3,871 results match your criteria: "Lacunar Syndromes"

Background: About 25% of patients with acute ischemic stroke have lacunar infarct on follow-up imaging. In this secondary analysis from the AcT (Alteplase Compared With Tenecteplase) trial, we assessed if there is variation in safety or efficacy of intravenous thrombolysis by infarct type in patients with no visible occlusion. We also determined if this effect differed between tenecteplase and alteplase.

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Introduction: Intracranial large artery atherosclerosis (ICAS) is a common cause of stroke in Asia. Prior epidemiological publications on ICAS have largely been single-country reports. This collaborative study involving several Asian countries aims to investigate the characteristics and outcomes of patients with stroke attributable to ICAS.

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Clinical and Biomarker Determinants for Recurrent Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Neurology

January 2025

From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (Y.C., M.F., D.B., T.C., R.C., S.C., E.D., S.G., M.O.C., M.J.O.D., P.S., D.W., P.J.K., J.J.M.); Neurovascular Unit for Applied Translational and Therapeutics Research (Y.C., M.F., S.G., P.S., P.J.K., J.J.M.), Catherine McAuley Centre; School of Medicine (Y.C., M.F., T.C., S.G., P.S., P.J.K., J.J.M.), University College Dublin; Stroke Service (Y.C., M.F., S.G., P.S., J.J.M.), Department of Geriatric Medicine, Mater Misericordiae University Hospital; School of Medicine (D.B., R.C.), Trinity College Dublin; Department of Neurology (D.B.), St James Hospital; Department of Geriatric Medicine (T.C.), St Vincent's University Hospital; Stroke Service (R.C.), Department of Geriatric Medicine, Tallaght University Hospital, Dublin; Department of Neurology (S.C.), Cork University Hospital; Clinical Neurosciences (S.C.), School of Medicine, University College Cork; Stroke Service (E.D.), Department of Geriatric Medicine, James Connolly Memorial Hospital, Dublin, Ireland; Department of Clinical Neurosciences (K.K., I.I.), University of Cambridge, Addenbrooke's Hospital, United Kingdom; Department of Neurology & Stroke Centre (M.K., A.Z.), University Hospital Basel, Switzerland; Department of Geriatric Medicine (M.O.C.), Limerick University Hospital; College of Medicine (M.J.O.D.), Nursing and Health Sciences, University of Galway and University Hospital Galway; Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences; Department of Geriatric Medicine (D.W.), and Department of Geriatric and Stroke Medicine (D.W.), Beaumont Hospital; and Stroke Service (P.J.K.), Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.

Background And Objectives: Despite effective secondary prevention, including oral anticoagulant (OAC) therapy, the risk of recurrent stroke (RS) in patients with atrial fibrillation (AF) remains substantial with an annualized risk of 3.2%-6.5% per year.

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Article Synopsis
  • Cerebral small vessel disease (cSVD) is linked to serious conditions like lacunar stroke and vascular dementia, but there's limited research on how managing traditional cardiovascular risk factors can specifically reduce stroke risk in cSVD.
  • This study used Mendelian randomization to explore genetic factors associated with various cardiovascular risk factors and how they relate to cSVD and lacunar stroke, examining data from large genetic studies.
  • Findings indicated that higher blood pressure and factors like diabetes, obesity, and smoking are linked to increased cSVD risk, while higher HDL levels and regular vigorous activity showed protective effects; blood pressure-lowering medications like calcium channel blockers were also found potentially beneficial.
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Circulating miRNAs Associated With 3-Month Outcome in Patients With Acute Ischemic Stroke.

Neurology

January 2025

From the Neurovascular Research Group (I.F.-P., M.V.-P., L.R.-Á., E.G.S., A.O., E.C.-G., A.R.-C., A.S.-P., A.M.-G., J.J.-B., J.J.-C.), Hospital del Mar Research Institute; Neurology Department (I.F.-P., E.G.S., A.O., E.C.-G., A.R.-C., A.S.-P., A.M.-G., J.J.-C.), Hospital Del Mar; Faculty of Medicine and Life Sciences (E.G.S., A.O., E.C.-G., A.R.-C., J.J.-C.), Universitat Pompeu Fabra, Barcelona, Spain; Department of Psychiatry (C.S.-T.), Washington University School of Medicine, St. Louis, MO; Department of Neurology (F.F.P.), Arnau de Vilanova Hospital, Lleida; Clinical Neurosciences Group (F.F.P., G.A.), Biomedical Research Institute of Lleida, University of Lleida; Neurobiology Laboratory (S.T., G.C., C.V.-B.), Neurology Department, Son Espases University Hospital, Health Research Institute of Balearic Islands; Department of Biology (G.C., C.V.-B.), Universitat de les Illes Balears, Palma de Mallorca; Department of Neurology (T.S.), and Research Unit (G.S.-H.), Albacete University Hospital Complex; and Center for Cooperative Research in Biosciences (U.L.), Basque Research and Technology Alliance, Bizkaia Technology Park, Derio, Spain.

Background And Objectives: Post-ischemic stroke (IS) outcomes vary widely among individuals, independently of clinical factors. This variability could be related to epigenetic mechanisms that regulate biological processes involved in recovery after ischemia. While several microRNAs (miRNAs) and their target genes are implicated in the pathophysiology of IS, their role in functional outcomes remains unclear.

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Introduction: To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging.

Material And Method: We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography.

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Circulating inflammatory cytokines and the risk of cerebral small vessel disease: a bidirectional Mendelian randomization analysis.

J Stroke Cerebrovasc Dis

December 2024

Translational Pharmaceutical Laboratory, Jining NO.1 People's Hospital, Shandong First Medical University, Jining 272000, Shandong, China; Institute of Translational Pharmacy, Jining Medical Research Academy, Jining 272000, Shandong, China. Electronic address:

Background: A correlation between inflammation and cerebral small vessel disease (CSVD) has been hypothesized by earlier observational research, while this correlation has not been well established. Considering the significant clinical value of this causality determination, Mendelian randomization (MR) was implemented to investigate the causality between inflammatory cytokines and CSVD radiological lesions.

Methods: Using the publicly available Genome-Wide Association Study (GWAS) datasets, a bidirectional two-sample MR analysis was employed to infer causality between 91 inflammatory cytokines and CSVD phenotypes [white matter hyperintensity (WHM), fractional anisotropy (FA), mean diffusivity (MD), cerebral microbleeds (CMBs), and lacunar stroke].

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Hypertension is the most important risk factor for stroke. For both primary and secondary stroke prevention, the target blood pressure level is 130/80 mmHg in the current guidelines. Intensive blood pressure lowering is useful for the prevention of intracerebral hemorrhage; therefore, blood pressure control of<120/80 mmHg would be beneficial for patients at a high risk of hemorrhagic stroke, including those with factors such as a history of intracerebral hemorrhage, use of more than two antithrombotic drugs, and the presence of more than two cerebral microbleeds.

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Lifestyle-related diseases are also associated with stroke incidence. Among these, hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome have significant impacts on stroke. Hypertension is the greatest risk factor for stroke among lifestyle-related diseases.

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Cerebral hypoperfusion reduces tau accumulation.

Ann Clin Transl Neurol

December 2024

Department of Aging Neurobiology, Center for Development of Advanced Medicine for Dementia, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan.

Objective: Alzheimer's disease (AD) often coexists with cerebrovascular diseases. However, the impact of cerebrovascular diseases such as stroke on AD pathology remains poorly understood.

Methods: This study examines the correlation between cerebrovascular diseases and AD pathology.

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Background: Acute coronary syndrome (ACS) presents with a variable prognosis, posing significant public health challenges. This study investigated the potential link between cerebral small vessel disease (CSVD) burden and outcomes in patients with ACS.

Methods: In this retrospective cohort study, ACS patients admitted to Beijing Friendship Hospital, Capital Medical University, Beijing, China from January 2020 to October 2021, were analyzed.

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Obesity with low bone mineral density is a risk for cerebral small-vessel disease in older adults: The Bunkyo Health Study.

Obes Res Clin Pract

December 2024

Department of Metabolism & Endocrinology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Sportology Center, Juntendo University Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

Article Synopsis
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: Perivascular spaces (PVS) are usually enlarged in small vessel disease (SVD). However, the significance of PVS patterns in different locations is uncertain. Hence, we analyzed the distribution of PVS in patients with a recent small subcortical infarct (RSSI) and their correlation with clinical and imaging factors.

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Outcome prediction comparison of ischaemic areas' radiomics in acute anterior circulation non-lacunar infarction.

Brain Commun

November 2024

Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.

The outcome prediction of acute anterior circulation non-lacunar infarction (AACNLI) is important for the precise clinical treatment of this disease. However, the accuracy of prognosis prediction is still limited. This study aims to develop and compare machine learning models based on MRI radiomics of multiple ischaemic-related areas for prognostic prediction in AACNLI.

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MRI-Proven Incident Ischemia: A New Marker of Disease Progression in Small Vessel Diseases.

Stroke

January 2025

Department of Neurology and FHU NeuroVasc (L.G., A. Dimitrovic, E.J.), Assistance Publique Hôpitaux de Paris (APHP), Lariboisière Hospital, Paris, France.

Article Synopsis
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Article Synopsis
  • The study investigates the role of SUR1, encoded by the ABCC8 gene, in ischemic strokes and its association with cerebral edema and functional outcomes.
  • Researchers analyzed data from 2,205 patients with acute non-lacunar ischemic strokes, focusing on four specific genetic variants (SNPs) of the ABCC8 gene.
  • The findings revealed no significant link between these SNPs and stroke infarct size or 3-month functional outcomes, suggesting the need for more thorough investigations with improved imaging and outcome assessments.
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Malignant hypertension (MHT) crisis triggers widespread microvascular damage, particularly in the brain. Despite recent MRI evidence highlighting acute cerebral injuries during MHT crises, follow-up data remain scarce. This study seeks to fill this gap by exploring how brain MRI markers evolve following acute MHT crisis management.

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Article Synopsis
  • This study investigates the link between enlarged perivascular spaces (EPVSs) observed in MRI scans and cognitive impairment shortly after an acute ischemic stroke (AIS) in a Chinese population, aiming to provide early indicators for clinicians.
  • Researchers analyzed clinical data from 208 patients using cognitive assessment tests (MoCA-BJ and MMSE) and found that factors like age, education, and the severity of EPVSs in specific brain areas correlated with increased cognitive impairment in AIS patients.
  • While EPVS severity and location are associated with cognitive issues such as attention and orientation, multivariate analysis did not classify EPVSs as a primary risk factor for early cognitive impairment after an AIS.
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Article Synopsis
  • Small-vessel occlusion, or small subcortical infarctions (SSIs), are responsible for about one-third of ischemic strokes and can be challenging to distinguish from other conditions based on size alone.
  • This study analyzed data from patients with acute SSIs to explore the relationship between infarct size and outcomes, particularly focusing on early neurological deterioration (END) and functional recovery.
  • Findings indicated that larger infarct sizes (15 mm or larger) were linked to a higher risk of END, with significant predictive thresholds identified, highlighting the importance of infarct size in assessing patient outcomes.
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Prevalence and Clinical Implications of Hemosiderin Deposits in Recent Small Subcortical Infarcts.

Neurology

November 2024

From the China National Clinical Research Center for Neurological Diseases (Y.-Y.X.), Beijing Tiantan Hospital, Capital Medical University; Centre for Clinical Brain Sciences (F.M.C., M.D.C.V.H., C.A.-R., U.C., D.J.G., S.W., M.S.S., M.T., A.C.C.J., F.D., J.M.W.), UK Dementia Research Institute, University of Edinburgh, United Kingdom; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu; Department of Neurology & Institute of Neurology (J.Z.), Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine; and Division of Neurology (X.L.), Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, China.

Article Synopsis
  • A significant portion of ischemic strokes are classified as lacunar subtypes, often characterized by recent small subcortical infarcts (RSSIs), but the long-term effects of these conditions are not well understood.
  • In a study involving 108 participants, hemosiderin deposits (HDs) were found in over half of them within 3 months, and in about 77% within 12 months, with a notable "rim" pattern suggesting they could resemble primary hemorrhage.
  • The study highlighted that the volume of the infarct and a higher total small vessel disease (SVD) score are predictive of the presence of HDs, emphasizing the importance of not misinterpreting these deposits as signs of bleeding in chronic
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Article Synopsis
  • - The COVID-19 pandemic significantly impacted stroke care, leading to a 24.75% decrease in average hospital occupancy rates and a notable drop in ischemic stroke admissions, especially for mild cases.
  • - Mechanical thrombectomy procedures increased by 5.4%, while intravenous thrombolysis decreased by 2.8%, particularly among severe stroke patients, indicating a shift in treatment approaches during the pandemic.
  • - The study highlights the importance of addressing the decline in stroke diagnoses and treatments during health emergencies, emphasizing the need for further research to understand these trends better.
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This case report discusses the diagnostic challenges posed by transient ischaemic attacks (TIAs) and minor strokes presenting with atypical symptoms, focusing on a 62-year-old male presenting with isolated speech difficulties reminiscent of Broca's aphasia. Despite initial inconclusive imaging, subsequent evaluation revealed minor periventricular changes consistent with ischaemic small vessel disease and a pre-existing lacunar infarct. The resolution of symptoms within 10 days highlights the transient nature of the event.

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CT Perfusion imaging as prognostic factor for outcome of lacunar stroke.

Neuroradiology

December 2024

Department of Neurology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Shmuel Bait 12, Jerusalem, 9103102, Israel.

Background: Early neurological deterioration (END) affects 20-30% of patients with lacunar stroke within 48 h despite optimal treatment. Previously established markers included infection and infarct location on imaging. We studied the utility of measuring global cerebral blood flow (gCBF) measured by CT-Perfusion (CTP) as an early predictor of END in patients with lacunar strokes.

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Introduction: Lacunar stroke (LS) subtype accounts for a quarter of ischemic strokes. Intravenous thrombolysis (IVT) is known to improve overall stroke outcomes. Very few studies have focused on the outcome of IVT in lacunar strokes.

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