Neurological research and practice最新文献

{"title":"Association of high-density lipoprotein cholesterol with reduced intracranial haemorrhage and favourable functional outcome after thrombectomy for ischaemic stroke: a propensity-matched analysis.","authors":"Annahita Sedghi, Sonja Schreckenbauer, Daniel P O Kaiser, Ani Cuberi, Witold H Polanski, Martin Arndt, Kristian Barlinn, Volker Puetz, Timo Siepmann","doi":"10.1186/s42466-025-00373-4","DOIUrl":"10.1186/s42466-025-00373-4","url":null,"abstract":"<p><strong>Background: </strong>Animal studies suggest that high-density lipoprotein cholesterol (HDL-C) attenuates reperfusion injury. We aimed to assess whether higher serum HDL-C levels modulate the risk of intracranial haemorrhage (ICH) after thrombectomy in human stroke survivors.</p><p><strong>Methods: </strong>We included consecutive patients from our prospective anterior circulation large vessel occlusion (acLVO) registry who underwent thrombectomy between 01/2017 and 01/2023 at the tertiary stroke centre of the University Hospital Carl Gustav Carus in Dresden, Germany in a propensity score-matched analysis. We assessed the association between serum HDL-C levels and post-interventional ICH as well as 90-day functional outcome quantified by the modified Rankin Scale (mRS). For sensitivity analysis, we used multivariable lasso logistic regression. Analyses were adjusted for demographics, cardiovascular risk profiles, stroke characteristics, and procedural times.</p><p><strong>Results: </strong>Of 1702 patients screened, 807 (420 women, median age 77 years [66-84, IQR]) were included. Post-interventional ICH reduced the probability of a favourable functional outcome (90-day mRS 0-2) by 14.8% (ß = 0.15; 95% CI [0.06;0.24]; p = 0.001. An HDL-C level above the median (1.15 mmol/L) decreased the probability of ICH by 13.6% (ß = - 0.14; 95CI% [- 0.22; - 0.05]; p = 0.002) and increased the probability of favourable functional outcome by 13.2% (ß = - 0.13; 95CI% [- 0.22; - 0.05]; p = 0.003). In sensitivity analyses, higher HDL-C levels were independently associated with lower odds of ICH (adjusted OR 0.62; 95% CI [0.43;0.88]; p = 0.008) and higher odds of favourable functional outcome (adjusted OR 0.60; 95% CI [0.40; 0.90]; p = 0.015).</p><p><strong>Conclusions: </strong>In patients undergoing thrombectomy for acLVO, higher HDL-C levels were associated with a reduced probability of post-interventional ICH and a favourable functional outcome. These observations could not be explained by conventional vascular risk profiles.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589023","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":"Chronic Candida albicans meningoencephalitis in a patient with mantle cell lymphoma: a diagnostic challenge.","authors":"Johannes L Busch, Justus Schikora, Lisa-Marie Wackernagel, Jawed Nawabi, Matthias Endres, Klemens Ruprecht","doi":"10.1186/s42466-025-00375-2","DOIUrl":"10.1186/s42466-025-00375-2","url":null,"abstract":"<p><p>Due to its unspecific clinical presentation and the multitude of possible etiologies, chronic meningoencephalitis in immunosuppressed patients often represents a diagnostic challenge. Here, we report the clinical, radiological, cerebrospinal fluid, and microbiological findings of a 54-year-old male immunocompromised patient with mantle cell lymphoma and a 2-month history of brainstem and spinal meningoencephalitis. After unsuccessful treatment trials with antibiotics, a Candida albicans infection was confirmed by biopsy of a spinal cord lesion and large-volume cerebrospinal fluid culture. Therapy with liposomal amphotericin B/flucytosine and subsequent fluconazole resulted in significant clinical improvement. This case illustrates the importance of identifying the underlying cause of chronic meningoencephalitides in immunocompromised patients.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538274","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":"Ghrelin promotes neurologic recovery and neurogenesis in the chronic phase after experimental stroke.","authors":"Carolin Beuker, Ulrike Schreiner, Jan-Kolja Strecker, Elena Altach, Verena Rätzel, Antje Schmidt-Pogoda, Heinz Wiendl, Jens Minnerup, Kai Diederich","doi":"10.1186/s42466-025-00371-6","DOIUrl":"10.1186/s42466-025-00371-6","url":null,"abstract":"<p><strong>Background: </strong>The neuroprotective and proangiogenic potential of ghrelin in acute ischemic stroke has been demonstrated in experimental studies. However, the transferability of these results is limited as ghrelin was administered either before or very early after stroke onset and follow-up was limited to the first days after stroke. The aim of this study was therefore to close and extend this knowledge gap. To this end, we investigated the effect of ghrelin in two different translational animal models, one investigating acute and one investigating long-term structural and functional recovery after experimental stroke.</p><p><strong>Methods: </strong>Middle cerebral artery occlusion (MCAO) or photothrombotic stroke was induced in 65 adult male Wistar rats. Eleven sham-operated animals served as controls. The rats were treated with either ghrelin, the ghrelin receptor antagonist [D-Lys]-GHRP-6 or a control substance. Up to four weeks after ischemia, behavioral tests such as the cylinder test, the tape removal test, and the rotarod test were performed to examine sensorimotor deficits, and the Morris water maze was performed to examine effects on the acquisition and consolidation of new memories. The structural outcome was determined by a differential analysis of neurogenesis in relation to survival and proliferation of newborn neurons in the post-ischemic brain, angiogenesis and determination of infarct size.</p><p><strong>Results: </strong>Ghrelin treatment improved motor and somatosensory functions and preserved the consolidation of new memories after photothrombotic stroke. As a structural correlate, long-term survival and sustained proliferation of neuronal cells after stroke was significantly increased in ghrelin-treated rats, while angiogenesis remained unaffected. In contrast to these neuroregenerative mechanisms, ghrelin did not induce immediate neuroprotective effects after MCAO.</p><p><strong>Conclusions: </strong>Our results suggest that ghrelin has a significant pro-neuroregenerative effect by enhancing long-term survival and sustained proliferation of neurons in the dentate gyrus and peri-infarct area, thus promoting functional recovery. Overall, ghrelin represents a promising target in the subacute and chronic phase after ischemic stroke.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538275","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":"Mind the guideline gap: emergent CT in patients with epilepsy for trauma rule-out-A retrospective cohort study.","authors":"Kristina Szabo, Udo Obertacke, Vesile Sandikci, Sarah Ghanayem, Angelika Alonso, Johann S Rink, Annika Marzina, Michael Platten, Carolin Hoyer","doi":"10.1186/s42466-025-00370-7","DOIUrl":"10.1186/s42466-025-00370-7","url":null,"abstract":"<p><strong>Background: </strong>Patients with epileptic seizures represent a significant proportion of emergency department (ED) admissions and are often referred for cranial imaging due to suspected or observed trauma. Neurological guidelines provide limited advice on indications for imaging in this scenario, and traumatological clinical decision rules on the use of CT in mild traumatic brain injury explicitly exclude patients with seizures preceding the trauma. This gap in recommendations may contribute to overimaging for trauma rule-out after a seizure.</p><p><strong>Methods: </strong>We analysed medical records of patients with known epilepsy admitted to our ED after a seizure between January 2022 and March 2024. Using clinical data including the findings from cranial CT and risk factors for traumatic brain injury, we re-assessed the need for CT imaging by application of the Canadian CT head rule (CCHR) or in the context of head trauma under anticoagulation.</p><p><strong>Results: </strong>During the observational period, 683 patients with known epilepsy were referred to our hospital due to a seizure (mean age 48.8 years, 57.7% male). A head CT scan was obtained in 337 (49.3%) of all encounters. In only two patients, CT diagnosed an acute seizure-related traumatic lesion, one focal subarachnoid haemorrhage and one skull base fracture. Twenty-six cases (3.8%) with seizure-related trauma were reassessed as requiring a CT for trauma-related injury evaluation. Particularly in the absence of head impact or risk factors, a high degree of variability regarding CT ordering practice was observed.</p><p><strong>Conclusions: </strong>Our results demonstrate frequent use and low diagnostic yield of CT in ED seizure patients with respect to trauma-related head injury. Circumstantial factors, clinical signs or symptoms and medical risk factors variedly impact on clinicians' decision to perform imaging. The absence of clear recommendations regarding imaging for trauma apparently provokes frequent diagnostic rule-out even in patients with low risk for traumatic brain injury. We suggest an approach to identify patients not requiring a head CT by considering the CCHR, presence of anticoagulation and appreciating the postictal state as a feature specific to patients with seizures.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485151","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":"Impact of the COVID-19 pandemic on brain death detection in German hospitals: a state-wide analysis of health data.","authors":"Daniela Schoene, Martin Roessler, Katharina Eder, Albrecht Günther, Konrad Pleul, Axel Rahmel, Kristian Barlinn","doi":"10.1186/s42466-025-00368-1","DOIUrl":"10.1186/s42466-025-00368-1","url":null,"abstract":"<p><strong>Background: </strong>The low rate of organ donation in Germany has been linked to a deficit in the detection of patients with brain death (BD) in hospitals. It is unclear how crisis-related health system disruptions, such as the COVID-19 pandemic, affect this detection deficit.</p><p><strong>Methods: </strong>Secondary data analysis of anonymized data from deceased patients with acute brain injury from Saxony, Saxony-Anhalt and Thuringia during the pre-pandemic and pandemic period (01/2019-12/2022). Pandemic phases were stratified according to the predominant SARS-CoV-2 variant. Logistic multilevel models were employed to assess outcomes including diagnosis of BD, deceased organ donations, missed cases with potential BD and organ donation-related interactions with the German Organ procurement organization. Models accounted for regional COVID-19 incidence and first-dose vaccination rates, as well as age, gender and types of brain injuries.</p><p><strong>Results: </strong>A total of 11,100 deceased individuals from 136 hospitals were analyzed. An inverse association was observed between COVID-19 incidence and the determination of BD (adjusted odds ratio [aOR] 0.94, 95%CI [0.91; 0.97]; p < 0.001) as well as deceased organ donation (aOR 0.94, 95%CI [0.90; 0.98]; p = 0.001). When stratified by pandemic phases, this inverse association was evident for both BD determination (aOR 0.92, 95%CI [0.87; 0.99]; p = 0.02) and deceased organ donation (aOR 0.90, 95%CI [0.83; 0.97]; p = 0.01) during the initial wild-type phase. In the alpha phase, the association was observed only for BD determination (aOR 0.76, 95%CI [0.59; 0.98]; p = 0.03). No association was found in subsequent pandemic phases.</p><p><strong>Conclusion: </strong>The initial impact on BD detection during the pandemic highlights the importance of the health system's adaptive capacity in times of crisis.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485059","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":"No disadvantages for women in acute stroke care in Germany: an analysis of access to stroke treatment services in Germany from 2017 to 2022.","authors":"Matthias N Ungerer, Dirk Bartig, Christine Tunkl, Daniel Richter, Aristeidis Katsanos, Christos Krogias, Werner Hacke, Christoph Gumbinger","doi":"10.1186/s42466-025-00365-4","DOIUrl":"10.1186/s42466-025-00365-4","url":null,"abstract":"<p><strong>Background: </strong>Several publications have raised concerns that female stroke patients may be at a disadvantage when accessing stroke treatment services. These publications have found significant regional differences in the provision of stroke treatment to male and female patients. In this study, we provide current nationwide data on stroke management differences between men and women in Germany.</p><p><strong>Methods: </strong>This large retrospective cohort study used national datasets from the German Federal Statistical Office for 2017-2022. We examined differences between female and male stroke patients in terms of case volume, intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), stroke unit (SU) treatment, intrahospital mortality, and prevalence of atrial fibrillation (AF).</p><p><strong>Results: </strong>Data from more than 1.3 million hospitalised stroke patients were included. Forty-seven percent of the patients were female. Female patients were older and more frequently ≥ 80 years old (50.3% versus 29.4%). Rates of IVT (16.3% versus 16.3%) were similar for both sexes but higher in females when adjusted for age. MTE rates (8.2% versus 6.3%) were consistently higher in female patients across all age groups. Female patients had higher rates of intrahospital mortality (9.1% versus 6.2%), and admission to SUs (73.6% versus 76.0%) was less common. Treatment rates in intensive care units were similar (10.6% versus 10.5%). AF, a surrogate for embolic (and more severe) strokes, was more prevalent in females (32.6% versus 25.4%).</p><p><strong>Conclusions: </strong>We found no evidence that female stroke patients in Germany face any disadvantage in accessing stroke treatment services. Acute stroke treatment rates were generally similar or higher when compared to males. Higher intrahospital mortality and lower SU rates were attributed to greater age, comorbidities, and stroke severity. However, the differences were not fully explained when adjusting for AF and age. Further research is needed on sex differences in stroke mechanisms and outcomes.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461113","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":"AI and Neurology.","authors":"Julian Bösel, Rohan Mathur, Lin Cheng, Marianna S Varelas, Markus A Hobert, José I Suarez","doi":"10.1186/s42466-025-00367-2","DOIUrl":"10.1186/s42466-025-00367-2","url":null,"abstract":"<p><strong>Background: </strong>Artificial Intelligence is influencing medicine on all levels. Neurology, one of the most complex and progressive medical disciplines, is no exception. No longer limited to neuroimaging, where data-driven approaches were initiated, machine and deep learning methodologies are taking neurologic diagnostics, prognostication, predictions, decision making and even therapy to very promising potentials.</p><p><strong>Main body: </strong>In this review, the basic principles of different types of Artificial Intelligence and the options to apply them to neurology are summarized. Examples of noteworthy studies on such applications are presented from the fields of acute and intensive care neurology, stroke, epilepsy, and movement disorders. Finally, these potentials are matched with risks and challenges jeopardizing ethics, safety and equality, that need to be heeded by neurologists welcoming Artificial Intelligence to their field of expertise.</p><p><strong>Conclusion: </strong>Artificial intelligence is and will be changing neurology. Studies need to be taken to the prospective level and algorithms undergo federated learning to reach generalizability. Neurologists need to master not only the benefits but also the risks in safety, ethics and equity of such data-driven form of medicine.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434642","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":"Neurological Research and Practice - the premier journal of the German Society of Neurology: recent development and future perspectives.","authors":"Werner Hacke, Wolf-Rüdiger Schäbitz","doi":"10.1186/s42466-025-00372-5","DOIUrl":"10.1186/s42466-025-00372-5","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426890","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":"Severe subacute combined degeneration of the spinal cord resulting from nitrous oxide (N2O) abuse: a case series.","authors":"Lucas C Adam, Anuschka Grobelny, Katrin Hahn, Heinrich J Audebert, Patricia Krause, Christiana Franke, Klemens Ruprecht","doi":"10.1186/s42466-024-00364-x","DOIUrl":"10.1186/s42466-024-00364-x","url":null,"abstract":"<p><strong>Objective: </strong>To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD).</p><p><strong>Methods: </strong>Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024.</p><p><strong>Results: </strong>The median age (range) of the seven patients (one woman, six men) was 24 (18-33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160-9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0-4.0) at baseline to 1.0 (1.0-2.0; p < 0.05, Wilcoxon matched-pairs signed-rank test) at follow-up after the start of vitamin B12 supplementation, all five patients who could be examined on follow-up exhibited persistent deficits on the last follow-up assessment at a median (range) of 5 (3-116) months after disease onset.</p><p><strong>Conclusions: </strong>N2O abuse over a few weeks can lead to severe SACD. The diagnosis is supported by characteristic findings on spinal MRI and elevated methylmalonic acid levels, while normal vitamin B12 levels do not rule out N2O-induced SACD. Although there was some clinical improvement upon cessation of N2O abuse and vitamin B12 supplementation, residual deficits persisted.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412184","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 oral anticoagulants with risk of brain haemorrhage expansion compared to no-anticoagulation.","authors":"Roland Veltkamp, Kirsten Haas, Viktoria Rücker, Uwe Malzahn, Adrian Heeger, David Kinzler, Patrick Müller, Pascal Rappard, Timolaos Rizos, Johannes Schiefer, Christian Opherk, Waltraud Pfeilschifter, Katharina Althaus, Peter Schellinger, Bernadette Gaida, Maria Magdalena Gabriel, Georg Royl, Darius G Nabavi, Karl Georg Haeusler, Christian H Nolte, Marc E Wolf, Sven Poli, Marilen Sieber, Pascal Mosimann, Peter U Heuschmann, Jan C Purrucker","doi":"10.1186/s42466-024-00358-9","DOIUrl":"10.1186/s42466-024-00358-9","url":null,"abstract":"<p><strong>Background: </strong>The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.</p><p><strong>Methods: </strong>The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.</p><p><strong>Results: </strong>Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.</p><p><strong>Conclusion: </strong>Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401113","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}