence. In East Asia, non-atherosclerotic vasculopathies are also often observed in ischemic stroke patients caused by large artery disease, highlighting the importance of identifying the specific etiologies of intracranial artery stenosis. Advances in diagnostic neuroimaging, such as high-resolution MRI (HR-MRI), can be helpful in distinguishing between them. For stroke prevention in patients with both asymptomatic and symptomatic ICAS, intensive management, including strict control of modifiable risk factors and appropriate antiplatelet therapies, is essential. There are no clear guidelines regarding the duration and combination of antiplatelet therapies. However, current recommendations suggest short-term dual antiplatelet therapies for 90 days to reduce the recurrence of stroke in symptomatic severe ICAS (70-99%). Cilostazol is also proposed as a good second-line treatment option, following clopidogrel, which remains the most widely used. In addition, endovascular or surgical interventions could be considered alternatives for a limited subset of symptomatic severe ICAS cases that are hemodynamically unstable. The key messages are as follows: (1) ICAS is a major cause of ischemic stroke, especially in Asian populations. Its distinct pathophysiology, compared to ECAS, requires different treatment strategies for secondary prevention; (2) differentiation of intracranial artery stenosis etiology is essential, and HR-MRI would be a valuable diagnostic tool; (3) stroke prevention includes strict vascular risk factor control and the use of antiplatelet therapies, with short-term DAPT recommended for symptomatic severe ICAS; (4) cilostazol may serve as an effective second-line option for preventing ischemic stroke, while endovascular or surgical interventions may be limited to hemodynamically unstable cases.

While obesity is a known risk factor for ischemic stroke, its prognostic value remains uncertain. We examined the independent and combined effects of body mass index (BMI) and waist-to-hip ratio (WHR) on early stroke outcomes across subtypes. In this prospective cohort study, 714 patients with acute ischemic stroke or transient ischemic attack were enrolled over 6 months. BMI and WHR were assessed on admission. Stroke severity (NIHSS) and functional outcome at discharge (modified Rankin Scale, mRS) were recorded. Stroke etiology was classified using TOAST and ESUS criteria. Multivariable regression and restricted cubic spline models were applied. A U-shaped association emerged between BMI and both stroke severity and recovery, with overweight patients (BMI 25.0-29.9 kg/m2) showing the lowest NIHSS and highest independence rate (mRS 0-2: 65%). Underweight and obese patients had significantly worse outcomes (p < 0.001). WHR was an independent predictor of higher stroke severity (&#x3b2; = +2.8; 95% CI: 2.1-3.5) and poor outcome (OR = 0.70; 95% CI: 0.52-0.94) and added prognostic value when combined with BMI. A sex-specific interaction indicated greater benefit from overweight in women (OR = 1.72; p = 0.02). Subtype analysis revealed a U-shaped BMI association in cardioembolic stroke (p = 0.014) but not in ESUS. BMI and WHR show distinct, nonlinear, and sex- and subtype-specific associations with stroke severity and functional outcome. WHR was a stronger, BMI-independent predictor of prognosis, particularly in non-cardioembolic stroke. These findings challenge the "obesity paradox" and support incorporating adiposity phenotypes into individualized stroke risk models.

Symptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India. This ambispective cohort study enrolled patients with symptomatic ICAD within 1 month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year. Of 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7 &#xb1; 10.2 years; men, 72.9%). At the end of 1-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to 1 year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p = 0.038), moderate to severe WMH (p = 0.050), hypertension (p = 0.040), diabetes (p = 0.043), and coronary artery disease (p = 0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p = 0.026), greater length of stenosis (p = 0.045), diabetes (p = 0.026), and coronary artery disease (p = 0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR: 2.15; 95% CI: 1.09-4.26; p = 0.028) independently predicted early stroke recurrence. A territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.

Intravenous thrombolysis using tissue-type plasminogen activator (tPA) is widely accepted as a fundamental therapy for acute ischemic stroke. However, its clinical benefit is counterbalanced by the risk of symptomatic intracranial hemorrhage (sICH), a serious complication that can substantially worsen patient outcomes and increase mortality. Functional outcome after stroke is most commonly assessed using the modified Rankin Scale at 3 months. In this study, we sought to construct predictive models for sICH and 3-month outcomes after tPA and to identify key prognostic variables that may support individualized treatment decisions. We analyzed data from 434 patients with ischemic stroke who received intravenous tPA at a tertiary medical center over a 5.5-year period. Three supervised classification models were constructed and validated using five-fold cross-validation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, recall, and precision, and the results were compared with those of six commonly used clinical scoring systems for predicting post-tPA sICH. All three machine learning models showed strong discriminatory performance for sICH prediction, with AUC values of 0.87 for logistic regression, 0.82 for random forest, and 0.89 for XGBoost. Each model consistently outperformed the six conventional scoring tools. Among all variables, the 24-h NIHSS score contributed most strongly to the prediction of both sICH and 3-month functional outcomes. In addition, a prior history of stroke and male sex were associated with an increased risk of sICH, whereas older age was closely linked to worse functional outcomes at 3 months. The proposed machine learning models achieved high predictive performance for post-tPA sICH and 3-month outcomes and identified key clinical variables with substantial prognostic importance. Notably, the 24-h NIHSS score emerged as the most influential predictor across models. Compared with existing sICH scoring systems, these models demonstrated superior performance, supporting their potential role as clinical decision-support tools in post-thrombolysis management.

High blood pressure (BP) is associated with a poor outcome after stroke. Trials of transdermal glyceryl trinitrate (GTN), a nitric oxide donor, have suggested that treatment between 3 and 5 h might improve functional outcome. We randomly assigned hospitalised patients with an acute ischaemic or haemorrhagic stroke to 2 days of transdermal GTN (5 mg/day) or sham, started between 3 and 5 h after onset. The primary feasibility outcome was recruitment rate; proof-of-concept (PoC) was assessed at 90 days by central observers blinded to treatment assignment using the modified Rankin Scale (mRS). Data are number (%), median [interquartile range], or mean (standard deviation). Comparisons were assessed by multiple linear regression. Thirty-nine of an intended 120 participants were recruited. A total of 3,314 people were excluded, commonly related to presentation >5 h of onset or outside of researcher working hours, no eligible symptoms/signs or an unclear onset time. Mean age was 72 (SD 13) years, females were 41%, BP was 161.8 (18.4)/80.8 (14.9) mm Hg, and time from onset at baseline was 216 [186, 251] minutes. The fall in BP over 24 h did not differ between GTN versus sham. mRS at 3 months did not differ between the groups (difference in means, DIM -0.20, 95% confidence intervals -1.30, 0.90; p = 0.72). GTN was associated with improved cognition on the telephone interview of cognition scale (DIM 8.0, 95% CI 1.3, 14.8; p = 0.020). Although headache was more common, GTN was associated with fewer serious adverse events (p = 0.020). Recruitment limitations in this small single-centre trial prevented demonstration of feasibility for patients in the time window of 3-5 h post ictus. GTN demonstrated some evidence of PoC and was safe. A multicentre trial needs to further test this hypothesis.

Accelerated demographic aging in Hungary and across Europe presents significant public health and socioeconomic challenges, particularly in preserving cognitive function and preventing neurodegenerative diseases. Modifiable lifestyle factors-especially dietary habits-play a critical role in brain aging and cognitive decline. This narrative review explores the mechanisms by which Western dietary patterns contribute to cognitive impairment and neurovascular aging, with specific attention to their relevance in the Hungarian context. It also outlines the rationale and design of the Semmelweis Study and its workplace-based health promotion program targeting lifestyle-related risk factors. A review of peer-reviewed literature was conducted focusing on Western diet, cognitive decline, cerebrovascular health, and dietary interventions. Emphasis was placed on mechanistic pathways involving systemic inflammation, oxidative stress, endothelial dysfunction, and decreased neurotrophic support. Western dietary patterns-characterized by high intakes of saturated fats, refined sugars, ultra-processed foods, and linoleic acid-are associated with elevated levels of 4-hydroxynonenal (4-HNE), a lipid peroxidation product linked to neuronal injury and accelerated cognitive aging. In contrast, adherence to Mediterranean dietary patterns-particularly those rich in polyphenols from extra virgin olive oil and moderate red wine consumption-supports neurovascular integrity and promotes brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) activity. The concept of "cognitive frailty" is introduced as a modifiable, intermediate state between healthy aging and dementia. The Semmelweis Study is a prospective cohort study involving employees of Semmelweis University aged &#x2265;25 years, collecting longitudinal data on dietary, psychosocial, and metabolic determinants of aging. The Semmelweis-EUniWell Workplace Health Promotion Model translates these findings into practical interventions targeting diet, physical activity, and cardiovascular risk factors in the workplace setting. Improving our understanding of the diet-brain health relationship through population-specific longitudinal research is crucial for developing culturally tailored preventive strategies. The Semmelweis Study offers a scalable, evidence-based model for reducing cognitive decline and supporting healthy aging across diverse populations.

To investigate the prospective association between baseline life satisfaction and incident stroke among middle-aged and older Chinese adults. 15,225 participants aged &#x2265;45 years were included from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Life satisfaction was assessed at baseline using a single-item 5-point scale. Incident stroke was self-reported in follow-up waves. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, lifestyle behaviors, comorbidities, and depressive symptoms. Subgroup analyses were performed by age, gender, comorbidities, BMI, and depressive symptoms. Over the follow-up of 9 years, 1,296 participants (8.5%) developed stroke. Higher life satisfaction was associated with a significantly reduced risk of stroke (HR: 0.83; 95% CI: 0.72-0.95). Subgroup analyses indicated that the protective association was more pronounced among older adults, females, participants with chronic conditions (hypertension, diabetes, heart disease), overweight individuals, and those with depressive symptoms. Higher life satisfaction was prospectively associated with a lower risk of incident stroke in middle-aged and older Chinese adults. Given the observational design and reliance on self-reported measures, these findings should be interpreted as evidence of association rather than causation. Future studies incorporating repeated assessments of well-being and clinically verified stroke outcomes are warranted.

Aim: To evaluate cerebral blood flow characteristics in patients with dyscirculatory encephalopathy (DE) and concomitant hypothyroidism in the long-term follow-up period. Materials and Methods: A single-center cohort study consecutively included 60 patients with hypertensive DE and concomitant hypothyroidism (mean age 61&#xb1;6 years; 95% women). In the long-term follow-up period (mean duration - 10 years), results of repeated clinical-neurological and instrumental examinations of 52 patients were analysed. Duplex scanning of extra- and intracranial vessels assessed peak systolic velocity (Vps) and end-diastolic velocity (Ved), and resistive index (RI) and pulsatility index (PI) were calculated. Results: At baseline, patients with DE and concomitant hypothyroidism predominantly presented with cephalgic (67.3%), vestibular (61.5%), and cerebroasthenic (63.5%) syndromes. In the long-term follow-up period, an increase in the frequency of vestibular syndrome was observed, reaching 80.8% (p=0.034). Duplex scanning demonstrated an increase in Vps in the left common carotid artery (CCA) and bilateral internal carotid arteries (ICA), accompanied by a decrease in Ved in the middle cerebral artery (MCA) on both sides. Additionally, an increase in RI was observed in the right CCA and left MCA. At the same time, in the vertebrobasilar system, a decrease in flow velocity parameters was noted in the right vertebral artery (V4 segment) and basilar artery (BA), along with an increased RI in the right V4 segment of the vertebral artery. Conclusions: Long-term follow-up demonstrated an increased frequency of vestibular syndrome, deterioration of cerebral blood flow predominantly in the carotid circulation due to reduced vascular elasticity, and decreased flow velocity in the vertebrobasilar system in patients with DE and concomitant hypothyroidism. These findings justify the need for timely diagnosis and correction of thyroid dysfunction in patients with chronic cerebral ischemia to optimize therapeutic, preventive, and rehabilitation strategies.