Background: Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF. Methods: Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT. Results: Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients. Conclusion: The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes.

Background/Objectives: Brainstem ischemic strokes comprise 10% of ischemic strokes and are challenging to diagnose due to small lesion size and complex presentations. Diffusion-weighted imaging (DWI) is crucial for detecting ischemia, yet it can miss small lesions, especially when only axial slices are employed. This study investigated whether ischemic lesions visible in a single imaging plane correspond to smaller volumes and whether coronal DWI enhances detection compared to axial DWI alone. Methods: This retrospective single-center study examined 134 patients with brainstem ischemic strokes between December 2018 and November 2023. All patients underwent axial and coronal DWI. Clinical data, NIH Stroke Scale (NIHSS) scores, and modified Rankin Scale (mRS) scores were recorded. Diffusion-restricted lesion volumes were calculated using multiple models (planimetric, ellipsoid, and spherical), and lesion visibility per imaging plane was analyzed. Results: Brainstem ischemic strokes were detected in 85.8% of patients. Coronal DWI alone identified 6% of lesions that were undetectable on axial DWI; meanwhile, axial DWI alone identified 6.7%. Combining both improved overall sensitivity to 86.6%. Ischemic lesions visible in only one plane were significantly smaller across all volume models. Higher NIHSS scores were strongly correlated with larger diffusion-restricted lesion volumes. Coronal DWI correlated better with clinical severity than axial DWI, especially in the midbrain and medulla. Conclusions: Coronal DWI significantly improves the detection of small brainstem infarcts and should be incorporated into routine stroke imaging protocols. Infarcts visible in only one plane are typically smaller, yet still clinically relevant. Combined imaging enhances diagnostic accuracy and supports early and precise intervention in posterior circulation strokes.

Background: Pharmacologic therapies to prevent decompensation in cirrhosis remain limited. Aim: To evaluate the association between aspirin use and cirrhosis‐related outcomes and mortality. Methods: This retrospective cohort study utilized deidentified electronic health records from a global federated network (January 2013–July 2025). Adults with cirrhosis without decompensation in the preceding 12 months and without prior HCC were included. Following 1:1 propensity score matching, outcomes were assessed at 12, 24, and 36 months. The primary outcome was a composite of cirrhosis‐related decompensation (ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, encephalopathy). Secondary outcomes included hepatocellular carcinoma (HCC), mortality, and gastrointestinal bleeding. Results: Among 458 165 patients, matching yielded 25 782 patients (12 891 per group; mean age 63.3 years). Aspirin was associated with a lower risk of the composite outcome at 12 (HR, 0.75; 95% CI, 0.67–0.83), 24 (HR, 0.76; 95% CI, 0.70–0.84), and 36 months (HR, 0.77; 95% CI, 0.68–0.84), driven by reduced variceal bleeding, spontaneous bacterial peritonitis, and ascites. Absolute risks were 17.8% vs. 22.7% at 12 months, 20.4% vs. 24.7% at 24 months, and 22.0% vs. 25.7% at 36 months. At 12 months, the NNT was 21 for the composite outcome and 20 for mortality. Despite an increased risk of nonvariceal bleeding (NNH 143 at 12 months), serving as a positive control outcome, aspirin demonstrated a net clinical benefit, with more pronounced benefits in high cardiovascular risk patients ( p _interaction < 0.05). Conclusions: Aspirin use is associated with reduced cirrhosis complications, HCC, and mortality, suggesting a potential role in the management of compensated cirrhosis.

Background: Severe strokes often require deep sedation, yet the optimal sedation regimen remains unclear. This comparative study compared the efficacy of achieving target sedation depth using inhaled (isoflurane) versus intravenous (propofol) sedation. Methods: This prospective, observational, proof-of-concept study was conducted between July 2022 and June 2023 at two University Hospitals with dedicated neurological intensive care units. We included conservatively treated patients with severe space-occupying strokes (ischemic or haemorrhagic) requiring deep sedation. Patients received either inhaled or intravenous sedation. Sedation targets were defined in the morning rounds using the Richmond-Agitation-Sedation-Scale and were assessed at two subsequent time points (7 p.m. and 7 a.m.) during hospital stay. The primary outcome was the number of days where the predefined sedation target was achieved at both time points, comparing between the two sedation regimens. Secondary and safety outcomes included the incidence of delirium, pneumonia, functional outcomes, mortality, and vasopressor doses. Results: Seventy-nine patients (age 71 [63–81] years, 31 female) were included. Patients sedated with isoflurane achieved the sedation target significantly more often, with 182/444 (41%) compared to 80/497 (16%) assessments in patients sedated with propofol (RR 1.4; 95%-CI: 1.3–1.6). This effect was consistent across all sedation stages, specifically in the deep sedation targets (RR 1.5; 95%-CI: 1.2–1.9) and no-sedation target (RR 5.1; 95%-CI: 2.8–9.4). Secondary and safety outcomes revealed no significant differences. Conclusions: Isoflurane sedation offers a benefit for invasively ventilated stroke patients with respect to sedation targets. Specifically, isoflurane facilitates faster awakening when transitioning from deep sedation to awakening. These data encourage further confirmatory studies for specific stroke-patient groups.

Background: Stroke is a time-critical emergency in which rapid diagnosis and treatment are essential to improve outcomes. While Emergency Medical Services (EMS) facilitate structured prehospital stroke care, a proportion of patients bypass EMS and self-present to emergency departments (EDs), potentially causing treatment delays. This study compares process times and outcomes between EMS-transported and self-presenting stroke patients. Methods: We conducted a retrospective analysis of prospectively collected data from 1805 patients with suspected stroke admitted between May 2019 and June 2021 to two hospitals in Germany. Patients were classified as EMS-transported or self-presenting. Process times included door-to-needle time (DNT), symptom onset to first medical contact (FMC), and intravenous thrombolysis (IVT) rates. Data are presented as mean ± standard deviation or median [interquartile range] for continuous variables and as number (%) for categorical variables. Results: A total of 1940 patients with suspected stroke were included. For the main analysis comparing EMS transport and self-presentation, 1805 patients (1525 EMS, 280 self-presenting) were evaluated. EMS patients were significantly older than self-presenting patients (73.1 ± 15.1 vs. 65.3 ± 14.9 years, p < 0.001). The median time from symptom onset to first medical contact was 114 [95–132] minutes in EMS patients and 727 [420–1440] minutes in self-presenting patients (p < 0.001). IVT was administered in 119/1197 (9.9%) EMS patients and 18/254 (7.1%) self-presenting patients (p = 0.158) among those with documented information on thrombolysis. Door-to-needle time was slightly but significantly longer in self-presenting patients (median 35 [32–54] vs. 30 [28–34] minutes, p < 0.001), while both groups remained well within certification targets. Conclusions: Self-presenting stroke patients experienced markedly longer prehospital delays and lower intravenous thrombolysis rates compared to EMS-transported patients, although the difference in IVT rates was not statistically significant. In-hospital door-to-needle times were comparable between groups. These findings highlight the need for targeted public education to improve stroke symptom recognition and timely EMS activation.

Background and Purpose: Internal carotid artery dissection is a leading cause of ischemic stroke in younger patients, though many cases lack a definitive etiology for the wall injury. This study evaluated whether the length of the styloid process (SP) and its spatial proximity to the internal carotid artery (ICA) are associated with ICA dissection. Methods: We included patients with extracranial ICA dissection and control subjects without ICA dissection treated between 2005 and 2025 at a German tertiary stroke center in a propensity score matched (1:2) cohort study. SP length and minimal SP-ICA distance were measured bilaterally on CT angiography using standardized multiplanar reconstructions. Characteristics of SP were compared by etiology (spontaneous vs. traumatic). Conditional logistic regression accounting for the matched design was used to evaluate associations between SP anatomy and ICA dissection. Results: The cohort included 65 patients with ICA dissection (median age 48 years [43–55, IQR], 44.6% females, 73.8% spontaneous, 26.2% traumatic) and 130 matched controls. Patients with ICA dissection exhibited significantly longer SP (median 33.0 [29.0–39.8, IQR] mm versus 31.3 [27.2–37.2, IQR] mm; p = 0.033) and a higher SP length/neck length index (p = 0.046). No differences were found in the minimal SP-ICA distance (p = 0.206) or between traumatic and spontaneous etiologies (p = 0.989). In conditional logistic regression, SP length was not independently associated with ICA dissection (adjusted odds ratio [aOR] 1.13 per 5 mm, 95% CI 0.95–1.36), whereas a shorter minimal SP-ICA distance was (aOR 0.89 per mm, 95% CI 0.79–0.99). Conclusions: Our results indicate a modest association between SP length and ICA dissection that was not independent of SP-ICA proximity in the matched multivariable analysis. The styloid complex may contribute to a mechanical predisposition for arterial wall injury in a subset of patients. SP morphometry can be readily assessed on CT angiography; its value as an imaging marker requires prospective validation.