Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Risk factors for clazosentan-induced fluid retention in subarachnoid hemorrhage from the Japanese adverse event database","authors":"Rie Ando-Matsuoka ,&nbsp;Kei Kawada ,&nbsp;Takahiro Niimura ,&nbsp;Hitoshi Fukuda ,&nbsp;Tomoaki Ishida ,&nbsp;Toshihiko Yoshioka ,&nbsp;Yu Kawanishi ,&nbsp;Tomohito Kadota ,&nbsp;Shinji Abe ,&nbsp;Fuka Aizawa ,&nbsp;Kenta Yagi ,&nbsp;Yuki Izawa-Ishizawa ,&nbsp;Mitsuhiro Goda ,&nbsp;Tetsuya Ueba ,&nbsp;Keisuke Ishizawa","doi":"10.1016/j.jstrokecerebrovasdis.2025.108296","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108296","url":null,"abstract":"<div><h3>Background</h3><div>Clazosentan, a selective endothelin receptor antagonist, is used to prevent cerebral vasospasm. We investigated patient characteristics and concomitant medications associated with an increased risk of clazosentan-induced fluid retention, the risk factors of which remain unknown.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed cases of clazosentan-induced adverse drug reactions from the Japanese Adverse Drug Event Report (JADER) database, published by the Pharmaceuticals and Medical Devices Agency. We investigated the time course of fluid retention onset following clazosentan administration before analyzing whether specific patient characteristics and concomitant medications were associated with an increased risk of clazosentan-induced fluid retention.</div></div><div><h3>Results</h3><div>Among 241 cases of clazosentan use identified, fluid retention occurred in 114 (47.3 %). The median time interval from clazosentan initiation to onset of fluid retention was 3 days, and 88.7 % of fluid retention cases were reported within 1 week of initiation. Patients with fluid retention were older than those without; patients &gt;70 years old accounted for 63.16 % of the cohort with fluid retention vs 44.1 % of the cohort without fluid retention. Fluid retention occurred more frequently in patients with concomitant use of fasudil hydrochloride, a conventional vasospasm drug in Japan, than in those without. Multivariate logistic regression analysis revealed that older age (&gt;70 years) and concomitant use of fasudil hydrochloride remained independent risk factors for fluid retention.</div></div><div><h3>Conclusions</h3><div>Clazosentan-induced fluid retention occurred more frequently in older adult patients. Clazosentan combined with fasudil hydrochloride increased the incidence of fluid retention. These findings can guide pharmacological treatment of cerebral vasospasm in patients with subarachnoid hemorrhage.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108296"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis and comparison of trends in the burden of subarachnoid hemorrhage in china and globally, 1990–2021","authors":"Zhihua Cheng ,&nbsp;Liang Wang ,&nbsp;Xiang Wang,&nbsp;Jialong Xuan,&nbsp;Bin Xu,&nbsp;Longfei You","doi":"10.1016/j.jstrokecerebrovasdis.2025.108303","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108303","url":null,"abstract":"<div><h3>Background</h3><div>Subarachnoid hemorrhage (SAH), the rarest form of hemorrhagic stroke, is associated with high mortality and disability rates. Therefore, it is a major public health concern.</div></div><div><h3>Methods</h3><div>This study reviewed the epidemiological characteristics of SAH in China and worldwide, focusing on the 2021 Global Burden of Disease (GBD) database. Researchers, using the GBD database, conducted epidemiological studies that included joinpoint regression analyses covering the incidence, mortality, prevalence, and disability-adjusted life years of SAH in the years 1990-2021. This analysis revealed the trends and effects of SAH in China and globally.</div></div><div><h3>Results</h3><div>From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 17.96 to 7.81 per 100,000 people. The age-standardized mortality rate (ASMR) decreased from 27.29 to 4.72 per 100,000 people. This resulted in a 51.58 % reduction in mortality. In contrast, both the ASIR and ASMR showed a slower decline at the global level. China has reported that women aged 70 years and older are at a high risk for SAH. Furthermore, middle-aged men have high prevalence and mortality rates.</div></div><div><h3>Conclusions</h3><div>The current observations warrant the design of focused interventions for both the elderly and female patients with oblique stroke. They can be useful for addressing the SAH burden globally. This study provides valuable information regarding the effectiveness of existing healthcare interventions. This information can also inform future strategies for the prevention and management of SAH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108303"},"PeriodicalIF":2.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143740058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging biomarkers on routine Computed Tomography (CT) after acute stroke and their association with post-stroke delirium: a cohort study.","authors":"Amanda Barugh, Andrew Farrall, Karen Ferguson, Susan Shenkin, Alasdair MacLullich, Gillian Mead","doi":"10.1016/j.jstrokecerebrovasdis.2025.108302","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108302","url":null,"abstract":"<p><strong>Background: </strong>Delirium affects a quarter of patients after acute stroke and predicts poorer outcomes. The aim of this pragmatic study was to determine whether either qualitative assessment or quantitative assessments of the regional atrophy obtained from routinely performed computed tomography (CT) brain imaging could identify patients most at risk of developing delirium.</p><p><strong>Methods: </strong>We recruited 95 patients with acute stroke (age ≥60) (ischaemic or intracerebral haemorrhage) over one year. Follow-up for delirium and cognition was performed at 1, 3, 5, 7, 14, 21, 28 days, 4 months and 12 months. All participants underwent routine CT brain (Toshiba 64-slice or 128-slice scanner) (within 24 hours of stroke onset). White matter lesions and atrophy were rated qualitatively (mild, moderate, severe). Atrophy in multiple specific areas was measured quantitatively.</p><p><strong>Results: </strong>Twenty-six (27%) developed delirium during the 12 months of follow-up. On univariable analysis, delirium was associated with increasing age, being female, less independent in pre-stroke activities of daily living, pre-existing cognitive impairment, increasing stroke severity, having had a total anterior circulation stroke and global cerebral atrophy on brain CT. Multivariable analysis demonstrated that only global cerebral atrophy, being female and having a more severe stroke predicted delirium. This model accounted for between 38% and 55% of the variance in delirium. For quantitative CT analysis, on univariable analysis, delirium was associated with atrophy in several specific brain areas. On multivariable analysis, only NIHSS (for every one point increase OR 1.23, 95% CI 1.06-1.43; p=0.006)) and cistern ambiens ratio (OR 1.41, 95% CI 1.48-4.96; p=0.028) were significantly associated. This model accounted for between 35.1% and 51.2% of delirium variance.</p><p><strong>Conclusion: </strong>Clinical variables together with either qualitative atrophy assessment or cistern ambiens ratio on routine CT brain could identify stroke patients most at risk of delirium and to stratify patients in clinical trials of delirium prevention and treatment.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108302"},"PeriodicalIF":2.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765902","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":"Melatonin attenuates brain edema via the PI3K/Akt/Nrf2 pathway in rats with cerebral ischemia-reperfusion injury.","authors":"Yang Liu, Xin Wang, Zhen Li, Xiaotian Gao, Xiaoli Wu, Jiayang Pi, Xizhen Wang, Qi Wang, Fenghua Zhou, Xiaoli Wang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108299","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108299","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the neuroprotective effects of Melatonin (Mel) administration on cerebral ischemia-reperfusion injury (CIRI) and elucidate its underlying mechanism in vivo to provide a theoretical foundation for the clinical application of Mel.</p><p><strong>Materials and methods: </strong>CIRI models were established in male adult Sprague Dawley rats by middle cerebral artery occlusion (MCAO) for 2 hours in male adult Sprague Dawley rats. Water content of brain tissue was assessed using both dry/wet weight method and T2-weighted Imaging (T2WI). The infarct volume of the brain was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Cell morphology changes and brain damage were detected through hematoxylin & eosin (H&E) staining and NeuN immunofluorescence staining. The integrity of blood-brain barrier (BBB) was examined using transmission electron microscopy (TEM). The expression of aquaporin 4 (AQP4) protein was quantified through western blots analysis and immunofluorescence staining. The expression of p-PI3K, p-AKT and Nrf2 were detected by immunohistochemistry staining and western blots analysis.</p><p><strong>Results: </strong>Compared with the CIRI group, Mel administration significantly reduced the infarct volume and ameliorated the morphology alterations, accompanied by an increase in the number of neurons. The water content of brain tissue decreased significantly, and the value of relative average diffusion coefficient (rADC) of injured brain increased in the CIRI + Mel group as compared with the CIRI group. Compared with the CIRI group, Mel administration improved the damage to the tight junctions of endothelial cells in the cerebral cortex. The expression of AQP4 protein decreased, and that of p-PI3K, p-AKT and Nrf2 proteins increased in the CIRI + Mel group compared with the CIRI group. After administration of p-PI3K inhibitor LY294002, the expression of AQP4 was upregulated, and that of the p-PI3K, p-AKT and Nrf2 protein decreased compared with the CIRI + Mel group.</p><p><strong>Conclusions: </strong>Mel administration exerts neuroprotective effects against CIRI by mitigating brain edema through upregulating the PI3K/AKT/Nrf2 signaling pathway, and then attenuating brain damage in CIRI rats.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108299"},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755712","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":"Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity.","authors":"Petra Larsson, Elisabeth Edvardsen, Caryl L Gay, Marie Ursin, Hege Ihle-Hansen, Milada Hagen, Anners Lerdal","doi":"10.1016/j.jstrokecerebrovasdis.2025.108297","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108297","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months post-stroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke.</p><p><strong>Materials and methods: </strong>In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36% females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers.</p><p><strong>Results: </strong>Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61%) patients, decreased in 14 (19%), and increased in another 14 (19%). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95%CI [-0.51, -0.12]).</p><p><strong>Conclusion: </strong>There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108297"},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755940","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":"Circulating Mucosal-associated Invariant T Cells Predict Early Neurological Deterioration in Acute Ischemic Stroke.","authors":"Ruihua Liu, Lulu Pei, Jiacheng Liu, Liang Peng, Cairu Guo, Yan Li, Zhihui Duan, Yanjiao Du, Dandan Shang, Shao Li, Yunting Zhang, Bo Song","doi":"10.1016/j.jstrokecerebrovasdis.2025.108301","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108301","url":null,"abstract":"<p><strong>Background: </strong>Mucosal-associated invariant T (MAIT) cells are innate-like T cells that rapidly produce cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-17 (IL-17) upon activation. The immune response is crucial in stroke-related injury. However, few studies have investigated the role of MAIT cells in ischemic brain injury. This study assessed the predictive value of circulating MAIT cells in acute ischemic stroke (AIS) and early neurological deterioration (END).</p><p><strong>Methods: </strong>We prospectively and continuously enrolled AIS patients within 72 h of stroke onset and included controls. END was defined as a ≥2-point increase in the National Institutes of Health Stroke Scale score within the first 72 h. Receiver operating characteristic curves were used to evaluate the predictive value of MAIT cells for END.</p><p><strong>Results: </strong>This study included 188 AIS patients and 135 controls, with 50 (26.6%) AIS patients experiencing END. After adjusting for all potential confounders, circulating MAIT cell frequencies were lower in AIS patients than in controls (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.70-0.97, P = 0.02). IL-17 and TNF-α levels were significantly higher in AIS patients and negatively correlated with MAIT cell frequencies (R = -0.26, P < 0.05; R = -0.19, P < 0.05). Multivariate logistic regression analysis revealed that MAIT cell frequencies were lower in patients with END compared to those without END (OR: 0.74, 95% CI: 0.55-0.96, P = 0.03). The area under the curve for MAIT cells in END prediction was 0.641 (95% CI: 0.548-0.725, P < 0.05).</p><p><strong>Conclusions: </strong>MAIT cell frequency was reduced in AIS patients and may serve as a predictive marker for END. Modulating these cells could be a novel AIS treatment strategy.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108301"},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744437","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":"Tenecteplase versus alteplase in patients with acute ischemic stroke: An updated meta-analysis of randomized controlled trials","authors":"Maheen Sheraz MBBS ,&nbsp;Nawal Asif MBBS ,&nbsp;Ariba Khan MBBS ,&nbsp;Muhammad Khubaib Khan MBBS ,&nbsp;Muhammad Maaz Bin Rehan MBBS ,&nbsp;Muhammad Tayyab Amer Ch MBBS ,&nbsp;Ahmed Sadain Khalid MBBS ,&nbsp;Caterina Oriana Alfieri MBBCh BAO ,&nbsp;Elmehdi Bouyarden MD ,&nbsp;Mohamed Amine Ghenai MD ,&nbsp;Ahmad Alareed MBBS, MRCP ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Mushood Ahmed MBBS ,&nbsp;Muhammad Ehsan MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108300","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108300","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. While alteplase has been widely used for acute management, recent clinical trials suggest that tenecteplase (TNK) may offer improved clinical outcomes. This study aims to compare the efficacy and safety of TNK compared with alteplase.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using PubMed, Embase and Cochrane Library from inception to October 2024 to identify randomized controlled trials that compared TNK at 0.25 mg/kg dosage with alteplase. Data about clinical outcomes was extracted from both groups and assessed by generating forest plots using the random-effects model and pooling odds ratios (ORs).</div></div><div><h3>Results</h3><div>A total of 11 RCTs with 7,546 patients were included in the analysis. TNK showed statistically significant improvement in excellent functional outcome (mRS 0-1) compared with alteplase (OR= 1.14, 95 % CI= 1.03-1.25). No statistically significant difference was observed for good functional outcome (mRS 0-2) (OR= 1.11, 95 % CI= 0.9-1.25), early neurological improvement (OR=1.08, 95 % CI= 0.93-1.26), all-cause death (OR=0.99, 95 % CI= 0.81-1.19), symptomatic intracranial hemorrhage (OR=1.11, 95 % CI=0.81-1.52) and poor functional outcome (mRS=4-6) (OR=0.95, 95 % CI=0.79-1.14).</div></div><div><h3>Conclusion</h3><div>In patients with acute ischemic stroke, TNK demonstrated a significant advantage over alteplase in achieving excellent functional outcomes. The incidence of early neurological improvement, symptomatic intracranial hemorrhage, all-cause death, and poor functional outcome remained comparable across the two groups.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108300"},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors and Outcomes Associated with National Institutes of Health Stroke Scale Scores in Acute Ischemic Stroke Patients Undergoing Thrombectomy in United States.","authors":"Adnan I Qureshi, Ibrahim A Bhatti, Syed A Gillani, Rami Fakih, Camilo R Gomez, Chun Shing Kwok","doi":"10.1016/j.jstrokecerebrovasdis.2025.108292","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108292","url":null,"abstract":"<p><strong>Background and purpose: </strong>The National Institutes of Health Stroke Scale (NIHSS) is the standard for assessing neurological deficits in acute ischemic stroke patients undergoing thrombectomy. However, data on NIHSS scores in patients undergoing thrombectomy at national-level studies in the United States are lacking.</p><p><strong>Methods: </strong>Acute ischemic stroke patients admitted between 2018 and 2021 were identified using ICD-10-CM codes from the Nationwide In-patient Sample, with NIHSS scores categorized into specific strata (0-9, 10-19, 20-29, 30-42). We analyzed the effect of NIHSS scores on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), poor outcome defined by NIS SAH outcome measure, and length and costs of hospitalization after adjusting for potential confounders.</p><p><strong>Results: </strong>The NIHSS score strata among 108,990 acute ischemic stroke patients undergoing thrombectomy were: NIHSS score 0-9 (29.6%), 10-19 (40.6%), 20-29 (26.4%), and 30-42 (3.4%). Patients in the Midwest and West regions (adjusted odds ratio [adjusted OR] = 1.51, p=0.002 and adjusted OR = 1.63, p<0.001, respectively), those treated in rural hospitals (adjusted OR = 1.35, p=0.009) and those who were self-pay (adjusted OR = 1.51, p=0.048) had higher odds of being in higher NIHSS score strata. Patients in higher NIHSS score strata (NIHSS score 10-19, 20-29, and 30-42 had significantly lower odds of discharge home without palliative care (adjusted OR= 0.50, 0.32, and 0.22 respectively, all p<0.001) and higher odds of in-hospital mortality (adjusted OR = 1.51, 2.30, and 3.80 respectively, all p<0.001) compared to those in NIHSS score strata of 0-9. Patients in higher NIHSS score strata had significantly higher hospital stays and higher hospitalization costs.</p><p><strong>Conclusions: </strong>We provide a comprehensive national-level analysis of NIHSS scores in acute ischemic stroke patients undergoing thrombectomy which may assist in understanding variations in outcomes and resource utilizations in United States.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108292"},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694511","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":"Morphologic variation of the circle of Willis is associated with cognitive impairment in a general population: the J-SHIPP study","authors":"Yoko Okada MD, PhD ,&nbsp;Yasuharu Tabara PhD ,&nbsp;Katsuhiko Kohara MD, PhD ,&nbsp;Satoko Takei MD ,&nbsp;Masayuki Ochi MD, PhD ,&nbsp;Michiya Igase MD, PhD ,&nbsp;Yasumasa Ohyagi MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108287","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108287","url":null,"abstract":"<div><h3>Background</h3><div>An incomplete circle of Willis (CoW) is associated with ischemic stroke severity and patient prognosis. However, the clinical significance of an incomplete CoW in healthy adults remains unclear. We examined the association between incomplete CoW and cognitive decline in community-dwelling, apparently healthy, older adults.</div></div><div><h3>Methods</h3><div>A cross sectional study in 829 community-dwelling, functionally independent ≥50 years older adults (mean age: 67.4 ± 8.2 years) who voluntarily participated in the health checkup program provided by the Anti-Aging Center of Ehime University Hospital. Variations in CoW and the degree of cerebral small vessel diseases by Fazekas grading scale were assessed using magnetic resonance imaging. Cognitive function was assessed using a computer-based questionnaire.</div></div><div><h3>Results</h3><div>A total of 317 participants had complete CoW. Cognitive impairment was frequently observed in participants with absent CoW vessels (complete CoW: 5.7%, absent 1 vessel: 9.0%, absent ≥2 vessels: 12.2%; P = 0.023). Grade 2 or higher white matter lesions in subcortical and periventricular regions were frequent in participants without multiple vessels. However, the association between incomplete CoW and cognitive impairment was independent of white matter lesions and conventional risk factors (absent 1 vessel: odds ratio = 1.76, P = 0.09; absent ≥2 vessels: odds ratio = 2.21, P = 0.014).</div></div><div><h3>Conclusion</h3><div>The absence of 2 or more vessels was independently associated with cognitive impairment in a general population, which suggests that CoW variation is a risk factor for cognitive decline.</div></div><div><h3>Funding</h3><div>This work was supported by a Grant-in-Aid for Scientific Research (20390185, 21H04850, 25293141) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108287"},"PeriodicalIF":2.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopausal hormone therapy in women with CADASIL: a health system-wide retrospective cross-sectional study","authors":"Md Manjurul Islam Shourav M.B.B.S. ,&nbsp;Dinith D. Mendis B.S. ,&nbsp;Maria A. Caruso M.S. ,&nbsp;Roaa Zayat M.D. ,&nbsp;Zhongwei Peng M.S. ,&nbsp;Olga P. Fermo M.D. ,&nbsp;Stephanie S. Faubion M.D.M.B.A. ,&nbsp;Michelle P. Lin M.D.M.P.H. ,&nbsp;Kevin M. Barrett M.D. ,&nbsp;James F. Meschia M.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108284","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108284","url":null,"abstract":"<div><h3>Background</h3><div>Menopausal hormone therapy (HT) alleviates menopause symptoms but may alter stroke risk and migraines. Concerns of compounding risk in patients with CADASIL may deter physicians from prescribing HT. We aimed to describe HT use patterns in women with CADASIL.</div></div><div><h3>Methods</h3><div>We reviewed women ≥45 years with genetically or dermato-pathologically confirmed CADASIL. Clinical features, menopause symptoms, and HT use were collected from the electronic health record across Mayo Clinic. Characteristics were compared between non-HT users and HT users using the Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables.</div></div><div><h3>Results</h3><div>Among 89 CADASIL patients, 45 met demographic criteria. Of these, 10 (22.2 %) ever received HT and 35 (77.8 %) did not. There was no significant age difference between HT and non-HT users (53.3 ± 11.8 vs. 54.1 ± 8.3 years; <em>P</em> ≥ 0.05). Migraine history was more common in HT users (100.0 % vs. 51.4 %; <em>P</em> = 0.007). Menopause symptoms were documented in 48.6 % of non-HT users, but HT use was discussed in only 23.5 %. Among HT users, non-systemic local vaginal formulations were most common (60.0 %), followed by the systemic transdermal (30.0 %). In follow-up, 50 % of patients either changed formulations or stopped HT. CADASIL was noted as a reason for the change in 40 %.</div></div><div><h3>Conclusions</h3><div>Many CADASIL patients experiencing menopause symptoms did not receive HT. About one-fourth of women received HT, most commonly with non-oral formulations. Transdermal and vaginal formulations and other non-hormonal medications used to treat vasomotor symptoms may be safer than oral HT for women with CADASIL.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108284"},"PeriodicalIF":2.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}