Jesús Antonio Rodríguez Santos, Iván Pineda, Eliezer Cardona, Carlos Maradiaga, Juan Galeano, Laura Giacaman, Selvin Z. Reyes-Garcia
Intravenous (IV) thrombolysis for acute ischemic stroke (AIS) is time-dependent and frequently underused in resource-limited settings. We aimed to characterize patients with AIS who did not receive IV thrombolysis at a national referral center in Honduras and to document the barriers to treatment. We conducted a retrospective, single-center, consecutive case report series of all eligible patients with AIS who were not thrombolyzed at Hospital Escuela Universitario between 1 October and 30 November 2025. We gathered demographics, socioeconomic status, admission severity, process-of-care intervals, contraindications, neuroimaging and thrombolytic availability, complications, and discharge outcomes. Contraindications were classified as absolute or relative according to the 2019 American Heart Association and American Stroke Association (AHA/ASA) guidelines. A thrombolysis eligibility cascade was the principal analysis. The study was approved by the institutional review board. A total of 23 patients were included (median age 70 years; 14 [60.9%] male). Extreme poverty (≥2 unsatisfied basic needs [UBN]) was present in 14 patients (60.9%). All 23 AIS presentations screened during the period were included, and no patient received thrombolysis (institutional thrombolysis rate 0%). The median onset-to-door time was 10.0 h (IQR 7.0–15.0), and only 1 of 22 patients with a recorded time (4.5%) arrived within 4.5 h. Late or unknown onset was the most frequent absolute contraindication (21 [91.3%]); neuroimaging was available in 22 (95.7%) patients, but the thrombolytic agent was unavailable in every patient (availability 0%). In the eligibility cascade, the single patient within the window had no absolute contraindication and could not be treated because no thrombolytic agent was available. The in-hospital mortality rate was 2 (8.7%), and a good functional outcome (modified Rankin Scale [mRS] score 0–2) occurred in 5 of 20 patients with an assessable score. Non-administration of thrombolysis reflected late presentation and, above all, the complete unavailability of the thrombolytic agent, whereas imaging and organizational capacity were largely in place. Drug supply was the proximate, modifiable obstacle to reperfusion in this setting.
Upper limb spastic paralysis after stroke often limits functional use of the affected hand and restricts activities of daily living, particularly in cases with long-standing impairment following childhood-onset stroke. Although various interventions for spasticity have been reported, many require specialized equipment or invasive procedures, which may limit long-term and home-based use. Flossing intervention, which involves compressive wrapping with an elastic band combined with movement, has recently been introduced in musculoskeletal practice; however, its application for post-stroke spasticity remains unclear. An adolescent girl in her teens (female, Asian) presented with long-standing right upper limb spastic paralysis following childhood-onset cerebral infarction associated with moyamoya disease. At baseline, she demonstrated marked distal spasticity, limited active wrist extension, and restricted functional use of the affected hand. A flossing intervention was applied to the distal forearm and elbow region, consisting of compressive wrapping followed by passive twisting and active movements. The intervention was performed both in outpatient therapy and as a home-based program. After 6 months of continuous intervention, Modified Ashworth Scale scores decreased, upper limb motor function assessed using the Fugl–Meyer Assessment improved, and real-world use of the affected hand assessed using the Motor Activity Log increased. Active wrist extension range of motion improved from −20° to 40°, and functional bilateral hand use, including button fastening, became possible. The patient reported improved ease of hand movement and high satisfaction, and functional gains were maintained during follow-up. This case suggests that flossing intervention may be a feasible, non-invasive, and home-based treatment option for improving upper limb function in patients with long-standing post-stroke spastic paralysis following childhood-onset stroke. Further studies are required to clarify its efficacy and appropriate indications.
Fadi Shbat, Karine Beiruti Wiegler, Najib Dally, Elias Saad, Saher Srour, Elizabeth Eshel, Adi Sharabi Nov, Radi Shahien, Ronen Leker, Naaem Simaan
Clopidogrel is commonly used for secondary prevention after ischemic cerebrovascular events, but substantial interindividual variability in pharmacodynamics response has been reported. Individuals demonstrating resistance to clopidogrel face a higher likelihood of recurrent ischemic events. This study evaluated clopidogrel responsiveness among Jewish and Arab patients treated within the same regional healthcare setting. This prospective cohort included 102 patients with ischemic cerebrovascular events (acute ischemic stroke or transient ischemic attack) receiving clopidogrel for secondary prevention. Patients received either a loading dose (300 in 62 patients, 600 mg in 1 patient) followed by maintenance therapy or at least 7 days of 75 mg daily maintenance dosing (n = 39) prior to blood sampling. Platelet responsiveness was measured using the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay (PLT VASP/P2Y12, BioCytex, France). Patients were categorized according to VASP platelet reactivity index (PRI) as adequate responders (PRI <50%), intermediate responders (PRI 50%−69%), or patients with high residual platelet reactivity, operationally defined in this study as PRI ≥70%. The study included 102 enrolled patients, of whom 57 (55.9%) were Jewish and 45 (44.1%) were Arab. A valid VASP-PRI measurement was available for 101 patients (57 Jewish and 44 Arab); one Arab patient had no evaluable PRI measurement. Therefore, analyses of platelet reactivity were based on 101 patients The median PRI for all patients was 65.5 (49.1–80.3), with no statistically significant differences between Jewish and Arab (p = 0.251). Overall, 42.6% were classified as non-responders, 29.7% as partial responders, and only 27.7% demonstrated adequate platelet inhibition. Jewish patients were significantly older than Arab patients (p = 0.008), whereas Arab patients had a significantly higher BMI (p = 0.019). Other demographic and clinical features were similar across groups. A high proportion of patients demonstrated elevated residual platelet reactivity according to the operational PRI threshold used in this study. No statistically significant ethnic difference in PRI was detected; however, the ethnic comparison was exploratory and the study was not powered to exclude modest between-group differences. Larger prospective studies incorporating CYP2C19 genotyping and longitudinal clinical outcomes are warranted.
Majid Khalili-Ardali, Vivek Sharma, Tarandeep Singh Mandahar, Francisco Páscoa dos Santos, Paul Tiesinga, Nick Ramsey
Stroke is a leading cause of long-term disability, often resulting in persistent motor impairments that reflect disruptions in large-scale brain networks. An integrated framework capturing spatiotemporal EEG dynamics would help clarify how these networks change during recovery. We analysed resting-state EEG from stroke patients at 1 week (Session 1) and three months (Session 2) post-stroke to investigate electrophysiological biomarkers of motor recovery, indexed by change in the Fugl-Meyer scale (Δ FM). We quantified relative alpha-band power, microstate metrics (mean duration, complexity, and transition probabilities), and measures of metastability and synchrony derived from the Kuramoto Order Parameter. Change in relative alpha power emerged as the strongest single correlate of motor improvement, accounting for the largest proportion of variance among the EEG measures examined. Metastability and synchrony did not individually reach statistical significance but showed moderate positive correlations with Δ FM, particularly in the alpha and theta bands, and added 26% explained variance in Δ FM when combined with alpha power. Microstate parameters did not explain additional variance once alpha power and network-level dynamics were accounted for. A hierarchical model combining alpha power, metastability/synchrony, and microstates explained over 78% of the variance in Δ FM. These findings indicate that stroke recovery involves restoring balanced alpha oscillations and flexible large-scale brain coordination. Larger samples and more frequent longitudinal assessments are required to confirm the prognostic utility of integrated EEG biomarkers for guiding personalised stroke rehabilitation strategies.
Marieta Peycheva, Charlotte Berger, Marino Costa, Lee Siegenthaler, Fiona Huber, Ismaël Rizzo, Marina Krasteva, Morin Beyeler, Tatiana Bremova-Ertl, Nedelina Slavova, Pasquale Mordasini, Roza M. Umarova, Philipp Bücke, Kateryna Antonenko, Angelika Hoffmann, Sara Pilgram-Pastor, Mirjam R. Heldner
Sex-specific differences in vascular risk factors, stroke etiology, and outcomes after endovascular treatment (EVT) remain uncertain. We investigated these differences in a contemporary single-center cohort. Consecutive patients with acute anterior circulation ischemic stroke undergoing EVT (with-/out intravenous thrombolysis) between February 2015 and March 2023 were included. Sex differences in risk factors, treatment, successful reperfusion, and 3-month outcomes (mRS ≤ 1, ≤ 2, and mortality) were examined; multivariable models included interactions with age, stroke etiology, and bridging therapy. Among 1,764 patients (median age 76 years, 48% women), women were older (79.4 vs. 73.3 years, p < 0.001) and more often had atrial fibrillation and chronic kidney disease, while men more frequently had coronary heart disease, diabetes, and smoking history. Cardioembolic stroke was more common in women, whereas large artery atherosclerosis was more frequent in men. Successful reperfusion rates did not differ by sex (overall: 86.2%, p = 0.084). At 3 months, men were more likely to achieve favorable functional outcome (mRS ≤ 2: 47.6% vs. 37.5%, p < 0.001) and excellent functional outcome (mRS ≤ 1: 31.4% vs. 25.6%, p = 0.008), while mortality was higher in women (31.9 vs. 24.9%, p = 0.001). Female sex was not independently associated with successful reperfusion (aOR: 0.79; 95%CI: 0.60–1.06), favorable outcome (0.88; 0.69–1.11), excellent outcome (0.93; 0.73–1.19), or mortality (1.06; 0.83–1.35). A sex-by-age interaction was observed for favorable outcome (p interaction = 0.006), with no evidence of interaction by stroke etiology or bridging therapy. Women and men differ in risk profiles, stroke mechanisms, and unadjusted outcomes after EVT. However, sex was not independently associated with outcomes overall, although age may modify its association with favorable functional outcome.
