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        <title>Frontiers in Stroke | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/stroke</link>
        <description>RSS Feed for Frontiers in Stroke | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-04-17T07:41:02.549+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1755828</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1755828</link>
        <title><![CDATA[Collateral status predicts functional outcome in early-treated large-core anterior circulation stroke]]></title>
        <pubdate>2026-04-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Andrés Gallardo</author><author>Pablo M. Lavados</author><author>Pablo Albiña-Palmarola</author><author>Gabriel Cavada</author><author>Andrés Roldán</author><author>Verónica V. Olavarría</author>
        <description><![CDATA[Background and purposeEndovascular therapy (EVT) is increasingly offered to patients with large-core acute ischemic stroke (AIS), yet outcomes remain highly heterogeneous. Collateral circulation may be a key determinant of infarct evolution and recovery, but its role in early-window large-core stroke is not fully defined.MethodsWe retrospectively analyzed consecutive adults from a prospective stroke registry who presented within 6 h with anterior-circulation large-vessel occlusion, NIHSS ≥6, and a large ischemic core (MRI core >50 mL or CT perfusion core >70 mL, up to 150 mL). All patients received reperfusion therapy (intravenous thrombolysis, EVT, or both). Collateral status on baseline single-phase CTA was graded using the Tan scale (0–3); no patients had grade 3. The primary outcome was 90-day modified Rankin Scale (mRS); secondary outcome was NIHSS at discharge.ResultsFifty-four patients met inclusion criteria (Tan 0: n = 24; Tan 1: n = 14; Tan 2: n = 16). Baseline NIHSS, ASPECTS, and core volume were similar across groups. Patients without collaterals (Tan 0) had worse 90-day outcomes (median mRS 4 [IQR 3–6]) compared with those with Tan 1 (2 [IQR 1–3]) or Tan 2 (1 [IQR 1–2]) collaterals (both p < 0.001), whereas Tan 1 and Tan 2 did not differ significantly (p = 0.27). NIHSS at discharge showed a similar gradient. In proportional-odds logistic regression, each one-grade increase in collateral status was associated with lower odds of worse 90-day mRS (adjusted per-grade OR 0.32; 95% CI 0.15–0.68; p = 0.003).ConclusionIn early-treated large-core AIS, even simple CTA-based collateral assessment strongly predicts recovery. Patients with absent collaterals follow a distinctly poorer trajectory, while those with any collateral filling behave more favorably. Incorporating collateral status into routine evaluation may improve prognostic accuracy and support treatment decisions in this challenging subgroup.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1805422</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1805422</link>
        <title><![CDATA[Comparison of primary and secondary stroke outcomes between government and private healthcare institutions: insights from the SPRINT India trial]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Shweta Jain Verma</author><author>Bhavya Nanda</author><author>Paramdeep Kaur</author><author>Arya Devi K. S.</author><author>Deepti Arora</author><author>Aneesh Dhasan</author><author>P. N. Sylaja</author><author>Dheeraj Khurana</author><author>Vijaya Pamidimukkala</author><author>Biman Kanti Ray</author><author>Vivek Nambiar</author><author>Sanjith Aaron</author><author>Gaurav Mittal</author><author>Aparna R. Pai</author><author>Sankar Prasad Gorthi</author><author>Somasundaram Kumaravelu</author><author>Yerasu Muralidhar Reddy</author><author>Sunil Narayan</author><author>Nomal Chandra Borah</author><author>Rupjyoti Das</author><author>Girish Baburao Kulkarni</author><author>Vikram Huded</author><author>Thomas Mathew</author><author>Rohit Bhatia</author><author>Pawan Kumar Ojha</author><author>Jayanta Roy</author><author>Anand Girish Vaishnav</author><author>Arvind Sharma</author><author>Abhishek Pathak</author><author>Sanjeev Kumar Bhoi</author><author>Sudhir Sharma</author><author>Sulena Sulena</author><author>Aralikatte Onkarappa Saroja</author><author>Neetu Ramrakhiani</author><author>Madhusudhan Byadarahalli Kempegowda</author><author>Mahesh Kate</author><author>Tina George</author><author>Ivy Sebastian</author><author>Meenakshi Sharma</author><author>Rupinder Dhaliwal</author><author>Jeyaraj D. Pandian</author>
        <description><![CDATA[IntroductionStroke recurrence and vascular events remain major contributors to post-stroke mortality in India, where care is delivered through heterogeneous government and private healthcare systems. This post-hoc analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals.MethodsSPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models.ResultsAmong 4,298 randomized patients, 3,038 completed 1-year follow-up (59.8% private; 40.2% government). There was no significant difference was observed in the composite primary outcome between private and government institutions (2.8 vs. 3.7%; p = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index.ConclusionsStroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context.Clinical trial registrationhttp://ctri.nic.in, identifier: CTRI/2017/09/009600.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1814085</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1814085</link>
        <title><![CDATA[Identifying wakeup stroke routine treatments in the emergency departments]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mehari Gebreyohanns</author><author>Sidarrth Prasad</author><author>Kim D. Barker</author><author>Joshua D. E. Amos</author><author>Erica M. Jones</author><author>Lindsay M. Riskey</author><author>Daiwai M. Olson</author><author>Asmiet K. Techan</author><author>Ty A. Johnson</author><author>Nneka L. Ifejika</author>
        <description><![CDATA[BackgroundThe term wake-up stroke refers to an acute ischemic stroke with an unknown time of onset, typically discovered when a patient awakens with symptoms. Wake-up strokes account for up to 25% of all acute ischemic strokes. There is limited understanding of how hospitals vary in their evaluation and treatment of these cases, and institutional protocols, imaging strategies, and therapeutic decision-making for wake-up stroke remain inconsistently defined.MethodsIn this prospective observational study, we surveyed hospitals in Texas and Louisiana to assess institutional approaches to wake-up stroke care including hospital characteristics, imaging protocols, treatment pathways, and decision-making criteria for acute ischemic stroke with unknown onset time.ResultsAmong 54 hospitals in Louisiana (29), and Texas (25), representing 48 unique zip codes, >80% followed a standardized institutional protocol when making decisions for wake-up strokes. Additionally, 75.5% of hospitals ordered MRIs for these cases in the acute setting.ConclusionA coordinated, systems-level approach to wake-up stroke care that integrates a standardized protocol may be valuable in promoting workflow processes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1751659</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1751659</link>
        <title><![CDATA[Study protocol for the Vivistim GRASP registry: capturing real-world outcomes of paired vagus nerve stimulation in the chronic stroke population]]></title>
        <pubdate>2026-03-31T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Shannon J. Doherty</author><author>Cecília N. Prudente</author><author>Reema Adham Hinds</author><author>David Pierce</author><author>Navzer D. Engineer</author><author>John Carrithers</author><author>Diana Hansen</author><author>W. Brent Tarver</author>
        <description><![CDATA[ObjectiveTo capture real-world use and outcomes from chronic stroke survivors with arm and hand impairment implanted with a paired vagus nerve stimulation (Paired VNS) device. The FDA-approved Vivistim Paired VNS System combines VNS with upper limb rehabilitation to reduce upper-extremity motor deficits and improve function in chronic stroke survivors.DesignObservational, postmarket patient registry collecting outcomes data from individuals who receive Vivistim for stroke recovery. Assessments will be conducted at baseline and at scheduled assessment timepoints over a period of up to 3 years.ParticipantsAdults aged 18 years or older with a history of stroke with moderate-to-severe upper limb deficits and clinically evaluated as appropriate candidates for Paired VNS Therapy.Outcome measuresMotor outcome assessments include the Fugl-Meyer Assessment-Upper Extremity, the Nine Hole Peg Test, and the Wolf Motor Function Test (optional). Patient-reported outcome assessments include a global quality of life questionnaire, Stroke Impact Scale, Motor Activity Log, and Beck Depression Inventory.ConclusionsThe registry is designed to provide real-world evidence on the use and outcomes of Paired VNS. These data will characterize functional changes, patient experiences, and therapy utilization in a heterogeneous chronic stroke population, supporting optimization and broader integration of Paired VNS into stroke recovery pathways.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05301140, identifier NCT05301140.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1780242</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1780242</link>
        <title><![CDATA[Implementing and sustaining 6-month post-stroke reviews: a complexity-informed, context-sensitive programme theory for clinical practice]]></title>
        <pubdate>2026-03-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rich Holmes</author><author>Suzanne Ackerley</author><author>Dawn Goodwin</author><author>Louise A. Connell</author>
        <description><![CDATA[IntroductionStroke is a leading cause of long-term disability. Six-month post-stroke reviews are recommended in multiple guidelines to identify the ongoing needs of stroke survivors and facilitate follow-up care. However, guidance on how to deliver these reviews optimally is limited. This study developed a complexity-informed, context-sensitive programme theory for the 6-month post-stroke review, clarifying its core components and producing actionable recommendations to guide implementation and sustainability across diverse contexts.MethodsThe programme theory was developed from empirically derived patterns identified in a multiple case study in England, based on data collected from interest-holder interviews, observations, and documentary analysis. Context-mechanism-outcome configurations were developed heuristically through a pragmatic approach. These informed the structure and content of the programme theory and logic model. A complexity theory lens facilitated identification of multi-level system dynamics, supporting applicability across diverse contexts. The model was iteratively refined by the research team and adjusted following validation feedback from international stroke rehabilitation experts and 6-month post-stroke review interest-holders.ResultsFourteen context-mechanism-outcome configurations informed 13 core components nested within four core domains of the 6-month review: Access & Inclusion; Identifying & Addressing Needs; Maintaining Quality; and System Integration. The real-world logic model illustrates how patient-, provider-, and service-level outcomes emerge from interactions between the 6-month review and the context in which it is delivered. The resulting actionable recommendations provide guidance for implementing and sustaining 6-month post-stroke reviews in clinical practice, including flexible delivery formats, person-centered tailoring, integration across services, and strategies to enhance quality and equity.ConclusionsThis study presents the first complexity-informed, context-sensitive programme theory for the 6-month post-stroke review. By translating empirically driven theory into actionable recommendations, it supports clinicians and service planners in delivering person-centered, contextually adaptable follow-up care. It also provides a foundation for future evaluation of post-stroke services internationally, enabling systematic testing of its hypothesized outcomes and adaptation across diverse healthcare settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1679668</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1679668</link>
        <title><![CDATA[Impact of left vs. right hemisphere stroke on driving: lateralized attention deficits and executive dysfunction linked to impaired driving]]></title>
        <pubdate>2026-03-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Krista Schendel</author><author>Isabella Santavicca</author><author>Timothy J. Herron</author><author>Sandy J. Lwi</author><author>Brian C. Curran</author><author>Jas M. Chok</author><author>Juliana Baldo</author>
        <description><![CDATA[IntroductionFor many people, driving is essential to quality of life because it facilitates social integration and community participation. Indeed, many stroke survivors return to driving within months post-stroke. Few studies, however, have specifically characterized post-stroke driving errors as a function of affected hemisphere (LH vs. RH) and cognitive impairment.MethodsThis study examined driving performance in LH and RH stroke survivors and age-matched controls using a fully interactive driving simulator.ResultsAnalysis revealed that the direction and severity of visuospatial attention deficits were significant predictors of post-stroke driving performance and executive dysfunction correlated with specific types of driving errors. Moreover, the cerebral hemisphere affected by stroke had a significant impact on lane positioning errors, with RH stroke survivors experiencing more difficulty maintaining lane position. In addition, a higher incidence of lane departures on the contralesional side of the lane was observed after stroke. Notably, neither age, months post-stroke, nor simple reaction time were reliably associated with scores or pass/fail ratings on the simulated driving assessment.DiscussionThis work highlights how LH and RH strokes differentially impact driving and suggests that driving assessment and rehabilitation efforts should consider both the direction and severity of visuospatial attention deficits as well as the degree of executive dysfunction in stroke survivors who wish to continue driving.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1738822</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1738822</link>
        <title><![CDATA[Neighborhood economic and demographic landscape as predictors of 90-day outcomes post-stroke hospitalization]]></title>
        <pubdate>2026-03-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Farya Fakoori</author><author>Karlon H. Johnson</author><author>Hannah Gardener</author><author>Carolina M. Gutierrez</author><author>Negar Asdaghi</author><author>Lauri Bishop</author><author>Scott C. Brown</author><author>Iszet Campo-Bustillo</author><author>Gillian Gordon Perue</author><author>Emir Veledar</author><author>Hao Ying</author><author>Lili Zhou</author><author>Jose G. Romano</author><author>Tatjana Rundek</author><author>Erika Marulanda</author>
        <description><![CDATA[ObjectiveAn in-depth exploration of neighborhood environmental impact on post-discharge stroke outcomes is lacking yet essential for identifying populations at high risk. We assess neighborhood economic and demographic characteristics associated with 90-day death or readmission post-stroke hospitalization.MethodsWe prospectively analyzed 1,329 acute stroke survivors in the Florida Stroke Registry's Transition of Care Stroke Disparities Study (91% ischemic, 56% male, 52% non-Hispanic White, 23% non-Hispanic Black, 22% Hispanic, median age 64). Neighborhood characteristics at the ZIP+4 level, including socioeconomic status (NSES), racial/ethnic composition, and business densities (food, tobacco/alcohol, gyms, medical services), were analyzed using factor analysis to generate four factors with eigenvalues greater than 1. Outcomes (death or readmission) were assessed through structured telephone interviews 90 days post-discharge. Logistic regression evaluated associations between neighborhood characteristics and outcomes, adjusting for demographics (race/ethnicity, sex, age), vascular risk factors, stroke severity from Get With The Guidelines-Stroke®, and social or economic conditions such as insurance, support, and living arrangements.ResultsWithin 90 days, 208 patients experienced death or readmission. Four factors explained 59% of the variance in 24 neighborhood characteristics. Factor 1, defined by lower NSES, higher population density, and urbanization (RUCA code 1, greater densities of tobacco/alcohol outlets, restaurants, grocery stores, gyms, and pharmacies), was associated with a 20% increased risk.ConclusionsLiving in densely populated, highly urbanized neighborhoods with lower SES and greater commercial density predicted poor stroke outcomes independent of individual health or SES. These findings can guide community interventions to reduce stroke mortality and readmission.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1731911</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1731911</link>
        <title><![CDATA[Relationships between arm and leg real-life activity and clinical assessments in individuals with disabling spasticity after stroke]]></title>
        <pubdate>2026-03-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sofi Andersson</author><author>Anna Danielsson</author><author>Katharina S. Sunnerhagen</author><author>Margit Alt Murphy</author>
        <description><![CDATA[BackgroundAccelerometer-based measures can provide valuable and objective information about arm and leg use in daily life. This information can be particularly useful in tailoring treatment and rehabilitation in people with disabling spasticity after stroke. To better understand clinical relevance of accelerometer-based measures, this study aimed to determine the strength of relationships between real-life arm and leg activity and a set of clinical assessments encompassing body function and activity domains.MethodsThirty-five individuals with disabling spasticity in the chronic stage of stroke (mean age 56.8 ± 8.9 years; 54% female) were included. Real-life activity was measured over 4 days using wrist- and ankle-worn accelerometers. Unilateral arm and leg activity as well as arm/leg ratio were derived from vector magnitude counts per minute. Associations between accelerometer-based measures and clinical assessments of motor function, spasticity, activity capacity, and self-perceived activity performance were analyzed using Spearman's rank-order correlation.ResultsAffected arm and leg real-life activity showed mostly moderate correlations with motor function and activity capacity assessments (ρ = 0.55–0.76), low correlations with spasticity assessments (ρ = −0.32 to −0.43) and high correlations with self-perceived manual and walking performance (ρ = 0.70–0.82). Arm activity ratio showed high correlations (ρ = 0.73–0.83) with motor function, activity capacity, and self-perceived performance. Real-life activity of the non-affected limbs demonstrated predominantly low correlations with clinical assessments.ConclusionAccelerometer-based real-life activity measures of the affected arm and leg, along with activity ratios, provide clinically valid information regarding motor function and activity in people with disabling spasticity. Self-reported activity performance questionnaires can be valid tools for clinical practice when accelerometer-based measurements are not readily available.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1684121</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1684121</link>
        <title><![CDATA[The APOE paradox: divergent genetic influences on hemorrhagic stroke risk—A meta-analysis]]></title>
        <pubdate>2026-03-04T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Manabesh Nath</author><author>Astha Rai</author><author>Shubham Misra</author><author>Pradeep Kumar</author>
        <description><![CDATA[BackgroundApolipoprotein E (APOE) regulates lipid metabolism and neuronal repair, yet its alleles show contrasting effects on hemorrhagic stroke (HS) risk. While some variants increase susceptibility, others appear protective, leading to inconsistent findings. This meta-analysis systematically evaluates the APOE-HS association to clarify its role in stroke pathophysiology.MethodsA comprehensive literature search was conducted across multiple databases up to January 31, 2025, using the keywords: (“Apolipoprotein E” OR “APOE” OR “APOE genotype”) AND (“Single Nucleotide Polymorphisms” OR “SNP”) AND (“Hemorrhagic stroke” OR “HS” OR “Intracerebral Hemorrhage” OR “ICH”). The APOE ε3/ε3 genotype served as the reference genotype in all studies, and only those studies with ε3/ε3 genotype were included in the analysis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and statistical analyses were performed using STATA version 13.0 (StataCorp LLC, College Station, Texas, United States).ResultsA total of 24 studies comprising 8,269 HS patients and 26,321 controls were included. Meta-analysis revealed a significant association of APOE ε2/ε2 (OR = 1.93, 95% CI = 1.32–2.81), ε4/ε4 (OR = 1.60, 95% CI = 1.21–2.13), ε2/ε4 (OR = 1.81, 95% CI = 1.34–2.44), ε2 (OR = 1.23, 95% CI = 1.12–1.35), and ε4 (OR = 1.31, 95% CI = 1.14–1.51) with an increased risk of HS.ConclusionOur findings suggest that APOE ε2/ε2, ε2/ε4, ε2, and ε4/ε4 genotypes and the ε4 allele are associated with an elevated risk of HS. These results highlight the potential role of APOE genotypes in HS susceptibility and warrant further investigation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1742758</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1742758</link>
        <title><![CDATA[Role of C-reactive protein and fibreoptic endoscopic evaluation of swallowing as early markers of stroke-associated pneumonia]]></title>
        <pubdate>2026-02-17T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Svetlana Politz Geleva</author><author>Ludwig D. Schelosky</author>
        <description><![CDATA[IntroductionStroke may result in dysphagia, which can subsequently lead to stroke-associated pneumonia (SaP). This condition has been shown to exert a significant negative impact on patient outcome. Early diagnosis and prevention are therefore desirable.MethodsThis retrospective study compared inflammatory markers during the first 4 days after stroke in 515 patients from 2015 and 2021, analyzing associations with dysphagia, year of treatment, dietary adjustments, stroke-associated pneumonia, and antibiotic use. Data entry and descriptive analyses were performed using Microsoft Excel®. Datasets from 2015 and 2021 were analyzed in SPSS® (IBM SPSS Statistics 27).ResultsThis retrospective analysis demonstrates that dysphagia significantly influences C-reactive protein (CRP) levels within the first 4 days after stroke. Dysphagia and elevated CRP are early markers of emergence of stroke-associated pneumonia, whereas leukocyte count and temperature show limited forewarning value. The combination of post-stroke inflammatory response, dysphagia (PAS > 5), and elevated CRP may serve as an early indicator of SaP and support timely FEES-based assessment.DiscussionEarly elevated CRP levels in dysphagic stroke patients are indicative of aspiration-related inflammation and may serve as a sensitive early biomarker for stroke-associated pneumonia. The combined assessment of dysphagia severity and CRP supports improved early risk stratification and preventive management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1751007</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1751007</link>
        <title><![CDATA[Is early thrombectomy of proximal middle cerebral artery occlusion to salvage internal capsule associated with improved clinical outcomes?]]></title>
        <pubdate>2026-02-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elochukwu Ibekwe</author><author>Robert Kassinger</author><author>Nicholas Mannix</author><author>Jing Peng</author><author>Archana Hinduja</author>
        <description><![CDATA[BackgroundEloquence of tissue rather than infarct volume is a better predictor of outcomes following proximal middle cerebral artery (MCA) occlusion. The aim of this study was to determine the impact of white matter tract involvement, specifically the internal capsule (IC), following occlusion of non-collateralized lenticulostriate arteries (LSAs) on functional outcomes.MethodsA retrospective observational single-center study of patients with proximal MCA occlusions in the period from 2015 to 2020 who were treated with mechanical thrombectomy and had post-interventional diffusion-weighted imaging was conducted. Patients were distributed based on the presence or absence of IC infarction (IC+ vs. IC−) at the level supplied by the MCA LSAs. Multivariate logistic or linear regression analysis was used to evaluate factors associated with the development of IC infarction.ResultsOf 368 patients with proximal MCA occlusion, 200 (55%) developed IC+ infarction. On univariate analysis, patients with IC+ infarction had higher baseline NIHSS (National Institute of Health Stroke Scale), lower ASPECTS (Alberta Stroke Program Early CT Score), lower collateral score, and were less likely to have partial reperfusion of LSA prior to thrombectomy. On multivariate analysis, those with higher baseline NIHSS, low ASPECTS, lack of successful reperfusion (TICI2b, 2c, 3), poor collateral circulation, and/or lack of partial perfusion of LSA prior to thrombectomy were likely to develop IC+ infarction. After adjusting for confounders, patients with IC+ infarction were less likely to experience early neurological improvement, more likely to develop hemorrhagic transformation of putamen, and had larger infarct volume. However, no significant correlation between IC+ infarction with poor 3-month functional outcome was observed.ConclusionDelayed recovery is possible despite IC+ infarction and hemorrhagic transformation of lenticulostriate territory. Larger studies are needed to confirm these findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1731953</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1731953</link>
        <title><![CDATA[Comprehensive immunological profiling of acute ischemic stroke during mechanical thrombectomy: myeloid cell activation and molecular signatures in blood and thrombus]]></title>
        <pubdate>2026-02-12T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Wirginia Krzyściak</author><author>Tadeusz Popiela</author>
        <description><![CDATA[BackgroundAcute ischemic stroke (AIS) induces a complex local and systemic inflammatory response; however, most studies rely solely on peripheral blood, providing an incomplete view of immune activity at the occlusion site and within the thrombus.ObjectiveTo characterize immune activation and transcriptomic signatures of myeloid cells across three compartments—arterial blood at the occlusion site, peripheral blood, and thrombus—and to evaluate their associations with radiological and clinical outcomes following mechanical thrombectomy.MethodsThis prospective, single-center study will include AIS patients treated with mechanical thrombectomy. Matched arterial, peripheral, and thrombus samples will undergo spectral flow cytometry, cytokine profiling, cell-free DNA (cfDNA) quantification, microscopy, and RNA sequencing. Immune and molecular readouts will be correlated with clinical scores (NIHSS, mRS), imaging markers (e.g., hyperdense middle cerebral artery sign [HMCAS]), and procedural outcomes (TICI score, number of passes).SignificanceIntegrating local and systemic immune profiles with clinical and radiological parameters may identify biomarkers predictive of thrombectomy efficacy and functional recovery, thereby supporting precision-medicine approaches in AIS.Clinical trial registrationwww.ClinicalTrials.gov]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1736530</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1736530</link>
        <title><![CDATA[Sex as a predictor and moderator of psychosocial determinants of cardiometabolic risks for Métis People in Canada]]></title>
        <pubdate>2026-02-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shara Johnson</author><author>Samantha Moore</author><author>Muqtasida Fatima</author><author>Adam McInnes</author><author>Heather Foulds</author>
        <description><![CDATA[IntroductionMétis People, one Indigenous group in Canada, have distinct culture, identity, and experiences. The determinants of Métis People's health, including stroke risk, may differ from other groups. This study examined relationships between psychosocial and lifestyle factors with cardiometabolic risk, a stroke risk indicator, and the moderating role of sex among Métis adults living in Saskatchewan, Canada.MethodsA community-based cross-sectional observation study was conducted with 70 Métis adults (39 ± 16 years; 66% female). Hierarchical multiple regression, moderated by sex, assessed psychosocial and lifestyle predictors of cardiometabolic risks (blood cholesterol, fasting glucose, glycosylated hemoglobin, blood pressure, and waist circumference).ResultsPsychosocial factors were significantly associated with cardiometabolic risk components. Psychological distress, adverse childhood experiences, age and sex explained 30% of the variance in average blood pressure, F (4, 65) = 6.997, p = 0.01. Well-being, discrimination experiences, age and sex significantly explained 27% of the variance in average blood pressure, F (4, 65) = 5.89, p = 0.04. Sex moderated relationships of wellbeing with glycosylated hemoglobin, F (6, 63) = 7.374, p = 0.02, R2 = 0.414, with age (β = −0.497, p < 0.01), wellbeing (β = 0.593, p = 0.01), and wellbeing × sex (β = −0.53, p = 0.01) being significant predictors. Psychological distress moderated by sex also predicted total cholesterol. Lifestyle factors did not significantly predict cardiometabolic risk.DiscussionPsychosocial determinants, particularly wellbeing, play a central role in Métis People's cardiometabolic risk, with effects differing by sex. This emphasized the need for Métis-specific, trauma, and sex-informed approaches to cardiovascular health promotion.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1746652</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1746652</link>
        <title><![CDATA[CXCL1: a novel therapeutic target to increase aneurysm healing after coil embolization]]></title>
        <pubdate>2026-02-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Devan Patel</author><author>Melanie Martinez</author><author>Supreeya A. Saengchote</author><author>Kartik Motwani</author><author>William S. Dodd</author><author>Zahra Hasanpour Segherlou</author><author>Haiyan Xu</author><author>Koji Hosaka</author><author>Brian L. Hoh</author>
        <description><![CDATA[ObjectiveCXCL1 is highly expressed in human aneurysms but its role in aneurysm healing is unknown. The objective of this study was to determine whether CXCL1 neutralization increases murine aneurysm healing post-coiling.MethodsCarotid artery aneurysms were created in female and male C57BL/6 mice. CXCL1 expression was compared between aneurysms and sham-operated carotid arteries. In a separate cohort, aneurysms were coiled with poly (lactic-co-glycolic acid) (PLGA)-coated coils. Mice received intraperitoneal injections of either CXCL1 neutralizing antibody or IgG control for 7, 14, or 21 days post-coiling. Coiled aneurysms were assessed for aneurysm healing, neutrophil infiltration, macrophage polarization, and total macrophage burden.ResultsCXCL1 is highly expressed in murine carotid artery aneurysms. CXCL1 neutralization significantly increased aneurysm healing compared to IgG when administered for 14 days (females: 66.4% vs. 51.2%, p = 0.03; males: 69.8% vs. 47.0%, p = 0.004) and 21 days (females: 71.9% vs. 44.3%, p = 0.002; males: 67.8% vs. 61.6%, p = 0.02), but not when given for only 7 days (females: 48.1% vs. 49.4%; males: 52.3% vs. 50.4%). 14 days of CXCL1 neutralization decreased neutrophil infiltration (females: 0.43 vs. 5.21 cells/high power field (hpf), p = 0.04; males: 0.00 vs. 4.42 cells/hpf, p = 0.04) and increased reparative M2 macrophages (females: 2.25 vs. 0.79 cells/hpf, p = 0.03; males: 2.00 vs. 0.27 cells/hpf, p = 0.02).ConclusionsCXCL1 neutralization for 14 or 21 days improved aneurysm healing in female and male mice. 14 days of CXCL1 neutralization decreased neutrophil infiltration and increased M2 macrophage polarization. Systemic CXCL1 neutralization is a promising potential therapy to improve aneurysm healing by modulating the inflammatory response after coiling.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2026.1706746</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2026.1706746</link>
        <title><![CDATA[Interaction between age and atrial fibrillation on ischemic stroke severity: a cross-sectional analysis]]></title>
        <pubdate>2026-02-02T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Daniel Zhihao Hong</author><author>Rehena Sultana</author><author>Nur Sarah Binte Ibrahim</author><author>Hui Meng Chang</author><author>Deidre Anne De Silva</author>
        <description><![CDATA[BackgroundWhile atrial fibrillation (AF) and older age are established independent risk factors for greater ischemic stroke severity, their interactive effect remains poorly characterized. This study aimed to evaluate the interaction between age and AF status on stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS).MethodsWe conducted a cross-sectional study using a prospectively collected institutional stroke registry comprising 5,044 patients with acute ischemic stroke from 2019–2023. The primary exposures were AF status and age, categorized as < 65 and ≥65 years, while stroke severity at admission measured by the NIHSS served as the outcome. NIHSS was modeled using a negative binomial distribution within PROC GLIMMIX with a logarithmic link function to account for overdispersion in the NIHSS scores. Model included age, AF, and their interaction term, along with relevant co-variates such as gender, race and premorbid mRS.ResultsAF was present in 17.3% of patients. Stroke severity was significantly greater in patients with AF across both age groups: IRR 1.88 (95% CI, 1.44–2.45; p < 0.0001) in patients < 65 years, and IRR 2.13 (95% CI, 1.89–2.39; p < 0.0001) in patients ≥65 years. The interaction between AF and age on stroke severity was not statistically significant (p for interaction = 0.40).ConclusionsAF is associated with greater stroke severity in both younger and older adults. There was no statistically significant interaction between age and AF status on NIHSS scores, indicating no evidence of effect modification by age within limits of our data. These findings underscore the need to consider stroke severity in risk stratification, especially in younger AF patients who often experience greater treatment burden.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2025.1643570</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2025.1643570</link>
        <title><![CDATA[Disconnection syndromes and injury to neural systems after ischemic stroke]]></title>
        <pubdate>2026-01-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Anne Schwarz</author><author>Christina K. Holl</author><author>Lorie Brinkman</author><author>Andrea J. Stehman</author><author>Isabel Cardoso Ferreira</author><author>Nina Soleimani</author><author>Eden Farahmand</author><author>Maeve Settle</author><author>Shivani Sakthi</author><author>Ivy Vo</author><author>Natalie Olivares</author><author>Min-Keun Song</author><author>Steven C. Cramer</author>
        <description><![CDATA[BackgroundStroke-related impairments present in wide-ranging combinations, including cognitive and upper extremity (UE) sensorimotor deficits, complicating an understanding of their relationship with the anatomy of injury. Here, we hypothesized that deficits in UE sensorimotor function, mood, and cognition would be associated with distinct patterns of neural injury, and we explored whether complex outcome measures that make both cognitive and motor demands are more vulnerable to injury-related disconnection after stroke.MethodsSubject testing included elementary sensorimotor behaviors (shoulder and finger strength [SAFE], Fugl-Meyer Assessment [FMUE], and wrist proprioception [WPST]), complex behaviors that require substantial motor and cognitive control (Box and Blocks Test [BBT] and Trail Making Test-A [TMT-A]), cognition (Montreal Cognitive Assessment [MoCA]), and mood (Geriatric Depression Scale). Infarcts were outlined on clinical scans and used to compute lesion volume, injury to the corticospinal tract (CST) as well as thalamocortical sensory tract, and measures of structural network disconnection. Associations between lesions and behavior were examined using three methods: [1] voxel-lesion-symptom mapping (VLSM) to identify lesioned voxels associated with behavioral deficits; [2] correlation, to identify bivariate relationships between neuroimaging and behavioral measures; and [3] LASSO regression to identify the most behaviorally relevant variables among neuroimaging and clinical measures.ResultsStroke patients (n = 55, mean age 69.2, 42% females) had lesion volumes ranging from 0.1 to 354.9 (mean 30.9) ml and averaged 10.4 ± 4.9 days post-stroke. Deficits in all three elementary UE sensorimotor behaviors (SAFE, WPST, FMUE) correlated with extent of injury to CST not disconnection measures, with VLSM largely consistent, while deficits in complex motor and cognitive behaviors (BBT and TMT-A) were related to widespread structural disconnection between brain networks. LASSO models that consider all neuroimaging and clinical measures revealed complex patterns of disconnections across behaviors.ConclusionThese findings indicate that elementary UE sensorimotor behaviors are related to the integrity of regional sensorimotor system structures, but that more complex motor and cognitive behaviors are more related to intact structural connectivity between multiple brain networks.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2025.1727719</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2025.1727719</link>
        <title><![CDATA[Value of routine heart rate variability parameters for atrial fibrillation detection in ischaemic stroke and high-risk TIA patients]]></title>
        <pubdate>2026-01-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kurt Moelgg</author><author>Anel Karisik</author><author>Lucie Buergi</author><author>Lukas Scherer</author><author>Luisa Delazer</author><author>Benjamin Dejakum</author><author>Silvia Felicetti</author><author>Theresa Koehler</author><author>Julian Granna</author><author>Christian Boehme</author><author>Raimund Pechlaner</author><author>Theresa Prock</author><author>Thomas Toell</author><author>Axel Bauer</author><author>Michael Schreinlechner</author><author>Daniel Pavluk</author><author>Michael Knoflach</author><author>Stefan Kiechl</author><author>Lukas Mayer-Suess</author>
        <description><![CDATA[IntroductionUndetected atrial fibrillation (AF) increases the risk of recurrent ischaemic stroke, but current prediction scores do not incorporate heart rate variability (HRV) measures readily available from 24-h Holter ECGs.MethodsIn 697 patients with non-AF ischaemic stroke or non-AF high-risk transient ischaemic attack (TIA) from the STROKE-CARD Registry (NCT04582825), we assessed eight time-domain HRV parameters for predicting incident AF within 1 year. ROC analyses, logistic regression, and the Youden index were used to identify optimal cut-offs and compare HRV performance with Brown-ESUS AF and AS5F scores.ResultsNew-onset AF was detected in 28 patients (4.0%). PNN50, rMSSD, and SDSD showed the best discrimination (AUC = 0.711, 0.766, and 0.775), outperforming both clinical scores (AUC ≤ 0.612). Optimal cut-offs were 5.5% (PNN50), 48.5 ms (rMSSD), and 43.5 ms (SDSD). Dichotomized analyses confirmed strong associations with AF (ORs 5.34–7.70, all p < 0.001), and adding HRV parameters significantly improved prediction beyond existing scores.ConclusionsPNN50, rMSSD, and SDSD from routine Holter ECGs enhance AF risk prediction after non-cardioembolic stroke or high-risk TIA and may support targeted monitoring strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2025.1719748</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2025.1719748</link>
        <title><![CDATA[Post-stroke delirium is a predictor of prolonged hospital stay and poor functional outcome at 3 months]]></title>
        <pubdate>2026-01-15T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yacine Boudiba</author><author>Robin Gens</author><author>Anissa Ourtani</author><author>Gaël De Backer</author><author>Kaat Guldolf</author><author>Fenne Vandervorst</author><author>Sylvie De Raedt</author>
        <description><![CDATA[BackgroundDelirium is a frequent complication of acute ischemic stroke associated with poor outcome. The complex interplay with post-stroke infections remains to be elucidated. Our study aimed to investigate whether post-stroke delirium (PSD) was a predictor of prolonged hospital stay, poor functional outcome, and mortality after acute ischemic stroke, independent of the development of post-stroke pneumonia (PSP) and post-stroke urinary tract infections (PSU).MethodsIn a previously published dataset of 514 patients with acute ischemic stroke, 201 patients (39%) developed delirium within the first week after stroke onset using a chart review method based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. Fifteen percent developed PSP and 22% PSU, using the modified criteria of the US Centers for Disease Control and Prevention. Logistic regression analyses were used to identify predictors of prolonged hospital stay (>median 9 days), poor functional outcome (modified Rankin Scale >2), and mortality at 3 months after stroke onset.ResultsMultiple logistic regression analysis showed that PSD was a predictor of prolonged hospital stay [odds ratio (OR): 4.085, 95% confidence interval (CI): 2.445–6.824] and poor functional outcome [OR: 3.362, 95% CI: 1.851–6.107) at 3 months after stroke onset, even after adjustment for age, premorbid disability, National Institutes of Health Stroke Scale on admission, PSP, and PSU. PSD was no predictor of mortality after stroke.ConclusionPSD is a predictor of prolonged hospital stay and poor functional outcome at 3 months after ischemic stroke, independent of PSP and PSU.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2025.1676220</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2025.1676220</link>
        <title><![CDATA[Association between RoPE score and PFO grading on bubble echocardiography in cryptogenic stroke patients: a retrospective cohort study]]></title>
        <pubdate>2026-01-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Saeedur Rahman</author><author>Erik Hendrickson</author><author>Jamie Henderson</author><author>Samuel McGrath</author><author>Ayah Mekhaimar</author><author>Kishen Mathi</author><author>Jake Hudson</author><author>Robert Sargent</author><author>Brian Clapp</author>
        <description><![CDATA[IntroductionIdentification of high-risk anatomical and physiological features of a patent foramen ovale (PFO) is important for patient selection for transcatheter device closure of PFO in patients with cryptogenic stroke. Currently, there are no clinical screening tools in use that can be used in predicting high-risk PFO features before undertaking transoesophageal echocardiography.MethodsThis retrospective cohort study, conducted in a stroke unit in South East England, included 130 patients diagnosed with ischaemic stroke or transient ischaemic attack who were deemed as cryptogenic in nature following initial evaluation (≤55 years with no known risk factors or immediately identified underlying etiology). Patients underwent comprehensive diagnostic evaluations, including bubble echocardiography. The primary predictor, risk of paradoxical embolism (RoPE) score (≥6), was assessed for its association with a significant PFO, categorized as model 1 (≥small) and model 2 (≥moderate). Multivariable logistic regression models were used to estimate adjusted odds ratios for the relationship between RoPE score and PFO presence.ResultsOf the 130 patients, 47 had a known etiology, and 83 had cryptogenic stroke. The known etiology group had higher rates of hypertension, hyperlipidaemia, and non-stenotic atherosclerosis, while the cryptogenic group had more cortical strokes and higher RoPE scores. Multivariable analysis showed that a lower RoPE score (≤5) was associated with known etiology (aOR: 3.91, p < 0.01). RoPE scores ≥6 were significantly associated with both small and moderate PFOs (aORs: 5.39, p < 0.01 and 15.95, p < 0.01, respectively). Of 28 candidates for PFO closure, 20 underwent the procedure, all with high RoPE scores and large PFOs.DiscussionThis study reinforces the importance of a multidisciplinary approach in the evaluation and management of patients with PFO and suspected embolic stroke. While PFO is prevalent in both cryptogenic and non-cryptogenic stroke patients, its pathogenic role is highly context dependent. Our findings confirm that a high RoPE score (≥6) and a cortical stroke phenotype are independently associated with clinically relevant, higher-grade PFOs. Furthermore, patients selected for device closure consistently exhibited high RoPE scores and multiple high-risk anatomical features, aligning with current international guidelines. Importantly, low RoPE scores (≤5) were significantly associated with strokes of known etiology, underscoring the utility of the RoPE score not only in identifying likely PFO-related strokes but also in ruling out embolic mechanisms. These results support the integration of clinical scoring systems like RoPE for patient selection about the suitability for device closures as higher RoPE scores predict high-risk PFO and therefore minimize unnecessary interventions.ConclusionRoPE scores may be utilized in predicting high-risk anatomical and physiological features of PFO. However, larger prospective studies are needed to validate these findings and refine pre-transoesophageal echocardiography screening tools.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fstro.2025.1718355</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fstro.2025.1718355</link>
        <title><![CDATA[Striving toward quality metrics for pediatric stroke: time from door to diagnosis]]></title>
        <pubdate>2026-01-07T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rachel Pearson</author><author>Nancy K. Hills</author><author>Kellie Bacon</author><author>Shelby K. Shelton</author><author>Rowena Roque</author><author>Tatiana Moreno</author><author>Maria Kuchherzki</author><author>Carl Schultz</author><author>Theodore W. Heyming</author><author>Christine K. Fox</author><author>Heather J. Fullerton</author>
        <description><![CDATA[Background/ObjectiveMost pediatric stroke survivors suffer long-term impairments. To minimize injury, it is essential to quickly restore perfusion to viable brain tissue. Minimizing the time to stroke diagnosis requires recognition of a possible stroke by prehospital and emergency healthcare personnel, and rapid neuroimaging. While CT suffices for diagnosing hemorrhagic stroke, MRI is necessary to diagnose acute ischemic stroke (IS), contributing to significant diagnostic delays and potentially missed opportunities for intervention.MethodsWe conducted a retrospective study of children 1–14 years old with acute neurological symptoms presenting by Emergency Medical Services (EMS) to the study institution from 1/2019–6/2023. We described patient characteristics and neuroimaging studies, then evaluated predictors of MRI acquisition and actionable findings, including stroke. To assess the generalizability of these data we analyzed a secondary retrospective cohort of all children admitted during this period with out-of-hospital strokes regardless of presentation modality [EMS, emergency department (ED) walk-in, and transfer].ResultsAmong 3,888 pediatric patients with acute neurological symptoms presenting via EMS, 695 (17.9%) had neuroimaging: CT only in 570 patients (14.7%); CT and MRI in 125 (3.2%). Median (IQR) times from EMS activation to neuroimaging were 2.29 (1.56, 3.21) hours for CT and 26.8 (16.3, 43.8) hours for MRI. An EMS primary impression of “stroke” was rare (n = 13) but strongly predictive of imaging acquisition: all had CT and 11 had MRI. Thirty-one of the 125 patients with MRI had actionable MRIs, including nine acute strokes. During the study period another 14 stroke patients presented as ED walk-ins. Median time from ED arrival to CT was 0.92 (0.47, 1.08) hours for EMS patients with hemorrhagic stroke and 5.69 (1.50, 9.76) hours for walk-ins; for MRI, median time was 4.15 (3.00, 5.31) hours for EMS patients with ischemic stroke and 10.2 (1.99, 36.3) hours for walk-ins.ConclusionAmong children with acute neurological symptoms selected for neuroimaging, CT was the most common modality while MRIs were performed with a substantial time delay. While EMS providers rarely suspected stroke, their diagnosis impacted imaging decisions in the ED, suggesting a need to raise awareness among prehospital providers. To measure quality improvement in pediatric stroke, new pediatric-specific metrics like “door to diagnosis” time, should be further explored.]]></description>
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