Frontiers in stroke最新文献

{"title":"Reducing onset-to-door times through the implementation of a prehospital large vessel occlusion bypass protocol: the Oahu experience.","authors":"Chung-Huan Sun, Ian Chun, Kazuma Nakagawa, Stacy Brown, Samuel Tsappidi, Ferdinand Hui, Yi Zhang, Rony Salem, Guangxiang Zhang, Daniel Galanis, Matthew Koenig","doi":"10.3389/fstro.2026.1903852","DOIUrl":"10.3389/fstro.2026.1903852","url":null,"abstract":"<p><strong>Background: </strong>The Oahu large vessel occlusion (LVO) bypass protocol is a real-world island-wide EMS initiative designed to identify patients with suspected LVOs in the field and triage them directly to a Comprehensive Stroke Center (CSC) for endovascular therapy (EVT).</p><p><strong>Methods: </strong>A retrospective preimplementation-postimplementation study was conducted to investigate the impact of the bypass protocol on endovascular treatment times and patient outcomes between January 1, 2017 to January 1, 2023.</p><p><strong>Results: </strong>A total of 351 patients met inclusion criteria (102 patients pre-bypass vs. 249 patients post-bypass). In an interrupted time series analysis, there was a sustained 66-min reduction in onset-to-CSC door time (<i>p</i> = 0.0046), and a 41-min reduction in onset-to-reperfusion time (<i>p</i> = 0.08) in the post-bypass period with no changes in temporal trends. Interfacility transfers for EVT declined 5-fold (55.9% to 11.6%; <i>p</i> < 0.001) with no delay in onset-to-thrombolytic time (<i>p</i> = 0.13). In multivariate logistic regression modeling, longer onset-to-reperfusion times were independently associated with worse clinical outcomes, where every 30-min delay increased the odds of a higher 90-day mRS score by 6% (OR 1.062, 95% CI 1.001-1.125, <i>p</i> = 0.033). The post-bypass era, itself, however, was not associated with improved 90-day good outcomes (mRS 0-2: 40.2% vs. 44.6%; adjusted OR 0.98 [95% CI, 0.57-1.69]; <i>p</i> = 0.93) or a shift in 90-day mRS disability (adjusted OR 0.93 [0.60-1.41]; <i>p</i> = 0.72), though a nonsignificant trend toward improved 90-day excellent outcomes was observed (mRS 0-1: 23.5% vs. 34.5%; unadjusted OR 1.75 [1.01-2.90], <i>p</i> = 0.045; adjusted OR 1.51 [0.84-2.72], <i>p</i> = 0.17).</p><p><strong>Conclusions: </strong>Implementation of a system-wide EMS LVO bypass protocol successfully reduced onset-to-door and onset-to-reperfusion times within a uniquely closed catchment geography. The impact on clinical outcomes, however, remains to be seen.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1903852"},"PeriodicalIF":1.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic drugs after stroke: time to embrace SGLT2 inhibitors and incretin-based therapies?","authors":"Håkon Ihle-Hansen, Hege Ihle-Hansen, Rolf A Blauenfeldt, Jesse Dawson, Søren Z Diederichsen, Guri Hagberg","doi":"10.3389/fstro.2026.1918465","DOIUrl":"10.3389/fstro.2026.1918465","url":null,"abstract":"<p><p>Stroke is a multifactorial cardiovascular disease (CVD), which predominantly affects older adults. Consequently, cardiovascular risk factors and related comorbidities are highly prevalent among people presenting with acute stroke. These conditions, and the stroke event itself, may require specific pharmacological therapies to reduce subsequent risk. Over recent decades, two novel pharmacological drug classes, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which were initially developed as glucose-lowering therapies for type 2 diabetes mellitus, have been used for management of related cardiovascular conditions. These agents are not currently included in secondary stroke prevention guidelines, despite growing evidence suggesting that they may directly or indirectly improve long-term, stroke-related outcomes. It is therefore essential that the stroke community remains up-to-date with these developments while awaiting updated clinical guidelines. This will ensure optimal management of coexisting cardiovascular disease and reduce subsequent risk. In this commentary, we summarize and discuss what we consider to be the most relevant and impactful recent studies for contemporary clinical stroke practice.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1918465"},"PeriodicalIF":1.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology unit, Kampala-Uganda: a mixed-methods study.","authors":"Ronald Bwambale, Ronald Ssenyonga, Mark Kaddumukasa, Martha Sajatovic, Aggrey David Mukose","doi":"10.3389/fstro.2026.1913292","DOIUrl":"10.3389/fstro.2026.1913292","url":null,"abstract":"<p><strong>Introduction: </strong>Rehabilitation is the primary form of therapy for stroke survivors. However, there is a dearth of information regarding access to stroke rehabilitation services following discharge from hospitalization. This study, therefore, examined the level of access and experiences of accessing stroke rehabilitation services following discharge from the Mulago National Referral Hospital (MNRH) Neurology unit, Kampala, Uganda.</p><p><strong>Methodology: </strong>This was a concurrent mixed-methods study. Quantitative data were collected using a study questionnaire from 120 participants and analyzed with STATA version 15.0. A 17-item multidimensional tool was used to measure access, and participants who scored 80% and above were categorized as having high access. Qualitative data were collected through in-depth, face-to-face interviews with six purposively selected participants and analyzed thematically using ATLAS.ti version 25.</p><p><strong>Results: </strong>Of the 120 participants, 55.0% (66/120) were female, 55.8% (67/120) were married, and 44.2% (53/120) had attained a primary level of education. The overall mean age [Standard deviation (SD)] was 58.4 years (±14.6). Only 7.5% of the participants had high access to stroke rehabilitation services. Among the dimensions of access, acceptability scored highest (66.4%), followed by accessibility (24.3%), availability (20.6%), accommodation (15.9%), and affordability (3.7%). Key themes for experiences faced while accessing stroke rehabilitation services included transport challenges, high cost of care, adequacy of rehabilitation resources at hospitals, and organization of stroke rehabilitation services.</p><p><strong>Conclusion: </strong>Access to stroke rehabilitation services after hospital discharge remains suboptimal, with only a small proportion of patients achieving high levels of access. The high cost and limited affordability of rehabilitation care are the predominant barriers to service utilization.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1913292"},"PeriodicalIF":1.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CFAST: a simplified and culturally adapted stroke education tool for Chinese communities.","authors":"Haroon Khan, Yang Wang, Jing Chen, Xiao-Bing Xie, Wei Xu, Meng Li, Dong-Ling Huang, Jiannan Xiao, Chuan-Cheng Ren","doi":"10.3389/fstro.2026.1845862","DOIUrl":"10.3389/fstro.2026.1845862","url":null,"abstract":"<p><strong>Background/objectives: </strong>Rapid recognition of stroke symptoms in Chinese populations is poor, and improving the timely and reliable identification of patients could significantly expedite the administration of stroke therapy. This study aimed to develop and evaluate CFAST (\"Zhongfeng, shuo-xiao-dong\" meaning \"stroke, speech, smile, move\"), compare its learning efficiency, comprehension, and 1-h recall with Stroke-120, and validate its performance in a larger pragmatic cohort.</p><p><strong>Methods: </strong>Phase 1 involved a comparison of standardized community sessions using CFAST (<i>n</i> = 192) or Stroke-120 (<i>n</i> = 192). The primary outcome was 1-h recall ability post-training (0-3-point checklist). The secondary outcomes were learning efficiency (time taken to recite the mnemonic) and immediate comprehension (0-3 elements explained correctly). In Phase 2, CFAST was implemented alone among 3,688 participants.</p><p><strong>Results: </strong>In Phase 1, all CFAST-trained participants (192/192; 100%) mastered the mnemonic within 5 min, compared to 3.65% (7/192) in the Stroke-120 group after a 30-min training (<i>p</i> < 0.001). When tested for comprehension, 100% of the CFAST group accurately explained the terms \"speaking,\" \"smiling\" and \"moving,\" whereas only 3.65% of the Stroke-120 group correctly identified the meaning of numbers associated with stroke symptoms. Short-term retention tests showed that 100% of CFAST-trained participants could accurately recall all mnemonic elements after 1 h, compared to none in the Stroke-120 group, where only 20.31% (39/192) could recall one or two items. These results were consistently replicated in a larger CFAST cohort (n = 3,688; 100% comprehension and recall, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The newly developed CFAST mnemonic achieved superior short-term comprehension and recall compared with Stroke-120 and demonstrated scalability across communities. Our findings support its feasibility for public stroke education in Chinese populations.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1845862"},"PeriodicalIF":1.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality monitoring in telestroke networks: real-world insights from survey response data and literature review.","authors":"Ayush Agarwal, Christine Tunkl, Alexandra Krauss, Emily R Ramage, Mirjam R Heldner, Stefan T Gerner, Teresa Ullberg, Leonardo A Carbonera, Jatinder S Minhas, Aristeidis Katsanos, Matias J Alet, Abdul H K Y Khan, Faddi Saleh Valez, Tamer Roushdy, Linxin Li, Bogdan Ciopleias, Zhe Kang Law, Radhika Lotlikar, Susanna M Zuurbier, Maria G Mosconi, Shirsho Shreyan, Shakti Shrestha, Gisele S Silva, Annemarei Ranta","doi":"10.3389/fstro.2026.1879025","DOIUrl":"10.3389/fstro.2026.1879025","url":null,"abstract":"<p><strong>Background and aims: </strong>The objective of telestroke services is to enhance the quality of stroke care delivered to remote locations. The American Heart Association/ American Stroke Association (AHA/ASA) and the European Stroke Organization (ESO) have issued recommendations for quality monitoring in telestroke. To provide real-world insights, our study analyzed data on quality monitoring practices among telestroke networks.</p><p><strong>Methodology: </strong>This is a secondary analysis of a global telestroke survey previously conducted by our group. The focus of the current analysis was on reported quality metrics. We also reviewed articles from our prior systematic review (SR) of the literature on telestroke networks to extract quality metrics from published data and compared these with those reported in survey responses.</p><p><strong>Results: </strong>Eighty-eight of 254 networks responded to the survey. The SR analyzed 92 studies describing 64 acute telestroke networks across 17 countries. Quality monitoring was performed in 64 of 88 surveyed networks (72%), and it was described in all networks identified in the published literature. The most frequently reported performance indicator across both data sources was thrombolysis rate (93% in survey, 87% in SR). Other recommended indicators were reported less frequently in both the survey and the SR, with recanalization rate reported as 54% vs. 35%, discharge NIHSS as 65% vs. 1%, and in-hospital mortality as 78% vs. 31%, respectively.</p><p><strong>Conclusion: </strong>Our study is the first real-world insight into the state of quality monitoring in telestroke, both from peer-reviewed literature and self-reported data. The observed heterogeneity and low uptake of recommended quality indicators highlight the potential need for consensus on a standardized minimal quality monitoring dataset to facilitate feasible quality monitoring and comparison of outcomes across networks.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1879025"},"PeriodicalIF":1.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between poor blood pressure control and intracranial haemorrhage-related mortality in patients with atrial fibrillation receiving oral anticoagulation: a retrospective observational cohort study.","authors":"Jin Un Kim, Zhen Cahilog, Zehra Kadani, Teledalase Olajoyegbe, Darren Fernandes, Dhiraj Ail, Karishma Oojageer, Telma Da Silva, Saeedur Rahman, Peter Kabunga","doi":"10.3389/fstro.2026.1840317","DOIUrl":"10.3389/fstro.2026.1840317","url":null,"abstract":"<p><strong>Study objective: </strong>Hypertension is a major modifiable risk factor for intracranial haemorrhage (ICH) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). We performed a retrospective exploratory analysis of the prevalence of poorly controlled hypertension, as evidenced by hypertensive vasculopathy on neuroimaging, among patients with AF on OAC who died after presenting with ICH at a large district general hospital in England.</p><p><strong>Methods: </strong>Between December 2020 and April 2024, the death registry data of a large district general hospital in the South East of England, United Kingdom, were analysed to identify patients who were anticoagulated for AF and who had ICH as the primary cause of their death. The confirmatory neuroimaging data were interrogated to assess the likely underlying cause of bleeding.</p><p><strong>Results: </strong>Of the 5,452 deaths within the study period, 46 patients on OAC for AF were included. The majority of patients (78.3%) had spontaneous ICH compared to traumatic ICH (11.7%). Most patients (84.8%) recorded hypertension (80% in the traumatic group, <i>n</i> = 8 vs. 86.1% in spontaneous ICH, <i>n</i> = 31). In those with spontaneous ICH, 28 (77.8%) demonstrated neuroradiological evidence of bleeding as a result of hypertensive vasculopathy.</p><p><strong>Conclusion: </strong>Hypertension is not only a major substrate of AF incidence but a cause of additional morbidity and mortality. Within our cohort, hypertensive vasculopathy was a significant underlying aetiology of spontaneous ICH-related mortality. Falls and trauma causing ICH in anticoagulated patients with AF may be overestimated. In line with the recently updated European Society of Cardiology (ESC) guideline, blood pressure should take priority in the management of AF to reduce major bleeding risk.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1840317"},"PeriodicalIF":1.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in non-bacterial thrombotic endocarditis: a patient-level systematic review of clinical characteristics, management, and outcomes.","authors":"Ahmed Aljabali, Deema Alhayali, Hallie Taylor-Wedge, Todd A Laffaye, Majd Al-Ahmed, Ayham Harahsheh, Mohammed Alamoush, Khaled Dweik, Mayowa A Osundiji, Amir A Mbonde, Cumara B O'Carroll, Bart M Demaerschalk, Ehab Harahsheh","doi":"10.3389/fstro.2026.1915602","DOIUrl":"10.3389/fstro.2026.1915602","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;Stroke is a frequent manifestation of non-bacterial thrombotic endocarditis (NBTE), yet current knowledge largely stems from case reports and small case series. This systematic review summarizes stroke presentation, imaging features, management, and outcomes in patients with NBTE-related stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a patient-level systematic review of published case reports and case series. PubMed, MEDLINE, Embase, Web of Science, and PsycINFO were searched from inception through August 2025 for studies reporting individual patients with NBTE-related stroke. Extracted data included demographics, vascular risk factors, stroke presentation, imaging features, NBTE etiology, treatment (unfractionated heparin/low-molecular-weight heparin [UFH/LMWH], vitamin K antagonists [VKA], direct oral anticoagulants [DOACs], and/or valvular surgery), and outcomes. Multivariable regression was used to explore factors associated with recurrent stroke and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 236 patients with NBTE and stroke from 218 studies (median age 56 years [IQR: 43-63], 63% female). Left hemispheric stroke syndromes predominated among clinical presentations (27%), and multi-vessel territory ischemic infarcts (&gt;2 territories) were observed in 65%. Conventional vascular risk factors were infrequent (0%-21%), whereas deep vein thrombosis (43%) and systemic embolism (41%) frequently preceded or coincided with stroke onset. Malignancy (70%) and autoimmune disease (25%) were the main NBTE etiologies. Anticoagulation was initiated in 70%, and 21% underwent valvular surgery. Over a median follow-up of 2.0 months, stroke recurred in 43% and death occurred in 49% of patients. Malignant etiology (aOR 10.3, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and metastases (aOR 3.9, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) were associated with increased mortality, while VKA use (aOR 0.08, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and autoimmune etiology (aOR 0.1, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) were associated with lower mortality. Malignancy (aOR 2.8, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and DOAC use (aOR 5.2, &lt;i&gt;P&lt;/i&gt; = 0.012) were associated with increased risk of recurrent stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;NBTE should be considered in stroke patients lacking conventional vascular risk factors, particularly those with malignancy or autoimmune disease. Malignancy and DOAC use were associated with higher recurrent stroke risk, while VKA use was associated with lower mortality; however, these anticoagulant-class findings should be considered hypothesis-generating and interpreted cautiously given the case-report evidence base, small treatment subgroups, potential confounding, and limited follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What this study adds: &lt;/strong&gt;By synthesizing patient-level data from published case reports and case series, this review provides a stroke-focused characterization of NBTE, including clinical presentation, infarct topography, underlying etiologies, management strategies, recurrent","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1915602"},"PeriodicalIF":1.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher allostatic load at hospitalization is linked to worse outcome 90 days after stroke.","authors":"Eva Birgitte Aamodt, Karim Borei, Thomas Potter, Farhaan Vahidy","doi":"10.3389/fstro.2026.1847419","DOIUrl":"10.3389/fstro.2026.1847419","url":null,"abstract":"<p><strong>Background: </strong>Allostatic load (AL), a marker of cumulative stress-related physiologic burden, may influence acute ischemic stroke (AIS) outcome through multisystem dysregulation.</p><p><strong>Methods: </strong>A total of 4,103 AIS patients were recruited from Houston Methodist Registry of Neurological Endpoint Assessments among Patients with Ischemic and Hemorrhagic Stroke (REINAH). Clinical information was collected at initial hospital stay and AL was created using ten parameters representing the metabolic, inflammatory and vascular systems. No neuroendocrine parameters were available. Length of stay (LOS) at the hospital was collected upon departure from the initial hospitalization, and mortality and dependency (modified Rankin Scale) were collected at 90 days post stroke. Factors independently associated with high AL were examined using a multivariable logistic regression model. Associations between baseline AL and post-stroke outcomes (LOS, mortality, and dependency) were examined using unadjusted and adjusted regression models.</p><p><strong>Results: </strong>High AL was associated with longer LOS, and higher mortality and dependency at 90 days. Factors independently associated with high AL included younger age, Black race, higher area deprivation index, being single, illegal drug use, diabetes mellitus, sepsis, higher Charlson comorbidity index, anticoagulation reversal therapy, antihypertensive therapy, and higher NIHSS at 6 and 24 h post stroke, whereas being a woman, hypercholesterolemia, atrial fibrillation, anticoagulant therapy, intravenous tissue plasminogen activator treatment, and endovascular thrombectomy were associated with moderate-low AL.</p><p><strong>Conclusion: </strong>High AL is associated with poorer functional and clinical outcomes after AIS and may support future risk stratification work.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1847419"},"PeriodicalIF":1.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission direct bilirubin and direct bilirubin-to-lymphocyte ratio as exploratory markers of early severity and in-hospital functional status in acute ischemic stroke.","authors":"Yingxia Li, Ruixing Zhang, Yang Luo, Youquan Gu","doi":"10.3389/fstro.2026.1800285","DOIUrl":"https://doi.org/10.3389/fstro.2026.1800285","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the correlation between direct bilirubin (DBIL), direct bilirubin-lymphocyte ratio (DBLR), and the severity of acute ischemic stroke (AIS), and to evaluate their potential as auxiliary biomarkers for early severity assessment and short-term in-hospital functional outcome of AIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study was conducted to enroll 234 patients with AIS who presented within 24 h of admission to The First Hospital of Lanzhou University as the AIS Group, and 180 healthy individuals who underwent a health checkup at the same time were randomly selected as the Control Group. The patients' general information, National Institute of Health Stroke Scale (NIHSS) scores, and laboratory indicators at admission were collected with DBLR calculated as DBIL divided by lymphocyte (LYM) count. The AIS Group was divided into Mild Group (NIHSS ≤ 6, &lt;i&gt;n&lt;/i&gt; = 91), Moderate Group (6 &lt; NIHSS &lt; 15, &lt;i&gt;n&lt;/i&gt; = 82), and Severe Group (NIHSS ≥ 15, &lt;i&gt;n&lt;/i&gt; = 61) according to the NIHSS scores at admission. The AIS Group was further divided into Good early functional outcome Group (mRS &lt; 3, &lt;i&gt;n&lt;/i&gt; = 133) and Poor early functional outcome Group (mRS ≥ 3, &lt;i&gt;n&lt;/i&gt; = 101) according to the Modified Rankin Scale (mRS) scores at 7 ± 2 days of treatment. The differences in past medical history, general clinical data, and laboratory indicators between the AIS Group and the Control Group were compared, and the differences in laboratory indicators between the different subgroups were analyzed respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared to the Control Group; the AIS Group exhibited significantly higher direct bilirubin (DBIL) levels and a lower lymphocyte (LYM) count (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). Both the Moderate and Severe Groups presented elevated direct bilirubin (DBIL) levels (&lt;i&gt;P&lt;/i&gt; &lt; 0.001), indirect bilirubin (IBIL) levels (&lt;i&gt;P&lt;/i&gt; = 0.021), and direct bilirubin ratio (DBLR) (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). Notably, DBIL (&lt;i&gt;r&lt;/i&gt; = 0.269, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and DBLR (&lt;i&gt;r&lt;/i&gt; = 0.321, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) were positively correlated with the extent of neurological deficit, while LYM count (&lt;i&gt;r&lt;/i&gt; = -0.274, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) exhibited a negative correlation with neurological deficit severity. At the time of admission, DBIL and DBLR were identified as risk factors for neurological deficits. This study performed receiver operating characteristic (ROC) curve analysis on DBLR and DBIL among patients with severe strokes. The area under the curve (AUC) for DBLR was 0.612, with an optimal diagnostic threshold of 2.82, yielding a sensitivity of 47.2% and a specificity of 79.4% (&lt;i&gt;P&lt;/i&gt; = 0.005, 95% CI: 0.537-0.686). For DBIL, the AUC was 0.596, the optimal diagnostic threshold was 2.85, with a sensitivity of 72.7% and a specificity of 43.5% (&lt;i&gt;P&lt;/i&gt; = 0.017, 95% CI: 0.521-0.671), and the difference was statistically significant (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). In comparison to the Good early functional outcome Group, the Poor early func","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1800285"},"PeriodicalIF":1.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-stroke glymphatic and meningeal lymphatic dysfunction: mechanisms, imaging evidence, and translational challenges.","authors":"Jin Yang, Ting Wang, Yaoyue Hu, Cuiying Liu, Tianliang Shi, Heng Zhao","doi":"10.3389/fstro.2026.1861562","DOIUrl":"https://doi.org/10.3389/fstro.2026.1861562","url":null,"abstract":"<p><p>Stroke may disrupt brain fluid and waste clearance pathways, including the glymphatic and meningeal lymphatic systems, across ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. This review synthesizes current evidence on post-stroke alterations in these pathways, with emphasis on subtype-specific mechanisms, the distinction between experimental and human evidence, and the strengths and limitations of available imaging approaches. Experimental studies suggest that ischemic stroke may involve hyperacute perivascular cerebrospinal fluid influx followed by impaired glymphatic transport, that intracerebral hemorrhage is more closely linked to blood-product-related disruption of glymphatic and meningeal lymphatic drainage, and that subarachnoid hemorrhage may involve combined glymphatic and meningeal lymphatic failure. We further review <i>in vivo</i> imaging methods, particularly magnetic resonance imaging (MRI) approaches such as dynamic contrast-enhanced MRI, diffusion tensor image analysis along the perivascular space, and structural perivascular space imaging, and we discuss their biological directness and translational limitations. Across modalities, the most direct evidence still comes mainly from experimental tracer-based MRI and selected intrathecal contrast-enhanced MRI studies in humans. Among stroke subtypes, subarachnoid hemorrhage currently provides the most direct human MRI evidence of combined clearance-pathway dysfunction, whereas most other human stroke data rely on indirect surrogate markers, especially diffusion tensor image analysis along the perivascular space. Accordingly, current clearance-pathway imaging should be regarded primarily as a mechanistic and early translational research tool rather than a validated clinical biomarker. Importantly, most proposed links between molecular mechanisms, imaging readouts, and clinical outcomes remain inferential and require prospective validation in human stroke cohorts. Prospective human studies are needed to test whether targeting brain clearance pathways improves post-stroke recovery and cognition.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1861562"},"PeriodicalIF":1.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}