Afshin Borhani-Haghighi

Background: Evidence to guide the optimal timing of antiplatelet and oral anticoagulants (OACs) therapy after hemorrhagic infarction (HI) versus parenchymal hematoma (PH) is limited and inconsistent, leading to substantial variation in practice. This study's goal was to study the practice pattern and compare clinical outcomes associated with early‐versus‐delayed initiation of antiplatelet/OACs after hemorrhagic transformation (HT). Methods: This multicenter, retrospective, cross‐sectional study included patients with acute ischemic stroke and HT. Patients with an HI or PH were categorized by HT to antithrombotic initiation time, and their outcomes—30‐day HT exacerbation, composite outcomes of recurrent stroke/systemic emboli, 90‐day vascular death, and functional outcomes—were compared. Results: Of 748 patients, 496 received antiplatelets, and 252 received OACs after HT. The median HT‐to‐antiplatelet time was significantly shorter after HI than PH (1 [interquartile range, 0–2] versus 3 [interquartile range, 1–5] days; P 3 days) antiplatelets after either HI or PH. Among patients on OACs, those with HI had shorter median HT‐to‐OAC time than PH (7 [interquartile range, 2–15] versus 15 [interquartile range, 7–32] days; P 15 days) OAC initiation after either HI or PH, late initiation after PH was accompanied by higher rates of composite outcomes (30‐day) than early initiation (20.7% versus 3%; P =0.044). Regression models adjusted for demographics, National Institutes of Health Stroke Scale, and stroke severity showed no statistically significant association between early initiation of antiplatelets or OACs with HT exacerbation risk. Conclusions: Our study found no statistically significant difference in HT exacerbation between early and late initiation of antiplatelets or OACs among patients with HI/PH, while prolonged delay among patients with PH were accompanied by increased systemic thromboembolic events. Although these findings offer preliminary clinical insight, prospective studies are needed.

Background: RP5-833A20.1, DYNLRB2-2, and APOA1 antisense are pivotal in atherosclerotic plaque pathogenesis. This study examined whether changes in these circulating lncRNAs could serve as biomarkers for high-risk ischemic stroke (IS) patients with intracranial atherosclerotic disease (ICAD). Methods: Sixty-three IS patients, presenting within the first 24 h after stroke onset, and 60 controls were included in the study. The circulating levels of RP5-833A20.1, DYNLRB2-2, and APOA1 antisense in IS patients were assessed using real-time polymerase chain reaction (RT-PCR). Results: Significant decreases in the circulating levels of DYNLRB2-2 and RP5-833A20.1 were observed in IS patients compared to controls (P < 0.05). However, no significant difference in APOA1 antisense levels was noted between the two groups. Subgroup analysis revealed higher RP5-833A20.1 expression in IS patients with lower National Institutes of Health Stroke Scale (NIHSS) scores (0–6) compared to those with higher scores (3.59 ± 0.783 vs. 1.05 ± 0.505, P = 0.006). After adjusting for relevant covariates, multiple logistic regression indicated an inverse association between RP5-833A20.1 and the risk of IS (adjusted OR = 0.846, P = 0.028). Linear regression analyses further demonstrated a negative correlation between RP5-833A20.1 expression and NIHSS (beta = − 0.398, P = 0.006), which was confirmed by a significant negative Spearman correlation (r = − 0.41, P = 0.0007). DYNLRB2-2 exhibited a non-significant negative relationship with NIHSS. Conclusion: The findings suggest a significant decrease in the circulating levels of RP5-833A20.1 and DYNLRB2-2 in IS patients with ICAD, potentially indicating a protective effect against ischemic stroke. These lncRNAs hold promise as valuable biomarkers for identifying high-risk IS patients, emphasizing the need for further exploration and validation in larger cohorts to elucidate their roles in IS pathogenesis and clinical applications.

Background: Several laboratory markers derived from a complete blood count (CBC) have been proposed as potential indicators for assessing the risk of cerebral venous thrombosis (CVT). However, limited and conflicting evidence exists regarding this association. This study aimed to evaluate the role of CBC parameters in CVT development and their link to disease characteristics. Methods: This case-control study included patients diagnosed with CVT between March 2018 and and March 2021. All participants with CVT were registered in the organized registry system at the Neurology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran (CVT registry code: 9001013381). The control group consisted of age- and sex-matched individuals without systemic diseases. CBC results from the control group and the first recorded hospital CBC of the patient group were collected. Results: The study included 295 patients with CVT [49 with idiopathic CVT (iCVT) and 246 with secondary CVT (sCVT)] and 341 healthy individuals. Among the CVT group, 72.54% were women. Patients with CVT had higher red cell distribution width (RDW) and lower red blood cell (RBC) count, hemoglobin (Hb) levels, and hematocrit compared to the non-CVT group. In iCVT cases, male gender, RBC count, Hb levels, and hematocrit were notably higher compared to sCVT cases. Logistic regression analysis showed that female gender, smoking, and higher hematocrit values were associated with increased probability of iCVT. Conclusion: The study suggests that certain CBC parameters may serve as potential markers for assessing CVT risk and differentiating between iCVT and sCVT cases. Validation and further research are needed to explore the underlying mechanisms.March 2021.

Background: Inflammation is the major contributor to the pathophysiology of ischemic stroke (IS). Long non-coding ribonucleic acids (lncRNAs) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and tumor necrosis factor and heterogeneous nuclear ribonucleoprotein L-related immunoregulatory (THRIL) have been demonstrated to be up-regulated in inflammation and atherosclerosis. Therefore, we aimed to study the expression profile of these lncRNAs after IS. Methods: This observational case-control study was conducted in Namazi Hospital, Shiraz, Iran. The real-time polymerase chain reaction (RT-PCR) measured the sequential changes in circulating levels of MALAT1 and THRIL on days 1, 3, and 5 after IS. The receiver operating characteristic (ROC) curve analysis was used to estimate the diagnostic and prognostic potential of lncRNAs with the area under the curve (AUC). Results: In patients with IS, the relative MALAT1 and THRIL expressions were significantly higher than the controls (P < 0.001 and P < 0.01, respectively), on days 1, 3, and 5 after stroke. We showed a significantly increase in lncRNAs expression on day five compared to days 1 and 3 after stroke. Moreover, a positive correlation was detected between MALAT1 expression and time within the first 24 hours after stroke (r = 0.27, P = 0.03). Logistic regression analysis showed a significant positive association between MALAT1 and THRIL and the risk of stroke evolution. We found a potential diagnostic marker for MALAT1 with an AUC of 0.78. Conclusion: We demonstrated the significant sequential upregulation in MALAT1 and THRIL expression on days 1, 3, and 5 after IS with a significant positive association with the risk of stroke. MALAT1 also significantly correlated with time within the first 24 hours after stroke.

Background: Oral contraceptive (OCP) use is a significant risk factor for cerebral venous thrombosis (CVT). There is limited research on its association with CVT development in Islamic countries. Therefore, our study aimed to assess the risk of different OCPs in developing CVT and their prognosis. Methods: This is an observational retrospective single-center cohort study that included CVT patients between March 2018 and March 2021. All CVT participants were registered in the organized registry system (CVT registry code: 9001013381) at the Neurology Research Center of Shiraz University of Medical Science. Univariate analysis and multivariable binary logistic regression modeling were applied to determine the associated factors leading to poor outcome. Results: A total of 204 patients (139 women, 65 men) were enrolled in the study. Seventy-four females (53.25% of total female patients) used OCPs, with second-generation OCPs being the most commonly used type (70%). OCP consumption was associated with a lower mortality rate (P=0.004, aOR=11.732) and a better 3-month follow-up outcome (p=0.001, aOR=9.882) than their female counterparts who did not use OCPs. The duration and generation of OCPs did not affect the follow-up outcome (P=0.148, P=0.428, respectively) or mortality (P=0.555, P=0.569, respectively). In multivariable analysis, the use of OCPs was a predictor of a favorable 3-month follow-up outcome in females (aOR =4.423, 95% CI: 0.423-46.248). Conclusion: These results suggest that OCPs may have a positive impact on the prognosis of CVT in women. However, further research is required to understand the underlying mechanisms and validate these findings.

Introduction: The treatment of Behçet’s disease has improved significantly with the introduction of biologic therapies. However, there is still a need for more information about their use. This study aimed to evaluate the indications, response, and side effects of biologic agents in patients...

Background: Long non-coding RNAs, known as LncRNAs, have demonstrated a robust association with the pathogenesis of stroke. NRON and SNHG are among the most extensively studied lncRNAs in the context of atherosclerosis and inflammatory conditions. Given the absence of a current pathophysiological hypothesis regarding the potential relevance of the SNHG family and NRON lncRNAs in ischemic stroke (IS), this study aimed to investigate the altered expression of NRON and SNHG11 following atherosclerotic ischemic stroke (AIS) and their potential association with the risk of AIS. Methods: Blood samples were collected from 65 AIS patients (with large artery atherosclerosis or small vessel disease) and 65 controls. The expression levels of NRON and SNHG11 were assessed within the first 24 h following the stroke using quantitative real-time PCR. Results: NRON expression exhibited a significant decrease in patients compared to controls, while no substantial difference was observed in the expression level of SNHG11 between the two groups. Furthermore, logistic regression analysis revealed a significant negative association between NRON expression and the risk of AIS (adjusted odds ratio = 0.70; 95% confidence interval 0.55–0.89, P = 0.004). Conclusions: These findings suggest that NRON may play a role in the pathogenesis of AIS and could potentially serve as a biomarker for the disease. To fully comprehend the mechanism underlying the association between NRON and AIS and to explore its potential therapeutic implications, further investigation is warranted.

Background: Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and brain structural integrity. Multiple studies have evaluated the link between ICAD and cognitive impairment, with mixed results. This study aims to systematically review and summarize the current evidence on this link. Methods and Results: PubMed, EMBASE, PsycInfo, and Web of Science were searched from 2000 to 2023 without language restriction. Cross‐sectional and prospective cohort studies as well as postmortem studies were included. Studies containing data on the link between ICAD, defined as at least 50% stenosis in 1 intracranial vessel, and cognitive impairment and dementia were screened by 2 independent reviewers. A total of 22 (17 observational and 5 postmortem) unique studies, comprising 11 184 individuals (average age range, 59.8–87.6 years; 45.7% women; 36.5% Asian race), were included in the systematic review. Seven of 10 cross‐sectional studies and 5 of 7 prospective studies showed a significant association between ICAD and cognitive impairment. In the pooled analysis, ICAD was associated with greater cognitive impairment (measure of association, 1.87 [95% CI, 1.49–2.35]). Meta‐regression analyses did not show a significant impact of age, sex, and race. All postmortem studies showed that patients with Alzheimer disease and vascular dementia had a higher burden of ICAD compared with controls. Conclusions: This study shows that ICAD is associated with cognitive impairment and dementia across age, sex, and race groups. Our findings may underscore the need to develop individualized dementia preventive care plans in patients with ICAD.

The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.