Stroke最新文献

{"title":"Volume Tolerance and Prognostic Impact of Hematoma Expansion in Deep and Lobar Intracerebral Hemorrhage.","authors":"Andrea Morotti, Qi Li, Jawed Nawabi, Federico Mazzacane, Frieder Schlunk, Ashkan Shoamanesh, Giorgio Busto, Anna Cavallini, Francesco Palmerini, Maurizio Paciaroni, Edip M Gurol, Anand Viswanathan, Ilaria Casetta, Laura Piccolo, Enrico Fainardi, Steven M Greenberg, Alessandro Padovani, Andrea Zini, Jonathan Rosand, Joseph P Broderick, Dar Dowlatshahi, Joshua N Goldstein","doi":"10.1161/STROKEAHA.124.049008","DOIUrl":"10.1161/STROKEAHA.124.049008","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of intracerebral hemorrhage (ICH) volume varies according to location, with smaller volume tolerance in deep ICH, and hematoma expansion (HE) contributes to final ICH volume. We tested the hypothesis that HE influences outcome only when the final ICH volume achieves a critical threshold that differs according to ICH location.</p><p><strong>Methods: </strong>Retrospective analysis of patients with supratentorial ICH admitted at 10 centers in North America and China (development cohort) and Europe (replication cohort). HE was defined as growth >33% and/or >6 mL. Location-specific (lobar versus deep) volume cutoffs for the prediction of poor outcomes were derived using receiver operating characteristic curves and the Youden index. The prognostic impact of HE stratified by location and final volume was explored with logistic regression (poor outcome: 90-day modified Rankin Scale score of 4-6), accounting for age, Glasgow Coma Scale, baseline volume, intraventricular hemorrhage, and admission center.</p><p><strong>Results: </strong>We identified 1774 patients with ICH in the development cohort and 1746 in the replication cohort. A total of 1058 (mean age, 68 years; 47.8% men) and 1423 (mean age, 71 years; 44.7% men) subjects met the inclusion criteria, respectively. The optimal final ICH volume cutoff for poor outcome differed by location: ≥36 mL for lobar and ≥17 mL for deep ICH. HE with final volume below the cutoff was not associated with higher odds of poor outcome compared with patients without HE (adjusted odds ratio, 1.85 [95% CI, 0.78-4.38]; <i>P</i>=0.163 in lobar ICH; adjusted odds ratio, 0.85 [95% CI, 0.38-1.89]; <i>P</i>=0.685 in deep ICH). The combination of HE and final volume over the critical threshold was, however, significantly associated with poor prognosis, and the magnitude of this effect was substantial (adjusted odds ratio, 8.55 [95% CI, 2.87-25.48]; <i>P</i><0.001 in lobar ICH; adjusted odds ratio, 10.34 [95% CI, 2.86-37.44]; <i>P</i><0.001 in deep ICH). These findings were confirmed in the replication cohort.</p><p><strong>Conclusions: </strong>HE significantly impacts severe outcomes only when the final ICH volume exceeds a critical target threshold, and this threshold is lower in deep versus lobar ICH. These findings might inform clinical practice and future trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1224-1231"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent Theta Burst Stimulation Over Cerebellum Facilitates Neurological Recovery in Poststroke Depression via the cAMP/PKA/CREB Pathway.","authors":"Xue Yang, Tengmin Gui, Shuxian Zhang, Tianling Wang, Xueting Chen, Huanhuan Ren, Chunyan Xu, Dingwei He, Liqing Yao","doi":"10.1161/STROKEAHA.124.048697","DOIUrl":"10.1161/STROKEAHA.124.048697","url":null,"abstract":"<p><strong>Background: </strong>Stroke causes somatic dysfunction and psychological disorders, leading to poststroke depression (PSD). This study investigates mood alterations in PSD models via cerebellar intermittent theta burst stimulation (iTBS).</p><p><strong>Methods: </strong>PSD animal models were developed using middle cerebral artery occlusion and chronic unpredictable mild stress procedures. PSD models underwent cerebellar iTBS with different pulse numbers. Neurological recovery was evaluated using open-field test, sucrose preference test, forced swimming test, and balance beam test. Golgi and hematoxylin-eosin staining assessed neuronal repair, while quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay (ELISA), immunofluorescence, and Western blotting evaluated effects on BDNF (brain-derived neurotrophic factor), hypothalamic-pituitary-adrenal axis factors, and the cAMP/PKA (protein kinase A)/CREB (cAMP-response element-binding protein) pathway. The study first determined the effects of different intensities of iTBS stimulation on neurological recovery in PSD rats. Second, the effects of iTBS stimulation on the cAMP/PKA/CREB pathway were verified using adenoviral blockade of PKA and CREB at iTBS-1800.</p><p><strong>Results: </strong>PSD models showed decreased vertical movement, locomotor distance, and sucrose preference and increased immobility time and balance beam test score, which were reversed by iTBS. iTBS increased dendritic length and spine density in Purkinje cells, alleviated neuronal damage in multiple brain regions, and enhanced BDNF synthesis. It also regulated adrenocorticotropic hormone, cortisol, and GR (glucocorticoid receptor) expression, and activated the cAMP/PKA/CREB pathway.</p><p><strong>Conclusions: </strong>Cerebellar iTBS improves PSD by activating the cAMP-PKA/CREB pathway, increasing BDNF, and reducing hypothalamic-pituitary-adrenal axis hyperactivity, suggesting potential for human PSD treatment.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1266-1279"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Window and Watch-and-Wait: Stroke.","authors":"Suman Ray","doi":"10.1161/STROKEAHA.125.051002","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051002","url":null,"abstract":"<p><p>According to Global Stroke Fact Sheet 2022, stroke is the second leading cause of death and a major cause of disability. Stroke treatment and care need immediate attention and fill the large existing gaps. This article focuses on the gaps in stroke prevention, management, and care. The author has highlighted 2 main facts, time window and watch-and-wait, which play a critical role in the management of patients upon stroke onset.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"1349-1350"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Associations of Modifiable Risk Factors on White Matter Injury: The SOL-INCA-MRI Study (HCHS/SOL).","authors":"Shraddha Sapkota, Pauline Maillard, Ariana M Stickel, Wassim Tarraf, Kevin A González, Vladimir Ivanovic, Alejandra Morlett-Paredes, Jianwen Cai, Carmen R Isasi, Richard B Lipton, Martha Daviglus, Fernando D Testai, Melissa Lamar, Linda C Gallo, Gregory A Talavera, Christian Agudelo, Alberto R Ramos, Hector M González, Charles DeCarli","doi":"10.1161/STROKEAHA.124.049904","DOIUrl":"10.1161/STROKEAHA.124.049904","url":null,"abstract":"<p><strong>Background: </strong>Modifiable risk factors play a central role in the development and course of neurodegenerative disorders of later life, including dementias. Although past research has focused on independent associations of modifiable risk factors, including cardiovascular disease risk factors using Framingham cardiovascular risk score, physical activity, dietary quality, body mass index, and sleep, on neurodegeneration, the impact of all 5 factors simultaneously in a multimodal model has not been studied. We examined independent associations and an overall combined model with 5 modifiable risk factors with white matter injury, a recognized risk factor for dementia, ≈10 years later in a diverse Hispanic/Latino population.</p><p><strong>Methods: </strong>Participants were from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) Investigation of Nerocognitive Aging-Magnetic Resonance Imaging longitudinal study (n=2667; clinical visit 1 mean age, 52.01 [8.90] years). We conducted path and mediation analyses across 5 modifiable risk factors obtained at clinical visit 1 (2008-2011) and 2 measures of white matter injury (free water and white matter hyperintensity volume) obtained at the magnetic resonance imaging visit (2018-2022; mean age, 62.37 [9.23] years). We controlled for age at the time of the dependent variable, sex, education, Hispanic/Latino heritage, overall cognitive status, and b-value when free water was included.</p><p><strong>Results: </strong>We observed 11 significant independent associations across modifiable risk factors and white matter injury measures. The association of Framingham cardiovascular risk score to white matter hyperintensity volume was mediated by free water (indirect mediation: β=2.473; SE=0.207; <i>P</i><0.001), and the association of physical activity to body mass index was mediated by sleep duration (indirect mediation: β=-0.038; SE=0.019; <i>P</i>=0.050). We combined the 2 mediational pathways and added diet associated with white matter hyperintensity volume (β=0.008; SE=0.007; <i>P</i>=0.004) and physical activity associated with Framingham cardiovascular risk score (β=-0.007; SE=0.002; <i>P</i>=0.001) in the overall model.</p><p><strong>Conclusions: </strong>Our findings identified how modifiable risk factors synergistically influence future white matter injury in Hispanic/Latino populations. Such multimodal models may lead to the development of novel and personalized lifestyle clinical interventions for adults at risk for dementia due to elevated white matter hyperintensity volume.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1138-1148"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Imaging Techniques in Ischemic Stroke.","authors":"Johanna M Ospel, Bijoy K Menon","doi":"10.1161/STROKEAHA.124.048280","DOIUrl":"10.1161/STROKEAHA.124.048280","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e141-e143"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions That Support Lifestyle Behavior Change for Secondary Prevention of Stroke.","authors":"Michael Soljak","doi":"10.1161/STROKEAHA.125.050696","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050696","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"1337-1338"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Rurality and Geographical Accessibility on Stroke Care and Outcomes.","authors":"Melanie Turner, Martin Dennis, Mark Barber, Mary-Joan Macleod","doi":"10.1161/STROKEAHA.124.048251","DOIUrl":"10.1161/STROKEAHA.124.048251","url":null,"abstract":"<p><strong>Background: </strong>Providing equitable health care to rural stroke patients is challenging and associated with less intervention and poorer outcomes. We assessed how several distinct patient-related geographic classifications influenced stroke care and outcomes in Scotland, United Kingdom.</p><p><strong>Methods: </strong>We conducted a population-level data-linkage study of ischemic stroke patients admitted to the hospital (2010-2018). Geographic classifications included 2 binary (urban versus rural; accessible versus remote) and 1 six-category classification encompassing both rurality and accessibility (large urban areas, other urban areas, accessible small towns, remote small towns, accessible rural areas, and remote rural areas). Process outcomes included achievement of a stroke care bundle and thrombolysis administration. Clinical outcomes included 30-day discharge from hospital care, 90-day home time, inpatient and 1-year all-cause mortality.</p><p><strong>Results: </strong>We included 42 917 ischemic stroke patients (35 766 urban and 7151 rural). Binary classifications of rurality or accessibility missed important differences in stroke care and outcomes revealed using 6-category classification. Using the latter, compared with large urban areas, patients in accessible rural areas were more likely to receive a complete stroke care bundle (adjusted odds ratio, 1.21 [95% CI, 1.12-1.31]); patients in remote rural areas were less likely (adjusted odds ratio, 0.85 [95% CI, 0.78-0.93]). Compared with large urban areas, 30-day discharge from hospital care was more likely for patients residing elsewhere (eg, remote rural areas adjusted subdistribution hazards ratio, 1.11 [95% CI, 1.05-1.17]); home time within 90 days was higher for other urban areas (adjusted incidence rate ratio, 1.05 [95% CI, 1.03-1.07]) and accessible rural areas (adjusted incidence rate ratio, 1.03 [95% CI, 1.01-1.06]); and 1-year mortality was less likely in other urban areas (adjusted hazard ratio, 0.93 [95% CI, 0.88-0.98]) and remote small towns (adjusted hazard ratio, 0.89 [95% CI, 0.80-0.99]).</p><p><strong>Conclusions: </strong>When considering geographic disparities in stroke care and outcomes across Scotland, it is important to account for both home location and accessibility of care. Despite patients residing in remote rural areas being less likely to achieve a complete stroke care bundle, this did not translate into poorer outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1210-1217"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Functional Connectivity Between Cortical Premotor Areas and the Spinal Cord in Chronic Stroke.","authors":"Hanna Braaß, Silke Wolf, Jan Feldheim, Ying Chu, Alexandra Tinnermann, Jürgen Finsterbusch, Christian Büchel, Christian Gerloff, Robert Schulz","doi":"10.1161/STROKEAHA.124.048384","DOIUrl":"10.1161/STROKEAHA.124.048384","url":null,"abstract":"<p><strong>Background: </strong>Neuroscience research has contributed significantly to understanding alterations in brain structure and function after ischemic stroke. Technical limitations have excluded the spinal cord from imaging-based research. Available data are restricted to a few microstructural analyses, and functional connectivity data are absent. The present study attempted to close this knowledge gap and assess alterations in corticospinal coupling in chronic stroke and their relation to motor deficits.</p><p><strong>Methods: </strong>In this cross-sectional study, patients with chronic stroke and healthy controls underwent corticospinal functional magnetic resonance imaging while performing a simple force generation task at the University Medical Center Hamburg-Eppendorf between September 2021 and June 2023. Task-related activation was localized in the ipsilesional ventral premotor cortex, the supplementary motor area, and the cervical spinal cord. Psycho-physiological interactions and linear modeling were used to infer functional connectivity between cortical motor regions and the cervical spinal cord and their associations with clinical scores.</p><p><strong>Results: </strong>Thirteen well-recovered patients with stroke (1 woman, 12 men; mean age, 62.6 years; mean time after stroke: 47.6 months) and 13 healthy controls (5 women, 8 men; mean age, 64.5 years) were included. The main finding was that ventral premotor cortex and supplementary motor area showed topographically distinct alterations in their connectivity with the spinal cord. Specifically, we found a reduced coupling between the supplementary motor area and the ipsilateral ventral spinal cord and an enhanced coupling between the ventral premotor cortex and ventral and intermediate central spinal zones. Lower supplementary motor area and higher ventral premotor cortex-related spinal cord couplings were correlated with residual deficits.</p><p><strong>Conclusions: </strong>This work provides first-in-human functional insights into stroke-related alterations in the functional connectivity between cortical premotor areas and the spinal cord, suggesting that different premotor areas and spinal neuronal assemblies might be involved in coupling changes. It adds a novel, promising approach to better understanding stroke recovery and developing innovative models to comprehend treatment strategies with spinal cord stimulation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1159-1168"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identity-by-Descent Analysis Uncovering a Founder Event in a Novel Hereditary Small Vessel Cerebral Disease.","authors":"Arnaud Maillard, Eva Pipiras, Philippe Jarnoux, Chaker Aloui, Thibault Coste, Michaelle Corpechot, Francoise Bergametti, Valérie Jobic, Audrey Delaforge, Elisabeth Tournier-Lasserve","doi":"10.1161/STROKEAHA.124.049839","DOIUrl":"10.1161/STROKEAHA.124.049839","url":null,"abstract":"<p><strong>Background: </strong>A novel genetic cerebral small vessel disease, linked to the insertion of a mobile genetic element in the <i>COL4A1</i> gene has recently been identified. Notably, 8 out of the 10 families carrying this mutation were known to come from Brittany, a specific region in France, suggesting the possibility of a common ancestor and a founder effect.</p><p><strong>Methods: </strong>Probands from each of the 10 families were analyzed with high-density single nucleotide polymorphism arrays. Bioinformatics tools were used to identify identical-by-descent chromosomal segments shared among probands.</p><p><strong>Results: </strong>Two of the 10 families were shown to be closely related. Furthermore, all probands shared a common identical-by-descent haplotype around the <i>COL4A1</i> locus on 13q34, establishing the inheritance of the mutation from a single common ancestor. The most recent common ancestor of the 10 families is estimated to be born around 1735 (95% CI, 1600-1820) and is most probably of European descent.</p><p><strong>Conclusions: </strong>This study demonstrates that this newly identified cerebral small vessel disease is the result of a founder effect, with strong clinical and epidemiological implications. This mutation is likely to be found mainly in regions with recent migratory ties to Brittany, such as the British Isles and North America, highlighting the need for further studies to assess the AluYa5 insertion in these areas. To our knowledge, this is the first reported instance of a founder effect contributing to a cerebral small vessel disease.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1285-1289"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonischemic Cerebral Enhancing Lesions After Pipeline Coil Embolization in Asymptomatic Patient.","authors":"Farid Khasiyev, Raeann Bourscheid","doi":"10.1161/STROKEAHA.125.050642","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050642","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"e137-e138"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}