Neurologist最新文献

{"title":"Psittacosis Combined With Central Nervous System Infection and Acute Cerebral Infarction: A Case Report Based on Metagenomic Next-Generation Sequencing.","authors":"Shuya Tian, Yuanyuan Xiao, Chuanfang Dong","doi":"10.1097/NRL.0000000000000636","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000636","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of psittacosis is still challenging due to the high risk of underdiagnosis and misdiagnosis. Here, we reported our diagnostic experience with psittacosis in combination with central nervous system (CNS) infection and acute cerebral infarction (CI).</p><p><strong>Case report: </strong>A 62-year-old gentleman presented to our department due to episodic vertigo for 4 hours. Pulmonary CT scan revealed high-density shadows in the right upper lobe, and brain MRI initially excluded new CI lesions. Seven days later, the patient began to show fever, with the highest temperature of 39.3°C. Pulmonary CT scan showed pneumonia. Cerebral MR was performed as the patient showed loss of consciousness and convulsion, which indicated pontine infarction. The patient was eventually transferred to the ICU due to severe pneumonia complicated by type I respiratory failure and acute respiratory distress syndrome (ARDS). Metagenomic next-generation sequencing (mNGS) confirmed psittacosis, and then the patient was treated with a regimen of piperacillin-tazobactam, moxifloxacin, and minocycline. However, the patient continued to have a fever and exhibited irritability after withdrawal of sedative medication, thereby, CNS infection was suspected. Upon cerebrospinal fluid collection following lumbar puncture, mNGS sequencing indicated Candida albicans infection. MR revealed progression of infarction featured by increased lesions in the right cerebellum, right pons, right fronto-parietal-temporal-occipital, and right corona radiata.</p><p><strong>Conclusion: </strong>We reported a case report of psittacosis combined with CNS infection based on the mNGS sequencing, along with acute CI based on conventional imaging technique.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Imaging Characteristics of Thalamic Infarction Combined With Moderate-to-Severe Stenosis of the Posterior Cerebral Artery: A Single-Center Experience.","authors":"Bailong Xin, Xiaomei Ye, Xiaoxue Liang, Yuzhen Wang, Yaozhuo Cai, Jingping Sun, Xueli Cai","doi":"10.1097/NRL.0000000000000634","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000634","url":null,"abstract":"<p><strong>Introduction: </strong>Ten patients with thalamic infarction caused by moderate-to-severe posterior cerebral artery (PCA) stenosis confirmed by computed tomography angiography (CTA) were enrolled. To better assess the vascular pathology, high-resolution magnetic resonance imaging (HRMRI) was subsequently used to evaluate the PCA in detail. In addition, we retrospectively analyzed clinical features, treatments, and prognostic outcomes.</p><p><strong>Case report: </strong>Ten patients were included, 7 males and 3 females, with an average age of 67.8±6.6 years. Past history includes: smoking (50%), drinking (30%), hypertension (70%), diabetes mellitus (40%), hyperlipidemia (10%), and cerebral infarction (10%). Clinical manifestations include sensory disorders (60%), motor disorders (50%), cognitive and consciousness disorders (10%), and language impairment (20%). HRMRI suggested that the PCA was moderately or severely stenosed in 4 cases, mildly stenosed in 5 cases, and normal in 1 case. It also suggested the presence of PCA atherosclerotic plaques in 9 patients.</p><p><strong>Conclusion: </strong>Antiplatelet therapy proves effective for this patient population. HRMRI identified atherosclerotic plaques mainly in the PCA's P1 and P2 segments. P1 stenosis often impairs consciousness, while P2 stenosis typically causes sensory/motor deficits. HRMRI aids in evaluating stenosis and plaque features for diagnosis and treatment guidance.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on Intermittent Theta Burst Stimulation Improves Expression Function and Mechanism in Patients With Aphasia After Stroke.","authors":"Guangtao Bai, Liang Jiang, Qi Li, Peiju Qiu","doi":"10.1097/NRL.0000000000000622","DOIUrl":"10.1097/NRL.0000000000000622","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effects of Intermittent Theta Burst Stimulation (iTBS) on the posterior inferior frontal gyrus of the left hemisphere on the expression function of patients with aphasia after stroke, and to explore the specific mechanism of fractional amplitude of low-frequency fluctuation (fALFF) analysis and degree centrality (DC) analysis of resting-state functional MRI.</p><p><strong>Methods: </strong>According to the inclusion and exclusion criteria, 40 patients with poststroke aphasia were randomized into a treatment group (iTBS group) and a control group (S-iTBS group). Patients in the iTBS group received iTBS +speech training, and patients in the S-iTBS group received sham iTBS + speech training. The Western aphasia test (Chinese version) was used to assess spontaneous language, naming, retelling, and aphasia quotient before and after treatment; resting-state fMRI scans were performed before and after treatment, and the scanned image data were analyzed to explore specific activated or suppressed brain regions.</p><p><strong>Results: </strong>Compared with before and after treatment, the scores of spontaneous language, naming, retelling, and aphasia quotient of the patients in iTBS group improved significantly, and the spontaneous language, naming, retelling, and aphasia quotient of the patients in S-iTBS group also improved. After the treatment, the scores of naming, retelling and aphasia quotient of the patients in the iTBS group improved significantly compared with that of the patients in the S-iTBS group. The resting-state fMRI results of the 2 groups before and after treatment were fALFF analysis found that the fALFF value increased in multiple brain regions in the left frontal and temporal lobes of the patients in iTBS group. Meanwhile, DC analysis also found increased DC values in multiple frontotemporal brain regions of the left hemisphere of patients in the iTBS group, indicating that the improved activation of the above brain regions of the patients in the iTBS group was significantly compared with that of the patients in the S-iTBS group.</p><p><strong>Conclusions: </strong>iTBS combined with conventional speech training significantly improved the expression function of patients with aphasia after stroke. After iTBS action on the left hemisphere, increased activation of multiple brain regions in the left hemisphere may be one of the important mechanisms by which iTBS improves expression function in poststroke aphasia patients.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"204-211"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Frontal Release Signs in Acute Anterior Cerebral Artery Infarction and Striatal Dopaminergic Dysfunction: A Case Report.","authors":"Gohei Yamada, Takanari Toyoda, Tomoyuki Kuno, Eiichi Katada, Noriyuki Matsukawa","doi":"10.1097/NRL.0000000000000628","DOIUrl":"10.1097/NRL.0000000000000628","url":null,"abstract":"<p><strong>Introduction: </strong>Dystonic hand postures are uncommon in patients with frontal lobe infarction. Here, we report the first case of a patient with frontal lobe infarction presenting with unique dystonic hand postures-specifically, a pointing gun posture and full-finger extension posture-in combination with frontal release signs.</p><p><strong>Case report: </strong>A 68-year-old man with a prior diagnosis of probable Parkinson disease acutely developed speech and communication impairment, along with reduced voluntary motor function in the right lower extremity. Neurological examination revealed apathy, motor and sensory aphasia, and flaccid paralysis of the right lower limb. Brain magnetic resonance imaging showed an ischemic stroke involving the left superior frontal gyrus, cingulate gyrus, and corpus callosum. Dopamine transporter single-photon emission computed tomography revealed reduced tracer accumulation in the left striatum. Ten days after stroke onset, the patient exhibited a pointing gun posture in the right hand. A repeat neurological examination revealed a grasp reflex. Removing grasped objects led to a transient index finger extension with flexion of the other fingers or a transient full extension of all fingers. The former resembled a pointing gun posture, while the latter, a newly described phenomenon, was termed the full-finger extension posture. In addition, groping movements with the pointing gun posture were observed.</p><p><strong>Conclusion: </strong>Atypical frontal release signs, including the pointing gun posture and full-finger extension posture, may reflect specific thalamocortical excitation resulting from a combination of contralateral striatal dopaminergic denervation and frontal lobe infarction involving the supplementary motor area.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"261-263"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thalamic Infarctions: A Case Study of Inferolateral and Posterior Choroidal Branch Involvement in a Patient Without Classic Vascular Risk Factors.","authors":"Igor Bueno Garrido, Brenda Lima do Espírito Santo, Vinicius Viana Abreu Montanaro","doi":"10.1097/NRL.0000000000000612","DOIUrl":"10.1097/NRL.0000000000000612","url":null,"abstract":"<p><strong>Introduction: </strong>Thalamic infarctions represent a rare subset of ischemic strokes, characterized by a diverse array of clinical manifestations and significant diagnostic challenges. These infarctions can lead to a wide range of neurological deficits, depending on the specific vascular territory involved. Infarctions within the posterior circulation territory of P2, particularly those affecting the inferolateral and posterior choroidal arteries, are associated with distinct neurological symptoms, including contralateral sensory loss, hemiparesis, hemiataxia, thalamic hand, and various sensory and motor disturbances.</p><p><strong>Case report: </strong>We present the case of a 47-year-old woman with a unilateral thalamic infarction involving occlusion of the P2 branch of the posterior cerebral artery. The infarction, caused by a paradoxical embolism secondary to a high-grade patent foramen ovale (PFO) with an interatrial septal aneurysm, occurred in the absence of classic vascular risk factors. The patient exhibited a clinical syndrome consistent with ischemic lesions in the inferolateral and posterior choroidal arteries, manifesting as right-sided hemiparesthesia, hemiataxia with neuropathic pain, thalamic hand, dystonia, and tremor in the upper right limb.</p><p><strong>Conclusion: </strong>Early and precise clinical identification of thalamic infarctions, especially in rare cases involving multiple vascular territories, is essential for improving patient care and outcomes. Recognizing the spectrum of potential symptoms facilitates effective symptom management, minimizes the risk of secondary complications, and optimize neurological rehabilitation.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"251-256"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors of Urinary Retention in Acute Ischemic Stroke Patients: A Retrospective Study.","authors":"Jie Li, Xiaoying Miao, Yan Chen, Jianke Gu, Yan Zeng, Qinhui Zhu, Huiqi Yao","doi":"10.1097/NRL.0000000000000619","DOIUrl":"10.1097/NRL.0000000000000619","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the incidence and risk factors of urinary retention in acute ischemic stroke (AIS) patients.</p><p><strong>Materials and methods: </strong>A total of 993 patients diagnosed with AIS were analyzed retrospectively. According to the incidence of urinary retention, these patients were divided into the urinary retention group and the nonurinary retention group. The incidence of urinary retention after AIS was analyzed. Univariate analysis and binary logistic regression analysis were performed to screen the independent risk factors for urinary retention after AIS.</p><p><strong>Results: </strong>The incidence of urinary retention in AIS patients was 10.98% (109/993). According to the results of the univariate analysis, age ( P <0.01), sex ( P =0.020), National Institutes of Health Stroke Scale (NIHSS) <10 ( P <0.01), Barthel Index (BI) <40 ( P <0.01), multiple cerebral infarction ( P =0.002), manual muscle test (MMT) ( P <0.01), urinary tract infection (UTI) ( P <0.01), and benign prostate hyperplasia (BPH) ( P <0.01) were significantly correlated with urinary retention incidence. The binary logistic regression analysis revealed that female (OR: 1.954, 95% CI: 1.065-3.587), BI <40 (OR: 24.067, 95% CI: 11.652-49.713), UTI (OR: 8.214, 95% CI: 3.714-18.169), and BPH (OR: 11.342, 95% CI: 5.460-12.560) were independent risk factors for urinary retention after AIS.</p><p><strong>Conclusions: </strong>The incidence of urinary retention in AIS patients was 10.98%. BI <40, UTI, and BPH were identified as risk factors for poststroke urinary retention. In addition, being female constituted another risk factor for urinary retention, requiring further study.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"222-225"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Fasting Triglyceride Level Influence Core Infarct Volume in Acute Stroke?","authors":"Surabhi Garg, Tuqa Asedi, Elyse Sandra Vetter, Hussein Alsadi, Rachel Alexis Dukes, Chelsey Marie Schartz, Mohammed Q Al-Sabbagh, Sibi Thirunavukkarasu, Prasanna Eswaradass","doi":"10.1097/NRL.0000000000000613","DOIUrl":"10.1097/NRL.0000000000000613","url":null,"abstract":"<p><strong>Objective: </strong>Our study explores the relationship between fasting triglyceride levels and initial infarct volume in acute ischemic stroke (AIS) patients.</p><p><strong>Methods: </strong>We performed a retrospective chart review and cross-sectional analysis of AIS patients admitted to a tertiary care center in Kansas from 2010 to 2023. Inclusion criteria were AIS patients who (1) underwent CTA and CTP within 24 hours of stroke onset, and (2) had fasting triglyceride levels measured within 24 hours of admission. Infarct volume was calculated using RAPID software (iSchemaView Inc.). Statistical analyses were conducted using STATA (Release 16), with T tests, ANOVA, χ 2 tests, and multivariable linear regression applied as appropriate.</p><p><strong>Results: </strong>We included 178 patients, 52% (n=92) of whom were male, and 31% were aged 61 to 70 years. Mean TG levels were 116.91±70.23 mg/dL, and mean infarct volume was 41.64±53.35 mL. Linear regression showed a significant positive association between TG levels and infarct volume ( P <0.01, β=0.17, 95% CI: 0.06-0.28), with a 0.17 mL increase in infarct volume per unit increase in TG levels. Patients with Embolic stroke of undetermined source (ESUS) had larger infarct volumes compared with those with large artery atherosclerosis ( P <0.05) and the highest mean TG levels (135.61 mg/dL).</p><p><strong>Conclusion: </strong>Hypertriglyceridemia was positively associated with larger infarct volumes, particularly in ESUS patients, who had the highest TG levels and larger infarct sizes. These findings suggest that elevated TG may predict worse stroke outcomes and could be a potential therapeutic target for stroke prevention.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"226-231"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review.","authors":"Jing Bai, Yusheng Zhao, Zihe Wang, Peng Qin, Jingjie Huang, Yupei Cheng, Chaoran Wang, Yuyan Chen, Longxiao Liu, Yuxing Zhang, Bangqi Wu","doi":"10.1097/NRL.0000000000000626","DOIUrl":"10.1097/NRL.0000000000000626","url":null,"abstract":"<p><strong>Background: </strong>Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the \"brain-gut-lung axis.\" Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the \"brain-gut-lung axis\" in SAP pathogenesis require further exploration.</p><p><strong>Review summary: </strong>This systematic literature review systematically searched databases, including PubMed, using the keywords \"stroke,\" \"gastrointestinal microbiome,\" and \"bacterial pneumonia,\" incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of \"neuro-microbial-immune\" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks.</p><p><strong>Conclusions: </strong>Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"237-250"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of Posterior Circulation Accounts for Higher Disability in Ischemic Strokes With NIHSS ≤3 But Not With NIHSS 4-5.","authors":"Maurizio Giorelli, Ruggiero Leone, Sergio Altomare, Anna Digiovanni","doi":"10.1097/NRL.0000000000000615","DOIUrl":"10.1097/NRL.0000000000000615","url":null,"abstract":"<p><strong>Objectives: </strong>Minor strokes are defined as ischemic cerebrovascular accidents that present with mild symptoms scoring ≤5 on the National Institute of Health Stroke Scale (NIHSS). We aimed to investigate whether features related to stroke characteristics, location, severity, or symptoms could predict the risk of disability after minor strokes.</p><p><strong>Methods: </strong>Minor strokes (105) were divided into 2 subgroups: those with baseline NIHSS ≤3 and those with baseline NIHSS 4-5. Comorbidities, occurrence of disability, stroke location, etiology, and outcomes were examined in the 2 subgroups and in those who developed a modified Rankin scale (mRs) of 0 to 1 or mRs >1.</p><p><strong>Results: </strong>No-IVT minor strokes in the NIHSS 4-5 subgroup were associated with more disability compared with the NIHSS ≤3 subgroup ( P >0.05). Residual disability (mRS >1) was associated with a higher incidence of posterior circulation strokes (PCS) ( P =0.0015), large vessel stenosis ( P =0.01), and PCS-related symptoms (imbalance, gait ataxia, and eye movement disorders) not accounted for by NIHSS, in strokes with baseline NIHSS ≤3. Disability (mRS >1) was associated with baseline disabling symptoms, which NIHSS effectively and reliably captured in patients with stroke with NIHSS 4-5.</p><p><strong>Conclusions: </strong>Symptoms that might predict unfavorable outcomes are not well captured by the available clinical instruments that are usually used to evaluate and score acute ischemic stroke at onset. When deciding on the management of minor stroke, clinicians must consider and judge all potentially disabling deficits, in addition to the pure scores of the adopted evaluation scales.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"196-203"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Implementation of Wake-Up Stroke Protocol for Treatment of Acute Ischemic Stroke in a Rural Stroke Network of the Midwest.","authors":"Andrea Loggini, Karam Dallow, Jessie Henson, Jonatan Hornik, Amber Schwertman, Alejandro Hornik","doi":"10.1097/NRL.0000000000000630","DOIUrl":"10.1097/NRL.0000000000000630","url":null,"abstract":"<p><strong>Objectives: </strong>The indication for thrombolytic therapy in \"wake-up strokes\" based on diffusion-positive and FLAIR-negative lesions on MRI has been introduced in the most recent AHA/ASA stroke guidelines. While this protocol is well established in urban centers, rural hospitals often face challenges due to limited resources and the availability of MRI scanners in the emergency department (ED). Here, we report on the successful implementation of the wake-up stroke protocol within our stroke network, highlighting the planning and execution process, its safety, and outcomes.</p><p><strong>Methods: </strong>After 2 months of planning, involving neurology, ED, radiology, and nursing leadership, the \"wake-up stroke\" protocol was implemented in our rural stroke network system in September 2022. Consecutive patients who received thrombolytics by the protocol were reviewed. For each patient, variables regarding demographics, relevant medical comorbidities and medications, clinical presentation, laboratory values, relevant timing of stroke metrics, complications of thrombolytic therapy, and mRS at 30 days were collected. The group was compared with a randomly severity-matched group of patients who received thrombolytic therapy by standard treatment (within 4.5 h from last known well).</p><p><strong>Results: </strong>Five consecutive acute ischemic stroke patients treated with thrombolytic therapy were identified. Mean age ± SD was 71.2 ± 7.2 years. Of the patients, 60% were males (n = 3). The most common reason for unknown time of symptom onset was nighttime sleep in 60% (n = 3) of the cohort. The median NIHSS (IQR) was 7 (6 to 13). Of the patients, 60% (n = 3) had a M2 occlusion on MR angiogram. The median interval between LKW and needle treatment was 11.68 (IQR: 5.32 to 13.23) hours. Compared with standard treatment, the wake-up stroke group had similar rate of complications (none in each group) and similar rate of mRS <2 at 1 month (60% vs 80%, P = 0.49).</p><p><strong>Conclusions: </strong>The implementation of the wake-up stroke protocol in our network was feasible, with the safety and outcomes of thrombolytics delivered by the protocol comparable to standard treatment. This study supports the utilization of the wake-up stroke protocol in real-world rural practice, highlighting its potential to improve access to high-quality stroke care in underserved areas.</p>","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"232-236"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}