Introduction: Paradoxical reactions during tuberculosis (TBC) therapy are characterized by clinical or radiological worsening of preexisting tuberculous lesions or the appearance of new manifestations following appropriate TBC treatment. Identifying this phenomenon is crucial, since it can be mistaken with treatment failure or relapse. Although widely described in HIV patients following immune reconstitution inflammatory syndrome, the literature on HIV‐negative patients is scarce. Case Series: We present three cases of immunocompetent patients with central nervous system tuberculosis (CNS‐TBC) who developed paradoxical reactions following appropriate TBC therapy. These included diverse clinical and radiological manifestations, such as persistent headaches, apparition or progression of tuberculomas, cerebral infarcts, and dorsal myelitis. Paradoxical reactions occurred within an average of 2.5 months from the start of anti‐TBC treatment. Conclusion: Our findings underscore the importance of closely monitoring patients following anti‐TBC treatment to identify potential complications rapidly. Paradoxical reactions due to exaggerated immune response to Mycobacterium tuberculosis complex antigens should be considered in a thorough differential diagnosis including other CNS infections, granulomatous or neoplastic disorders, treatment failure, or treatment‐related toxicities. Ensuring adequate adherence to anti‐TBC treatment and immunosuppressants is essential in such cases.

Background: Recent studies show an increase in the incidence of Cerebral Venous Thrombosis (CVT), with varying patterns across age and sex subgroups. This study analyzes hospital discharges with a primary diagnosis of CVT in Spain, examining year-on-year trends, demographic variations, and in-hospital mortality rates. Methods: A retrospective analysis of CVT cases from 2005 to 2021 was conducted using data from the Hospital Morbidity Survey provided by the National Statistics Institute of Spain. CVT incidence rates were standardized using the European Standard Population. Results: Among 76,793,382 hospital discharges, 4,293 were primarily diagnosed with CVT, with a mean age of 45.1 years (SD 20.4). Women represented 61.4% of CVT diagnoses. The standardized incidence increased from 0.41 cases per 100,000 inhabitants in 2005 to 0.84 in 2021. The rise occurred mainly among older adults—especially men over 50 (+4.6 cases/year) and women over 50 (+3.1)—whereas younger women, despite the highest incidence rates, showed the smallest increase (+0.8). Segmented regression revealed an acceleration in trends after 2016, notably in men over 50 (+8.0/year post-2016 vs. +1.4 pre-2016, p = 0.019), and a reversal in younger women from decline to growth (+10.9/year post-2016, p = 0.074). Time series analysis showed a proportional decrease in younger women (p < 0.001) and a rising relative burden in older men (p < 0.001). Overall, in-hospital mortality was 2.96%, with no significant differences between sexes. Conclusions: Trends in hospital discharges with a primary diagnosis of CVT in Spain vary by age and sex. Incidence rates have shown an overall increase, primarily driven by rising cases among adults aged ≥50 years—especially men. Although younger women continue to exhibit the highest incidence, their relative contribution has declined over time.

Background/Objectives: Although comprehensive transthoracic echocardiography (TTE) is part of the diagnostic workup in acute ischemic stroke, it is not cost-effective to use it for all patients. Guidelines recommend using it only for selected patients to guide secondary prevention. Neurologist-led, stroke-focused cardiac ultrasound (S-FoCUS) is an emerging bedside screening tool that optimizes cardiac evaluation in acute stroke care. We hypothesize that the implementation of S-FoCUS screening may reduce resource utilization in terms of hospital stay and TTE procedures. Methods: We conducted a retrospective before-and-after cohort study of patients with suspected acute ischemic stroke or TIA admitted to our comprehensive stroke center. We compared two 6-month periods: the pre-S-FoCUS period, during which patients underwent TTE as the initial cardiac imaging modality; and the post-S-FoCUS period, during which patients initially underwent S-FoCUS, with subsequent TTE performed only in the presence of abnormal findings or at the clinician’s discretion. We compared the time from admission to first cardiac ultrasound assessment, length of stay, relative reduction in TTE procedures and estimated in-hospital costs. Results: The pre-S-FoCUS period included 224 patients, and the post-S-FoCUS period included 229 patients. The S-FoCUS protocol reduced the median time to first cardiac ultrasound assessment by two days (median [IQR] 3 [2–5] vs. 1 [1–2], p < 0.001) and the median length of stay by one day (6 [4–9] vs. 5 [3–10], p = 0.014). Implementing the S-FoCUS protocol was associated with an exploratory estimate of lower in-hospital costs (approximately €716 per screened patient) driven mainly by a shorter length of stay. The distribution of the frequency of predefined cardioembolic sources was similar between both periods. There was a high agreement rate between the S-FoCUS and TTE findings in patients who underwent both tests: mitral stenosis (κ = 0.78), left atrial severe enlargement (κ = 0.74), left ventricular hypokinesia/akinesia (κ = 0.84), and depressed LVEF (κ = 0.88). Conclusions: Neurologist-led S-FoCUS is a feasible triage strategy to improve efficiency in the acute stroke pathway.