Frontiers in stroke最新文献

{"title":"Acute cerebrovascular disease in the Philippine Neurological Association One Database (PNA1DB)-patient profiles and disparities between public and private hospitals.","authors":"Robert N Gan, Jose Leonard R Pascual V, Maria Epifania V Collantes, John Harold B Hiyadan, Dan Neftalie A Juangco, Ma Cristina Z Macrohon-Valdez, Cyrus G Escabillas, Christian Oliver C Co, Gemmalynn B Sarapuddin, Maria Teresa A Cañete, Raquel M Alvarez, Belinda L Mesina-Nepomuceno, Johnny K Lokin, Marie Charmaine Sy Lukban, Rosalina E Picar","doi":"10.3389/fstro.2026.1835562","DOIUrl":"10.3389/fstro.2026.1835562","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a leading cause of death in the Philippines, yet data on epidemiology, care, and outcomes remain scarce. We aimed to describe the caseload, patient profile, management, and outcomes of acute cerebrovascular events, and to assess disparities between publicly funded and privately funded tertiary hospitals in the Philippines.</p><p><strong>Methods: </strong>The PNA1DB-Stroke project is a prospective, multicenter, registry of consecutive patients aged ≥18 years admitted with transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, or cerebral venous thrombosis (CVT) in 11 (five publicly-funded, six privately-funded) accredited neurology training tertiary hospitals across the Philippines. Data on socio-demographics, medical history, event type, clinical assessments, diagnostic procedures, treatments and discharge outcomes were collected from June 1, 2021, to August 31, 2024.</p><p><strong>Results: </strong>Among the 15,230 cases included, mean age 58.0 ± 14.2 years, 6,726 (44.2%) women, hemorrhagic strokes accounted for 38.6%. A total of 10,974 (72.1%) cases were admitted in public hospitals with a larger proportion of hemorrhagic strokes compared to private hospitals (<i>p</i> < 0.001). Public hospitals cases were younger, socioeconomically disadvantaged, and more often have lifestyle risk factors. Only 620 (9.3%) ischemic stroke cases underwent revascularization. While relatively more cases received thrombolysis in public hospitals, major diagnostic and therapeutic procedures were performed less compared to private hospitals. Overall, in-hospital fatality was 16.4%, higher in public hospitals (20.5%) with worse neurological outcomes at discharge than in private hospitals.</p><p><strong>Conclusions: </strong>Our registry demonstrated a high burden of hemorrhagic stroke, delayed hospital arrival, underutilization of reperfusion therapies, and striking disparities between public and private hospitals in the PNA1DB. Study Registration: ClinicalTrials.gov NCT04972058.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1835562"},"PeriodicalIF":1.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431683","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":"Sex differences in imaging features including cerebral amyloid angiopathy markers in intracerebral hemorrhage.","authors":"Trine Apostolaki-Hansson, Christine Kremer, Amir Hillal, Cheryl Carcel, Teresa Ullberg, Bo Norrving, Jesper Petersson","doi":"10.3389/fstro.2026.1810711","DOIUrl":"10.3389/fstro.2026.1810711","url":null,"abstract":"<p><strong>Background: </strong>Reports on sex differences in radiological characteristics of intracerebral hemorrhage (ICH) are few. Sex-related differences in hematoma location, volume, and imaging markers may contribute to variations in clinical presentation and outcome. We aimed to assess sex differences in non-contrast computed tomography (NCCT) features in an unselected ICH cohort.</p><p><strong>Methods: </strong>This observational study included 1,398 patients with spontaneous supratentorial ICH from the Skåne Hospital Region, Sweden (2016-2021), registered in Riksstroke. Radiological characteristics were compared between males and females. Multivariable logistic regression, adjusted for confounders, analyzed sex differences overall and stratified by hematoma location (deep/lobar). CAA probability was assessed using the simplified Edinburgh CT criteria.</p><p><strong>Results: </strong>Among 785 males and 613 females, hematoma volume, location, and antithrombotic use were similar. Women were older (79 vs. 73 years; <i>p</i> < 0.001), more often had severe white matter changes on baseline NCCT, with overall differences in white matter change distribution between sexes (<i>p</i> = 0.006), intraventricular hemorrhage (45.2% vs. 38.7%; <i>p</i> = 0.02), finger-like projections (18.1% vs. 10.6%; <i>p</i> < 0.001), subarachnoid extension (25.1% vs. 15.7%; <i>p</i> < 0.001), and hydrocephalus (16.6% vs. 10.0%; <i>p</i> = 0.001). In lobar ICH (<i>n</i> = 666), high CAA probability was more common in women (28.8% vs. 15.0%, <i>p</i> < 0.001), and in multivariable analysis, female sex was independently associated with subarachnoid extension (OR 1.89 95%CI 1.29-2.77).</p><p><strong>Conclusion: </strong>In this large, unselected cohort of supratentorial ICH, no sex differences were observed in hematoma volume, location, or intraventricular extension. However, in lobar ICH, female sex was independently associated with subarachnoid extension and CT features suggestive of higher CAA probability. These findings indicate similar hemorrhage severity between sexes but differences in lobar hemorrhage morphology that require further validation and explanation.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1810711"},"PeriodicalIF":1.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431691","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":"Application of TOAST criteria, comorbidities and outcomes in patients with ischemic stroke: multicenter collaboration in the Dominican Republic.","authors":"Ryna Then, Maria Muñoz, Cristina Ramos, Marcos Mota, Priscilla Sepulveda, Lisa José, Luis Suazo, Francisco Mendez, Yahaira Franco, Cosme González Villamán, Acela Gonell, Violiza Inoa, Gillian Gordon Perue, Manuel Colomé-Hidalgo, Nadja García","doi":"10.3389/fstro.2026.1877826","DOIUrl":"10.3389/fstro.2026.1877826","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of neurological-related death in the Caribbean. The Dominican Republic has among the highest stroke-related mortality rates in the Americas. We aimed to determine ischemic stroke etiologies, characterize comorbidities, and describe outcomes in the Dominican Republic using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.</p><p><strong>Methods: </strong>We analyzed a multicenter quality registry between January 2022 and October 2024. Statistical analyses included Mann-Whitney <i>U</i> and Kruskal-Wallis tests with Bonferroni correction, chi-square tests, and Spearman correlation.</p><p><strong>Results: </strong>The most common stroke subtype was undetermined etiology (54.8%), followed by large artery atherosclerosis (17.2%) and cardioembolism (16.5%). Hypertension (73.8%), diabetes mellitus (47.2%), and prior stroke (19.9%) were the most prevalent risk factors. Cardioembolic stroke had the highest median NIHSS score (6). Prior stroke was associated with increased odds of large artery atherosclerosis (OR 1.53, <i>p</i> < 0.05). Hyperlipidemia was associated with small vessel occlusion (OR 2.14), and atrial flutter/fibrillation with cardioembolic stroke (OR 19.6). Reperfusion therapy was administered to 162 patients (16.6%): intravenous thrombolysis (57%), thrombectomy (33%), and bridging therapy (10%). Inpatient rehabilitation access was limited. Physical therapy was the most common. Modified Rankin Scale scores at discharge increased significantly across all etiologies (<i>p</i> < 0.001), with the greatest worsening in cardioembolic stroke (+2).</p><p><strong>Conclusions: </strong>Most ischemic strokes were of undetermined etiology, with higher severity observed in cardioembolic stroke. Limited diagnostic workup, reperfusion therapies, and rehabilitation access highlight critical gaps in stroke care. These findings provide baseline data to inform targeted prevention and health system interventions in the Dominican Republic and similar settings.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1877826"},"PeriodicalIF":1.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431706","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":"Attributable risk and time trend in hemorrhagic and ischemic stroke mortality due to high sodium intake in Zhenjiang City from 2010 to 2021: an Age-Period-Cohort (APC) analysis.","authors":"Xiaoyong Gu, Yuelan Zhu, Hongyu Wang, Lu Xu, Jiajia He","doi":"10.3389/fstro.2026.1722772","DOIUrl":"10.3389/fstro.2026.1722772","url":null,"abstract":"<p><strong>Introduction: </strong>GBD studies have showed high sodium intake's attributable burden on stroke mortality, while existing risk data remain predominantly global, national, or provincial-level, lacking representativeness for specific cities or regional areas. By associating salt intake with elevated systolic blood pressure, it becomes feasible to conduct risk analysis attributing high sodium intake to specific population groups.</p><p><strong>Objective: </strong>To determine the attributable risk of stroke mortality due to high sodium intake in Zhenjiang City, Jiangsu Province, China, from 2010 to 2021, and analyze time trends in hemorrhagic and ischemic stroke mortality rates associated with high sodium intake, to provide a scientific basis for evaluating and improving the effectiveness of local dietary salt reduction policies.</p><p><strong>Methods: </strong>Using GBD data and Zhenjiang chronic disease surveillance records, this study calculated the attributable burden of hemorrhagic and ischemic stroke mortality caused by high sodium intake through a sodium intake-increase of SBP correlation method, referencing the death risk of elevated SBP leads to hemorrhagic and ischemic stroke. Joinpoint regression was employed to analyze mortality trend amplitude and direction, while an APC model evaluated age, period and cohort effects.</p><p><strong>Results: </strong>From 2010 to 2021, the PAFs for hemorrhagic and ischemic stroke death due to high sodium intake ranged between 12.0% and 19.3%, showing a yearly decreasing trend with higher amplitude observed in males than females. The AAPC of ASMR for hemorrhagic and ischemic stroke was -8.10% (95% CI: -12.00% to -3.90%), with hemorrhagic stroke was -11.10% (95% CI: -13.30% to -8.90%), and ischemic stroke ASMR demonstrated a downward trend after 2013, with its AAPC was -12.30% (95% CI: -14.80% to -9.70%). The overall net drift of mortality for hemorrhagic and ischemic stroke due to high sodium intake was below 0, with hemorrhagic stroke showing greater decline amplitude than ischemic stroke. The value of local drifts with age showed a trend that initially stabilizes and shifted to decreasing and then increasing. Although the age effects on female ischemic stroke mortality due to high sodium intake increased after age 85, both period and cohort effects show a downward trend in stroke mortality risks, the favorable and unfavorable cohort effects on different stroke mortality in different genders deserved more attention.</p><p><strong>Conclusion: </strong>In Zhenjiang City, the attributable risk of hemorrhagic and ischemic stroke mortality due to high sodium intake has shown a downward trend. Priority should be given to women and elderly populations, with continued implementation of salt-reduction-focused stroke prevention strategies to mitigate the health impacts of excessive sodium intake.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1722772"},"PeriodicalIF":1.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426971","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":"Treatment of carotid stenosis: an updated review.","authors":"Antônio Vinícius Pimentel Lima, Maria Victória Pimentel Lima, Marina Trombin Marques, Vivian Dias Batista Gagliardi, Rubens Jose Gagliardi","doi":"10.3389/fstro.2026.1849877","DOIUrl":"10.3389/fstro.2026.1849877","url":null,"abstract":"<p><strong>Introduction: </strong>Atherosclerotic carotid stenosis represents one of the main treatable causes of ischemic stroke, accounting for approximately 10%-15% of all cerebrovascular events. Treatment of this condition has evolved significantly over the past decades, shifting from exclusively surgical approaches to a paradigm that includes optimized medical treatment, carotid endarterectomy, and stenting. Recent 2025 publications, including CREST-2 and ECST-2, have brought paradigm-shifting data that challenge previously established concepts.</p><p><strong>Objective: </strong>To provide an extensive and rigorous narrative review on the treatment of carotid stenosis, including common and internal carotid arteries.</p><p><strong>Methods: </strong>This narrative review was carried out using the PubMed/MEDLINE, LILACS-VHL, Google Scholar, and SciELO databases. DeCS and MeSH descriptors were employed to identify articles published from 2020 to 2025, without restrictions regarding language or geography.</p><p><strong>Results: </strong>In the CREST-2 stenting trial, adding carotid stenting to optimal medical therapy (OMT) was superior to OMT alone for the 4-year composite primary endpoint (any periprocedural stroke or death, or subsequent ipsilateral ischemic stroke): 2.8% vs. 6.0% (<i>p</i> = 0.02; number needed to treat = 31). This net benefit was driven by a lower rate of ipsilateral stroke beyond the periprocedural window and was obtained despite a higher upfront periprocedural risk in the stenting arm. In the parallel endarterectomy trial, adding endarterectomy to OMT did not reach statistical significance (3.7% vs. 5.3%; p = 0.24). ECST-2, in its 2-year interim analysis of asymptomatic or low-to-intermediate-risk symptomatic patients, showed no benefit of revascularization added to OMT.</p><p><strong>Conclusion: </strong>Contemporary data indicate a paradigm shift in the management of carotid stenosis. Optimal medical therapy (OMT), intensified by increasingly stringent LDL-c and blood-pressure targets, is the cornerstone of management for all patients and the principal driver of the marked decline in stroke risk observed over the past two decades. Against this strengthened medical background, the role of revascularization has become more selective: in high-grade asymptomatic stenosis, adding carotid stenting to OMT conferred a modest absolute benefit over OMT alone, whereas carotid endarterectomy (the long-standing gold standard) did not show a statistically significant benefit. These findings support an individualized, plaque- and risk-based strategy in which OMT is universal and revascularization (preferentially by stenting when an intervention is chosen) is reserved for selected patients, with timing and modality guided by stenosis severity, plaque vulnerability, life expectancy, and patient preference.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1849877"},"PeriodicalIF":1.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413862","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":"Beneficial effects of the novel first-in-class compound DX243 on ischemic outcomes following <i>in vitro</i> and <i>in vivo</i> models of stroke.","authors":"Quentin Marlier, Alexia Boreux, Arnaud Rives, Dario Mosca, Helene Michaux, Louisa Schmitz, Pierre Attali, Stéphane Silvente, Philippe Lefebvre, Brigitte Malgrange, Nicolas Caron","doi":"10.3389/fstro.2026.1802085","DOIUrl":"10.3389/fstro.2026.1802085","url":null,"abstract":"<p><strong>Introduction: </strong>New therapeutic strategies to mitigate the devastating consequences of stroke are urgently needed, as restoration of blood flow is currently the only and limited available treatment.</p><p><strong>Methods: </strong>In our study, we employed a comprehensive combination of <i>in vitro</i> and <i>in vivo</i> stroke models to investigate the therapeutic potential of the DX243. Specifically, we used glutamate and oxygen-glucose deprivation/reoxygenation (OGD) treatment models to mimic ischemic conditions <i>in vitro</i>. To transpose these data <i>in vivo</i>, we used the middle cerebral artery occlusion (MCAO) model to induce an ischemic stroke in male C57BL/6J mice.</p><p><strong>Results: </strong>Our results demonstrated that DX243 significantly increased ATP production following glutamate treatment and neuronal viability following OGD.Forty-eight hours after 1 h of MCAO, mice that received one subcutaneous injection of DX243 presented a reduced infarct volume and preserved motor coordination on the rotarod, while effects on open field locomotion were not statistically significant.</p><p><strong>Conclusion: </strong>These results highlight the promising neurorestorative properties of this new molecule and suggest its potential as a therapeutic agent for stroke patients. Further investigations in preclinical and clinical settings are warranted to elucidate its full therapeutic potential.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1802085"},"PeriodicalIF":1.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392656","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":"Closing the stroke care gap: a collaborative, self-sustainable telemedicine enabled model from rural Nepal.","authors":"Khechar Nath Paudel, Mahesh Kumar Khanal, Lekhjung Thapa, Raju Paudel, Christoph Gumbinger, Apsara Hamal, Christine Tunkl","doi":"10.3389/fstro.2026.1818548","DOIUrl":"10.3389/fstro.2026.1818548","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a challenging global public health concern, disproportionately affecting people in rural communities. Stroke care is challenging in low and middle-income countries as it requires a coordinated multidisciplinary approach integrating pre-hospital recognition; acute stroke care, and long-term rehabilitation. Multiple barriers exist in LMICs: lack of community awareness; geographical and financial barriers; poor health systems; absence of standardized care pathways; and inadequate training among primary health care workers. Based on this background, this descriptive implementation-focused retrospective program evaluation describes the implementation and early impact of a collaborative, telemedicine supported multi-component health system intervention for stroke care in a rural government hospital in Nepal.</p><p><strong>Methods: </strong>A non-government organization \"Nepal Stroke Project (NSP)\" partnered with Province Hospital Surkhet (PHS), a community-based tertiary center in remote western Nepal strengthening the stroke care capacity in the region via formation of a multidisciplinary stroke team, infrastructure development and capacity strengthening. NSP experts also provided telemedicine supported clinical guidance to the local stroke team through free digital platform such as WhatsApp. The program evaluation was guided by the RE-AIM framework and interpreted through a health systems strengthening perspective.</p><p><strong>Results: </strong>Baseline assessment identified major system-level barriers, including the absence of a dedicated stroke pathway, thrombolysis services, stroke-specific infrastructure, and specialist support. Following implementation, annual stroke admissions increased from 154 to 178 cases per year, and 10 healthcare personnel were trained. Intravenous thrombolysis, previously unavailable, was successfully administered to two patients, supported by telemedicine-guided decision-making and subsequent ICU transfer. Over the implementation period, 20 stroke patients received telemedicine consultations, routine stroke pathway activation was achieved for thrombolysis cases, and NIHSS documentation improved from absent at baseline to approximately 50% of cases. Service readiness was further strengthened through establishment of two dedicated stroke beds and provision of essential monitoring equipment.</p><p><strong>Discussion: </strong>The collaborative model has a potential for sustainable impact by strengthening long term capacity building, and enabling the local team to deliver comprehensive stroke care independently. This implementation model highlights the importance of maximizing existing resources through task-shifting, integrating stroke care within existing health systems, and fostering local ownership to ensure sustainability.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1818548"},"PeriodicalIF":1.2,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310541","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":"Flow diverters for intracranial aneurysm embolization with coil embolization in children with ruptured aneurysm: two cases reports.","authors":"Quan Zhou, Shixin Jiang, Bingbing Wang, Feng Guo","doi":"10.3389/fstro.2026.1775674","DOIUrl":"10.3389/fstro.2026.1775674","url":null,"abstract":"<p><p>Pediatric intracranial aneurysms are relatively rare and exhibit distinct characteristics compared with those in adults, particularly in terms of sex distribution, incidence, anatomical location, morphology, and underlying etiology. Notably, the risk of rupture and hemorrhage is substantially higher in the pediatric population. Among children younger than five years, approximately 85% of intracranial aneurysms initially present with rupture and bleeding, whereas this proportion decreases to 45% in those older than five years, still significantly exceeding the hemorrhagic risk observed in adults. Current standard treatment modalities for intracranial aneurysms include microsurgical clipping, stent-assisted coil embolization, and flow diverter implantation. However, there are relatively few reports on the use of flow diverters in pediatric patients, and the optimal antiplatelet regimen following endovascular treatment in this population remains controversial. In this study, we report two cases of ruptured giant intracranial aneurysms in children treated with flow diverter placement combined with dense coil embolization. One patient presented with a space-occupying intracerebral hematoma and subsequently developed intracranial hypertension with cerebral herniation after the procedure, necessitating decompressive craniectomy. Different antiplatelet strategies were employed in the two cases. Both patients survived and were discharged in stable condition. At 6-month follow-up, imaging demonstrated no evidence of aneurysm recurrence, and both children had a favorable quality of life.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1775674"},"PeriodicalIF":1.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13275361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297636","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":"Improving stroke outcomes through progressive implementation of stroke unit care in Brazil: a longitudinal observational study.","authors":"Giovani Noll, Artur Francisco Schumacher Schuh, Lenise Valler, Andrea Garcia de Almeida, Rosane Brondani, Magda Carla Ouriques Martins, Gustavo Weiss, Angélica Dal Pizzol, Letícia Costa Rebello, Luiz Antônio Nasi, Sheila Cristina Ouriques Martins","doi":"10.3389/fstro.2026.1825941","DOIUrl":"10.3389/fstro.2026.1825941","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke remains a leading cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries (LMICs). Although stroke unit (SU) care improves outcomes, evidence from LMIC settings is still limited. We evaluated the impact of three sequential stroke-care models implemented in a Brazilian public university hospital.</p><p><strong>Patients and methods: </strong>This longitudinal observational study included 1,889 patients with ischemic or hemorrhagic stroke across three care models: before stroke unit (BSU), acute stroke unit (ASU), and comprehensive stroke unit (CSU). Demographic characteristics, stroke subtype, baseline severity, imaging metrics, and outcomes were collected using retrospective and prospective approaches. Primary outcomes were 90-day case fatality and functional status assessed by the modified Rankin scale (mRS). Secondary outcomes included door-to-CT time, thrombolysis rates, pneumonia, access to rehabilitation, and length of stay. Multivariable logistic regression was used to identify predictors of mortality and excellent functional outcome (mRS 0-1).</p><p><strong>Results: </strong>The implementation of structured stroke-care models was associated with significant improvements in outcomes. Functional independence at 90 days (mRS 0-2) increased from 45.6% (BSU) to 60.3% (ASU) and 56.3% (CSU) (<i>p</i> < 0.001), while case fatality declined from 24.3 to 10.2% and 7.7%, respectively (<i>p</i> < 0.001). Key quality indicators improved substantially: mean door-to-CT time decreased from 527 to 170 and 107 min (<i>p</i> < 0.001), thrombolysis rates increased from 0 to 14.1% and 22.2% (<i>p</i> < 0.001), and post-stroke pneumonia rates declined from 29.4 to 16.3% and 12.5% (<i>p</i> < 0.001). In multivariable analyses, older age and higher baseline NIHSS were independently associated with increased mortality, whereas intravenous thrombolysis and SU care were associated with reduced odds of death. SU care was associated with more than a threefold increase in the likelihood of excellent functional outcome, while thrombolysis remained the strongest predictor (OR 6.19).</p><p><strong>Conclusion: </strong>Stepwise implementation of structured stroke-care models significantly reduced mortality and improved functional outcomes in this LMIC setting. These findings support the effectiveness and scalability of SU-particularly comprehensive models-as key strategies to strengthen stroke systems of care.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1825941"},"PeriodicalIF":1.2,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213520","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 of hyponatremia and risk of in-hospital mortality in patients with acute stroke: a systematic review and meta-analysis.","authors":"Prachi Sharma, Anuradha Pawar, Manabesh Nath, Deepti Vibha, Pradeep Kumar","doi":"10.3389/fstro.2026.1816483","DOIUrl":"10.3389/fstro.2026.1816483","url":null,"abstract":"<p><strong>Objective: </strong>Hyponatremia is among the most common electrolyte disturbances in acute stroke and has been increasingly recognized as a potential predictor of early complications. We aimed to evaluate whether hyponatremia on admission is associated with increased in-hospital mortality in patients with acute ischemic stroke (IS) and hemorrhagic stroke (HS).</p><p><strong>Methods: </strong>We conducted a comprehensive systematic search of PubMed, Scopus, and Embase to identify relevant studies published between 1st January 2000 and 30th October 2025. Eligible studies included patients with acute stroke, reported admission serum sodium levels, and compared outcomes between hyponatremic and normonatremic groups. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Subgroup analyses were performed based on stroke type.</p><p><strong>Results: </strong>Seventeen studies involving patients assessed within 24-72 h of stroke onset were included. Hyponatremia on admission was significantly associated with higher in-hospital mortality (RR 1.41, 95% CI 1.14-1.74). The association remained significant in ischemic stroke (RR 1.29, 95% CI 1.16-1.42) and in studies including mixed IS and HS populations (RR 1.59, 95% CI 1.19-2.12). No significant association was observed in hemorrhagic stroke alone (RR 1.47, 95% CI 0.70-3.10). Between-study heterogeneity was moderate (<i>I</i> ² = 58.9%, <i>p</i> < 0.001). Funnel plot assessment suggested no significant publication bias.</p><p><strong>Conclusions: </strong>Hyponatremia on admission is associated with increased in-hospital mortality in acute stroke, particularly in ischemic stroke. Early identification and management of hyponatremia may have prognostic and therapeutic relevance in acute stroke care.</p><p><strong>Systematic review registration: </strong>PROSPERO: CRD420251110001.</p>","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"5 ","pages":"1816483"},"PeriodicalIF":1.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140098","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}