Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Impact of allocentric and egocentric perspectives on far transfer effects following cognitive neurorehabilitation in stroke patients: A randomized control trial","authors":"Jovita Janavičiūtė-Pužauskė ,&nbsp;Raimonda Petrolienė ,&nbsp;Loreta Zajančkauskaitė-Staskevičienė ,&nbsp;Andrius Paulauskas ,&nbsp;Liuda Šinkariova","doi":"10.1016/j.jstrokecerebrovasdis.2026.108583","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108583","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the role of egocentric and allocentric perspectives in facilitating far transfer (improvement of emotional state and psychomotor functions) following cognitive training in stroke patients.</div></div><div><h3>Methods</h3><div>In a three-arm, non-blind, randomized clinical trial, 128 patients with acute stroke were randomly allocated to one of the following groups: 1) control, 2) allocentric perspective, or 3) egocentric perspective groups. Each group received a 2-week intervention, with the experimental groups completing an additional 10 sessions. Cognitive function was measured by the Addenbrooke Cognitive Evaluation-III, depression by the Patient Health Questionnaire-9, anxiety by the Generalized Anxiety Disorder-7 scale, and psychomotor function by the Finger Tapping Test.</div></div><div><h3>Results</h3><div>Cognitive training tasks based on allocentric and egocentric perspectives, when combined with conventional rehabilitation, did not yield a statistically significant far transfer effect compared to conventional rehabilitation alone. No significant differences between-groups were observed for changes in anxiety (F(2, 111) = .056, <em>p</em> = .945, η² = .058), depression (F(2, 109) = 0.831, <em>p</em> = .160, η² = .074), or dominant (F(2, 111) = 0.059, <em>p</em> = .943, η² = .001) and non-dominant (F(2, 108) = 1.375, <em>p</em> = .257, η² = .290) psychomotor functions.</div></div><div><h3>Conclusion</h3><div>The incorporation of an allocentric and egocentric perspective based cognitive training tasks in conventional rehabilitation do not provide significantly better improvements in emotional state and psychomotor functions.</div><div>The ISRCTN clinical trial registry (<span><span>https://doi.org/10.1186/ISRCTN14922230</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 4","pages":"Article 108583"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184145","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":"Methodological concerns undermining causal interpretation in early gastrostomy timing after intracerebral hemorrhage","authors":"Ahmad Shafi Antar","doi":"10.1016/j.jstrokecerebrovasdis.2026.108551","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108551","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108551"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937388","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":"Temporal trends in the use of direct oral anticoagulants prior to stroke admission","authors":"Lily W. Zhou MD, MS, FRCPC ,&nbsp;Dibbya Pravas Dasgupta MS ,&nbsp;Ashkan Shoamanesh MD, FRCPC ,&nbsp;Bijoy K. Menon MD, DM, MSc, FRCPC ,&nbsp;Jason Sutherland PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108574","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108574","url":null,"abstract":"<div><h3>BACKGROUND and AIMS</h3><div>This population-based cohort study measures temporal trends in direct oral anticoagulants (DOAC) use before hospital admission among intracranial haemorrhage (ICH) and acute ischemic stroke (AIS) hospitalizations.</div></div><div><h3>METHODS</h3><div>Consecutive patients with ICH and AIS in British Columbia (B.C.), Canada between 2015 and 2023 were identified using ICD-10 diagnosis codes from Canada’s Discharge Abstract Database. Linkages were made with outpatient prescriptions. We used Cox regression with cause-specific hazard models to explore differences in hospitalization outcomes by DOAC use adjusting for patient demographics and stroke treatment.</div></div><div><h3>RESULTS</h3><div>562/5434 (10.3%) of ICH and 3002/35,666 (8.4%) AIS discharges had DOAC exposure prior to hospital admission. Apixaban was the most common DOAC (49.7%) followed by rivaroxaban (41.4%), dabigatran (8.2%) and edoxaban (0.7%). The proportion of patients on DOACs increased every year among ICH patients by 9% (IRR 1.09, 95% CI 1.05-1.13; from 6.3% to 12.0%) and AIS by 10% (IRR 1.10, 95% CI 1.08-1.12; from 5.1% to 10.1%). After adjustment for patient demographics, health authority location in BC, patient comorbidities, ambulance use and reperfusion treatment, ICH patients admitted on DOACs were more likely to die in hospital (HR 1.27, 95% CI 1.06-1.51) and be transferred to long term care (HR 1.36, 95% 1.04-1.76).</div></div><div><h3>CONCLUSIONS</h3><div>The proportion of patients on DOACs at admission doubled between 2015 and 2023. Patients on DOACs were older, had more comorbidities. Patients with ICH on DOAC prior to admission were more likely to have died during their hospitalization or be discharged to long-term care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108574"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055967","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":"Recent advances and mechanistic insights of non-invasive brain stimulation in post-stroke dysphagia rehabilitation","authors":"En-li Jiang ,&nbsp;Qi-zu Jin ,&nbsp;Qing-yun Zhang ,&nbsp;Ri-bo Peng ,&nbsp;Hai-bo Ai","doi":"10.1016/j.jstrokecerebrovasdis.2026.108576","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108576","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke dysphagia (PSD) affects nearly half of stroke survivors and is associated with aspiration pneumonia, malnutrition, and increased mortality. Conventional swallowing rehabilitation often yields limited functional recovery. In recent years, non-invasive brain stimulation (NIBS), particularly repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has emerged as a promising adjunctive therapy for promoting neuroplasticity and improving swallowing function in patients with PSD.</div></div><div><h3>Methods</h3><div>This structured narrative review summarizes current clinical evidence on the application of rTMS and tDCS in PSD rehabilitation. A literature search was conducted in PubMed, Web of Science, CNKI, and the Cochrane Library from database inception to August 31, 2025. Randomized controlled trials evaluating the effects of rTMS or tDCS on swallowing-related outcomes in patients with PSD were included and narratively synthesized according to stimulation modality, target site, and clinical efficacy.</div></div><div><h3>Results</h3><div>Across the included studies, both rTMS and tDCS significantly improved swallowing function compared with sham stimulation or conventional therapy alone, with good safety and tolerability. Therapeutic benefits were observed using various stimulation protocols, including high-frequency rTMS applied to the affected hemisphere, low-frequency rTMS applied to the unaffected hemisphere, and anodal tDCS delivered to the affected, unaffected, or bilateral hemispheres. However, stimulation parameters and target selection varied widely across studies, and no direct comparisons between rTMS and tDCS or combined-stimulation trials were identified.</div></div><div><h3>Conclusions</h3><div>Current evidence supports rTMS and tDCS as effective, safe, and feasible adjuncts to conventional rehabilitation for post-stroke dysphagia. Nevertheless, heterogeneity in study design and outcome measures limits protocol standardization. Future large-scale, multimodal studies incorporating neuroimaging and guided by the bimodal balance–recovery model are warranted to optimize stimulation strategies and further elucidate the mechanisms underlying cortical reorganization in PSD recovery.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108576"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079884","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":"Associations between methylglyoxal and cerebral small vessel disease and cognitive function – The Maastricht Study","authors":"Eline Berends ,&nbsp;Simone J.P.M. Eussen ,&nbsp;Walter H. Backes ,&nbsp;Pieter C. Dagnelie ,&nbsp;Jacobus F.A. Jansen ,&nbsp;Bastiaan E. de Galan ,&nbsp;Marleen M.J. van Greevenbroek ,&nbsp;Sebastian Köhler ,&nbsp;Miranda T. Schram ,&nbsp;Anke Wesselius ,&nbsp;Robert J. van Oostenbrugge ,&nbsp;Sébastien Foulquier ,&nbsp;Casper G. Schalkwijk","doi":"10.1016/j.jstrokecerebrovasdis.2026.108578","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108578","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral small vessel disease (CSVD) and dementia are increasingly prevalent in the aging population. Diabetes is a major risk factor for CSVD and cognitive impairment, but the underlying mechanisms remain unclear. Methylglyoxal (MGO), a glycolysis by-product and precursor of advanced glycation endproducts (AGEs), is elevated in diabetes and linked to microvascular complications. The aim of this study is to investigate the association between levels of MGO in plasma with MRI-derived markers of CSVD and cognitive impairment in a population-based setting.</div></div><div><h3>Methods</h3><div>Cross-sectional data from The Maastricht Study, a population-based cohort with an oversampling of type 2 diabetes (age 59.7 ± 8.2 years, 49.9 % male, 26 % type 2 diabetes), were analysed. Plasma MGO concentrations were measured using UPLC-MS/MS after overnight fasting. Participants underwent MRI (n = 1789) and cognitive testing (n = 2515). CSVD markers included white matter hyperintensity volume, lacunar infarcts, and cerebral microbleeds. Logistic and linear regressions, adjusted for confounders, assessed the associations between plasma MGO levels, CSVD markers, and cognitive function.</div></div><div><h3>Results</h3><div>No linear associations were found in any of the outcomes. When dividing the population into tertiles (lowest, intermediate, highest) based on plasma MGO concentration, intermediate compared to lowest levels of plasma MGO were associated with increased odds of having a lacunar infarct (OR: 2.26, 95 %CI: 1.27; 4.01). This was not observed for highest plasma MGO (OR: 1.56, 95 %CI: 0.85; 2.86).</div></div><div><h3>Conclusion</h3><div>Intermediate plasma MGO levels were associated with the presence of more lacunar infarcts. Further research is needed to determine whether MGO contributes to lacunar infarct formation in a causal manner.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108578"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097719","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":"Transcatheter closure versus antithrombotic therapy for cryptogenic stroke in elderly patients with patent foramen ovale: a systematic review and meta-analysis of non-randomized studies","authors":"Yang Dong MD ,&nbsp;Cong Lu MD ,&nbsp;Tiantian Luo PhD ,&nbsp;Hao Huang MD ,&nbsp;Yan Xiong MD ,&nbsp;Jie Zeng MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108562","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108562","url":null,"abstract":"<div><h3>Background</h3><div>There is lacking of robust clinical evidence comparing transcatheter closure with antithrombotic therapy in elderly patent foramen ovale (PFO) patients with cryptogenic stroke.</div></div><div><h3>Methods</h3><div>The Pubmed, Embase, Web of Science, clinicaltrials.gov and Cochrane Library databases were systematically searched. Studies comparing transcatheter closure therapy with antithrombotic drug therapy in PFO patients in older age (≥55 years old) were included. The number of patients with and without events in both experimental group and control group were extracted. There were three study endpoints: composite endpoint of recurrent ischemic stroke and transient ischemic attack (TIA); all-cause death; new-onset atrial fibrillation. A random-effect model was performed. Heterogeneity among selected publications was assessed using Q-test based on a χ² test. I²&gt;50% was defined as high heterogeneity. P &lt; 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Nine studies of 7275 elderly PFO patients with cryptogenic stroke were included. Patients undergoing PFO closure had significantly lower risk of a composite endpoint of recurrent stroke and TIA (4.74% versus 8.08%, OR=0.517, 95% CI:0.325-0.821) and all-cause death (1.17% versus 1.24%, OR=0.531, 95% CI: 0.317-0.891). There was no significant different occurrence of new-onset atrial fibrillation between the two groups (3.81% versus 2.82%, OR=1.218, 95% CI: 0.826-1.798). None of the studies measuring the three endpoints manifested high heterogeneity.</div></div><div><h3>Conclusions</h3><div>PFO closure might reduce the risk of composite endpoint of recurrent stroke and TIA and all-cause death, while not increase the risk of new-onset atrial fibrillation comparing with medication therapy in elderly PFO patients with cryptogenic stroke. PFO closure should be considered part of a comprehensive secondary prevention strategy in elderly patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108562"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994757","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":"The role of artificial intelligence in estimating stroke events in Moyamoya patients: A systematic review and meta-analysis of diagnostic test accuracy","authors":"Jeremiah Hilkiah Wijaya ,&nbsp;Miguel Quintero Consuegra ,&nbsp;Daniela A Perez-Chadid ,&nbsp;Aafreen Azmi ,&nbsp;Juan Pablo Avila Madrigal ,&nbsp;Shane Shahrestani ,&nbsp;Sofia Ramirez-Guerrero ,&nbsp;Anil Nanda ,&nbsp;Abdelrahman Ramadan Elashry ,&nbsp;Nestor R. Gonzalez","doi":"10.1016/j.jstrokecerebrovasdis.2026.108542","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108542","url":null,"abstract":"<div><h3>Introduction</h3><div>Moyamoya disease (MMD) and syndrome (MMS) are rare cerebrovascular arteriopathies marked by progressive internal carotid stenosis, fragile collateral networks, and a five-year stroke risk near 10% despite optimal care. Artificial-intelligence (AI) models integrating angiographic, perfusion, and clinical data show promise for risk stratification, but their diagnostic accuracy and clinical readiness remain uncertain.</div></div><div><h3>Method</h3><div>We conducted a systematic review of AI algorithms for predicting ischemic or hemorrhagic stroke events in angiographically or magnetic resonance imaging (MRI)-confirmed MMD/MMS. PubMed, EMBASE, and Scopus were searched through September 3, 2025, for English-language studies employing machine-learning, deep-learning, or radiomics models. We extracted sensitivity, specificity, and area under the curve (AUC) metrics and assessed study quality with Radiomics Quality Score and CLEAR checklists. Pooled estimates and summary receiver-operating characteristic curves were generated; decision-curve analysis evaluated clinical net benefit.</div></div><div><h3>Results</h3><div>Seven retrospective cohorts (<em>n</em> = 4,795) met inclusion criteria. The pooled sensitivity was 0.65 (95% CI 0.50–0.79) and specificity 0.85 (95% CI 0.82–0.89). The summary AUC was 0.85. Decision-curve analysis demonstrated that AI predictions improved net benefit over “treat-all” or “treat-none” strategies across relevant risk thresholds. Tree-based classifiers (XGBoost, random forest) showed more stable external performance than deep-learning networks. Explainability tools enhanced model interpretability.</div></div><div><h3>Conclusion</h3><div>AI models achieve moderate-to-high accuracy for stroke prediction in MMD/MMS and offer potential for individualized risk stratification. However, small single-center datasets, heterogeneous imaging protocols, and opaque modeling limit clinical adoption. Prospective multicenter validation, standardized data pipelines, and robust explainability frameworks are essential for integrating AI into routine neurovascular care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108542"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902092","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":"Factors associated with in-hospital case fatality following spontaneous intracerebral hemorrhage among young ghanaians: findings from a hospital-based stroke registry","authors":"Priscilla Abrafi Opare-Addo MD, MSCR ,&nbsp;Fred Stephen Sarfo MD, PhD, PhD ,&nbsp;Minas Aikins MD ,&nbsp;Serwaa Asare-Bediako MD ,&nbsp;Adwoa Agyemang Adu-Gyamfi MD ,&nbsp;Nessya Taylor MD ,&nbsp;Emmanuella Naa Ayerki Nartey MD ,&nbsp;Maxwell Nyenaah BSc ,&nbsp;Jessey Mahama Holu BSc ,&nbsp;Samuel Kekeli MPhil ,&nbsp;Christian Obirikorang PhD ,&nbsp;Francis Agyemang-Yeboah PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108568","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108568","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of spontaneous Intracerebral Hemorrhage (sICH) in Low-Middle-Income Countries (LMICs) has risen steeply over the past decade, with a relatively earlier age of onset and higher rates of adverse outcomes compared to the rest of the world.</div></div><div><h3>Aim</h3><div>To determine the factors associated with in-hospital case fatality among patients aged ≤ 50 years with spontaneous Intracerebral Hemorrhage, admitted to a Ghanaian tertiary Hospital.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study among individuals aged 18-50 years admitted with Intracerebral Hemorrhage to Komfo Anokye Teaching Hospital over 2 years, from 2022 to 2023. Multivariable Logistic regression was performed to determine the factors associated with ICH-related case fatality during hospital admission. Survival was compared across categories of explanatory variables using the Kaplan-Meier curve. Predictors of time to death were identified using the Cox regression model.</div></div><div><h3>Results</h3><div>46.2% (190 out of 411) of all ICH cases were aged ≤ 50 years, with the majority (63.7%) of those affected in this age group being male. The overall case fatality rate among hospitalized patients in this age group was 27.4% (52 out of 190). The factors independently associated with in-hospital case fatality were the presence of aspiration pneumonia (aOR 6.00 (2.47-15.46), p=0.000), NIHSS score at the time of admission (aOR 1.16 (1.08-1.24), p=0.000), and the presence of neuroimaging features of raised intracranial pressure (aOR 2.66 (1.04-7.00), p=0.044). Independent predictors of time to death included the presence of aspiration pneumonia (aOR 3.51 (1.44-8.55), p=0.004) and NIHSS score (aOR 1.07 (1.01-1.13), p=1.27e-08).</div></div><div><h3>Conclusions</h3><div>Up to 1 in 4 young Ghanaian patients succumb to spontaneous ICH during hospitalization. Prevention, prompt detection, and management of complications, notably aspiration pneumonia during the acute phase of admission, may significantly reduce ICH-related mortality among young individuals in our setting.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108568"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042267","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":"Exposure to cadmium, lead, and mercury and long-term mortality after stroke: a cohort study","authors":"Yanling Gao ,&nbsp;Zhonghui Lin ,&nbsp;Qingyue Dai ,&nbsp;Qing Sun ,&nbsp;Qingyan Su ,&nbsp;Yijing Jiang","doi":"10.1016/j.jstrokecerebrovasdis.2026.108577","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108577","url":null,"abstract":"<div><h3>Background and objective</h3><div>While the neurotoxic effects of cadmium, lead, and mercury are well-documented, their associations with mortality outcomes in stroke survivors remain unclear. This study aimed to investigate the relationships between blood concentrations of these metals and mortality risk in individuals with a history of stroke.</div></div><div><h3>Methods</h3><div>Data from the National Health and Nutrition Examination Survey (NHANES) and National Death Index (NDI) spanning 1999–2018 were analyzed, including 765 stroke survivors. Metal levels were measured via Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and categorized into quartiles. Cox proportional hazards models evaluated associations with all-cause and cause-specific mortalities, adjusting for demographic, clinical, and lifestyle covariates in three hierarchical models. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.</div></div><div><h3>Results</h3><div>Higher cadmium levels were significantly associated with increased all-cause mortality (fully adjusted HR, 2.02, 95%CI 1.30 to 3.16, <em>p</em> = 0.002). Lead demonstrated a significant association only in the highest quartile for all-cause mortality (HR 1.63, 95%CI 1.04 to 2.57, <em>p</em> = 0.035). Mercury exhibited protective effects against all-cause (HR 0.54, 95%CI 0.34 to 0.87, <em>p</em> = 0.011) and malignant neoplasm mortality (HR 0.08, 95%CI 0.02 to 0.39, <em>p</em> = 0.002). No significant associations were observed for cadmium or lead with cardio-cerebrovascular mortality, nor for lead with malignant neoplasm mortality.</div></div><div><h3>Conclusion</h3><div>Elevated blood cadmium levels are independently associated with increased all-cause mortality in stroke survivors. Lead shows a modest association with all-cause mortality, while mercury may exert protective effects against specific mortality outcomes. Further studies are needed to confirm these findings and explore underlying mechanisms.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108577"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097731","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":"Assessment of perioperative outcome factors after hemicraniectomy confirms age as the prognostic factor in patients with middle cerebral artery infarction: Evidence from real-world data","authors":"Regina Isemann MD ,&nbsp;Florian Wild MD ,&nbsp;Paul Bronzlik MD ,&nbsp;Joachim K. Krauss MD ,&nbsp;Thomas Stüber MD ,&nbsp;Kurt-Wolfram Sühs MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108557","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108557","url":null,"abstract":"<div><h3>Background</h3><div>Malignant middle cerebral artery (MCA) infarction is a serious condition for which hemicraniectomy can improve survival and outcome. However, it remains unclear to what extent other perioperative factors contribute to the outcome.</div></div><div><h3>Methods</h3><div>This monocentric, retrospective observational study included patients with MCA infarction and subsequent hemicraniectomy. Perioperative parameters were collected from 68 patients between 01/2012 and 12/2020. Logistic regression analysis was performed to establish determinants for the outcome measured by the Modified Rankin Scale (mRS) (dichotomized in mRS 0-3: favorable outcome, mRS 4-6: poor outcome) 12 months after stroke.</div></div><div><h3>Results</h3><div>Before event, most patients had no impairment (mRS 0, 75 %) or mild impairment (mRS 1-3, 23.5 %). 12 months after stroke, 18 patients (32 %) had favorable outcome (mRS 0-3). In univariable analysis, age (OR[95 %CI]: 1.124[1.045,1.208], p = 0.002) and the pre-existing conditions diabetes (OR[95 %CI]: 10.625[1.279,88.293], p = 0.029) and hypertension (OR[95 %CI]: 3.875[1.159,12.961], p = 0.028) were associated with poor outcome, as were more points of effort for intensive care complex treatment in the Simplified Acute Physiology Score (SAPS) in the first two days after stroke (OR_day1[95 %CI_day1]: 1.109[1.023,1.203], p_day1 = 0.012) (OR_day2[95 %CI_day2]: 1.209[1.078,1.355], p_day2 = 0.001). All other collected periinterventional parameters (i.e. sedation, fever) did not influence the outcome. In multivariable analysis, older age (OR[95 %CI]: 1.107[1.029,1.190], p = 0.006) was found to be an independent predictor of higher mRS (4-6). For age, our ROC analysis showed a cut-off point of 57 years.</div></div><div><h3>Conclusion</h3><div>Our data provide information about changes in the degree of impairment and its improvement over time beyond the acute phase of stroke. Of all included parameters, age emerged as the most important prognostic factor.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108557"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981130","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}