Autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disease characterized by recurrent strokes, cognitive impairment, psychiatric symptoms, apathy, and migraine. Approximately 40% of patients with CADASIL experience migraine with aura (MA). In addition to MA, CADASIL patients are described in the literature as having migraine without aura (MO) and other types of headaches. Mutations in the NOTCH3 gene cause CADASIL. This study investigated NOTCH3 genetic variants in CADASIL patients and their potential association with headache types. Genetic tests were performed on 30 patients with CADASIL (20 women aged 43.6 ± 11.5 and 10 men aged 39.6 ± 15.8). PCR-HRM and sequencing methods were used in the genetic study. We described three variants as pathogenic/likely pathogenic (p.Tyr189Cys, p.Arg153Cys, p.Cys144Arg) and two benign variants (p.Ala202=, p.Thr101=) in the NOTCH3 gene and also presented the NOTCH3 gene variant (chr19:15192257 T>G). Clinical features including headache associated with NOTCH3 (chr19:15192257 T>G) are described for the first time. Patients with pathogenic/likely pathogenic variants had similar headache courses. People with benign variants showed a more diverse clinical picture. It seems that different NOTCH3 variants may contribute to the differential presentation of a CADASIL headache, highlighting the diagnostic and prognostic value of headache characteristics in this disease.

Purpose: The aim of the article is to outline the frequency of the occurrence, course, diagnosis and possible treatment of spinal cord ischemia (SCI) on the basis of a literature overview and to raise awareness of this rare yet devastating condition. Views: SCI, when compared to cerebral stroke, is a relatively rare disease, being diagnosed 100 times less often. Our knowledge as to its root causes, proper treatment for it and long-term prognosis is still inconclusive. Magnetic resonance imaging with diffusion- weighted contrast is a main tool with which to confirm SCI and rule out a broad spectrum of possible alternative diagnoses. SCI is a condition in which prompt recognition, accurate diagnostic steps, and reperfusion therapy are essential to ensure a desirable functional outcome and reduce mortality and disability. Although there are no specific guidelines regarding treatment, the administration of rt-PA might be an effective therapy for acute ischemic stroke, preventing permanent spinal dysfunction. In surgical causes close cooperation between a neurologist and a neurosurgeon is necessary to provide combined appropriate management promptly. Conclusions: Due to the relative rarity of SCI, multi-center studies of ischemia of the spinal cord and its treatment would be advisable in neurological practice to enhance current knowledge. A rapid diagnosis is crucial for appropriate care and desirable long-term outcomes.

Aim of study. We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase.
Clinical rationale for study. We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study.
Materials and methods. This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality.
Results. Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). Conclusions. Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis. Aim of study. We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase.
Clinical rationale for study. We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study.
Materials and methods. This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality.
Results. Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). Conclusions. Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.

Migraine is a prevalent neurological disorder that affects over 1 billion individuals worldwide. The pathogenesis of migraine remains incompletely understood, though evidence suggests a multifactorial etiology involving genetic factors. The CACNA1A gene has been implicated in rare forms of Familial Hemiplegic Migraine (FHM). This study aimed to investigate the role of CACNA1A variants in individuals with and without a family history of migraine. We genotyped 150 subjects (100 migraine patients: 50 with migraine without aura (MO), 50 with migraine with aura (MA) and 50 controls) for six CACNA1A variants using Sanger sequencing. Statistical analyses were performed in Statistica (p < 0.05). The CADD v1.7 model was used to assess the potential pathogenicity of novel variants. Three variants described in databases (rs10405121, rs894252513, and rs1012663275) and three novel variants (ch19:13228374 G > C, ch19:13228428 G > C, and ch19:13228348 A > T) were identified. The rs10405121 variant was associated with both migraine types, with the homozygous AA genotype exclusively found in familial cases. Abnormal genotype of rs894252513 and rs1012663275 were detected only in familial cases with MO. The novel variants were observed exclusively in patients with a family history of migraine, suggesting their potential relevance to inherited migraine pathogenesis. Novel variants may contribute to migraine pathogenesis by altering calcium channel function and lowering the threshold for cortical spreading depression (CSD).

Purpose: The aim of this article is to outline the impact of COVID-19 on the frequency of occurrence, course of stroke treatment, and to highlight the cause-effect relationship between SARS-CoV-2 infection and stroke on the basis of a literature overview. Views: Since the end of 2019, the whole world has been struggling with the effects of the pandemic caused by the coronavirus SARS-CoV-2. The virus induces a wide spectrum of symptoms, ranging from mild or serious ones, which may lead to a severe multiorgan failure. Acute ischaemic stroke (AIS) might be associated with COVID-19 as a potentially fatal complication, while hemorrhagic stroke is less frequent. In most cases, stroke is caused by large artery occlusion. One of its reasons is hypercoagulation with a complex mechanism, which has not been fully explained. Research has shown that during COVID-19 pandemic, the number of patients admitted to hospitals due to AIS decreased. During the first pandemic wave there was no change regarding the proportion of patients with cerebral vessel obstruction who received endovascular treatment. Conclusions: In the COVID-19 pandemic era, rapid intravenous administration of tissue plasminogen activator remains the main treatment for acute ischaemic stroke. Patients often fail to report to hospital for the fear of SARS-CoV-2 infection. It is of the utmost importance to raise society's awareness of the necessity to report to hospital when experiencing serious symptoms, including stroke.

Background/Objectives: Management of the acute phase of ischemic stroke requires intensive interdisciplinary collaboration among medical personnel. Dysphagia, or swallowing disorders, represents a serious complication of stroke. Accurate diagnosis and identification of the causes of dysphagia are essential for implementing effective treatment. The aim of the study was to investigate the impact of age, acute stroke treatment, localization, comorbidities, and early rehabilitation on the severity and progression of dysphagia in patients with acute ischemic stroke. Methods: The study analyzed the severity and progression of dysphagia in patients with ischemic stroke, considering patient age, stroke localization, comorbidities, and the impact of thrombolytic therapy and early rehabilitation on swallowing outcomes. Results: Severe dysphagia was more common among older patients and those with cardiovascular conditions. Early rehabilitation was particularly effective in improving swallowing in right hemisphere strokes, while thrombolytic therapy demonstrated benefits for patients under 65 years. Conclusions: Therapy led to an improvement in the condition of all patients with dysphagia following ischemic stroke. Further prospective research is needed to better understand swallowing disorders and optimize treatment.