Brain arteriovenous malformations (AVMs) are the leading cause of spontaneous intracranial hemorrhage in children. The recently developed VALE scoring system has demonstrated predictive value for hemorrhage risk in adult AVM patients; however, its applicability to pediatric populations remains unknown. We performed a retrospective analysis of a prospectively maintained vascular database at University Hospital Frankfurt. Pediatric patients (≤ 18years) diagnosed with a single brain AVM between 2005 and 2023 were included. VALE scores were calculated according to the original model using ventricular system involvement, associated venous aneurysms, deep location, and exclusively deep venous drainage. Logistic regression analyses were performed to evaluate associations with hemorrhagic presentation. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis. A total of 52 pediatric AVM patients were included, of whom 31 (60%) presented with hemorrhage. Associated venous aneurysms were observed in 29% of ruptured AVMs compared with 5% of unruptured lesions and represented the only VALE component that remained significant in multivariable analysis. The complete VALE score demonstrated limited discriminatory performance, yielding an area under the ROC curve (AUC) of 0.608 (95% CI 0.454-0.762). Classification into VALE-defined risk categories showed similarly limited predictive ability (AUC 0.545, 95% CI 0.390-0.700), with no significant increase in hemorrhage risk across risk groups. This study represents the first external validation of the VALE scoring system in a pediatric AVM cohort. In our population, the VALE score demonstrated limited discriminatory performance and could not be conclusively validated. While associated venous aneurysms remained associated with hemorrhagic presentation, larger multicenter studies are required to further evaluate the applicability of the VALE score in pediatric patients and to determine whether pediatric-specific hemorrhage risk prediction models may be beneficial.

Background & Objective: Spontaneous intracranial hemorrhage (ICH) is associated with high morbidity and mortality. Early identification of patients at risk for poor outcomes is crucial to guide management and optimize intensive care utilization. Glucose-to-potassium ratio (GPR) is an emerging biomarker that may reflect combined metabolic and systemic derangements. The objective of this study is to evaluate the prognostic performance of GPR in predicting in-hospital mortality among patients with spontaneous ICH. Methods: In this retrospective observational study, 168 consecutive patients diagnosed with spontaneous ICH between January and December 2024 were included. Demographics, clinical parameters, laboratory results, and interventions were extracted from electronic medical records. The primary outcome was in-hospital mortality. GPR was calculated from admission serum glucose and potassium levels. Statistical analyses included Mann-Whitney U and chi-square tests for group comparisons, receiver operating characteristic (ROC) curve analysis for predictive performance, and multivariable logistic regression to identify independent mortality predictors. Results: Among 168 patients, 103 (61.3%) survived and 65 (38.7%) died during hospitalization. Non-survivors were older (median 64 vs. 58 years, p = 0.017) and had lower GCS scores (12 vs. 15, p < 0.001). ROC analysis of GPR yielded an area under the curve of 0.718 (95% CI, 0.637–0.800) with an optimal cut-off of ≥37.29, sensitivity of 65.6%, and specificity of 70.8%. In multivariable logistic regression, higher GPR (OR 1.04, 95% CI 1.01–1.07, p = 0.004), older age (OR 1.04, 95% CI 1.01–1.06, p = 0.002), and decompressive craniectomy (OR 3.60, 95% CI 1.52–8.53, p = 0.004) independently predicted in- hospital mortality. Conclusion: GPR is a simple, cost-effective, and readily obtainable biomarker that independently predicts in-hospital mortality in patients with spontaneous ICH. When combined with established predictors such as age and surgical intervention, GPR may facilitate early risk stratification and guide clinical management. Prospective multicenter studies are warranted to further validate these findings.

We externally validated the performance of deep learning (DL) solution for detection of spontaneous intracerebral (ICH), intraventricular (IVH) and subarachnoid hemorrhages (SAH) on non-contrast enhanced head CT scans (NCCTs). We analyzed 901 NCCTs collected retrospectively from two Swiss hospitals: University Hospital Zürich (USZ) and HOCH Health Ostschweiz, Kantonsspital St. Gallen (KSSG). Of these 901 NCCTs, 81 had spontaneous ICH, IVH or SAH. The diagnostic accuracy was evaluated using the radiologist's reports as the reference standard. The DL solution correctly identified 74 out of the 81 intracranial hemorrhages (sensitivity 91.4%). In the USZ cohort, the sensitivity was 88.5% and the specificity was 89.7%. Using the original KSSG-NCCTs, the DL solution had a sensitivity of 100.0% and a specificity of 47.5%. After adjusting the KSSG-NCCTs pixel matrix to a standardized 512 × 512 resolution the KSSG cohort sensitivity remained at 100.0%, and the specificity increased to 74.0%. The overall specificity was 78.4% when using the original imaging data. The overall specificity increased to 85.5% when using the padded KSSG-NCCTs along with original imaging data from USZ. Particularly the specificity varied substantially depending on imaging acquisition parameters. In a clinical setting, this would mean a high variability in a false positive rate.

Diminished levels of FXIII are significantly correlated with hematoma expansion (HE) and unfavorable clinical outcomes. Although the crucial function of FXIII in coagulation is well-recognized, the connection between FXIII deficiency and either HE or negative prognosis in patients with spontaneous intracerebral hemorrhage (sICH) is not well understood. Patients with sICH were confirmed through baseline computed tomography scans conducted within 6 h of symptom onset. Plasma FXIII levels were assessed at the time of admission using a standardized enzyme-linked immunosorbent assay. Restricted cubic spline models were employed to explore potential nonlinear relationships between admission FXIII levels and both hematoma expansion and clinical outcomes. Multivariable logistic regression analyses were performed to ascertain the association between FXIII levels and functional outcomes at 3 months postonset. In the study cohort of 132 patients with sICH, 49 experienced HE. The median admission level of FXIII was significantly lower in patients with HE, with a median [IQR] of 8.21mg/L (6.33, 10.37), compared with those without HE, who had a median value [IQR] of 11.68mg/L (8.49, 21.20), p < 0.001. A deficiency in Factor XIII, defined as a plasma level < 10mg/L, was associated with HE, with a fivefold increase in risk as indicated by an adjusted odds ratio of 5 (95% CI 2.031-12.325; p < 0.001). Furthermore, multivariable analysis revealed that this deficiency was associated with poor functional outcomes, defined as a modified Rankin Scale (mRS) score of > 3, by a factor of 59.45 (OR 59.45, 95% CI 7.258-487.006; p < 0.001), and increased the risk of mortality by a factor of 12.07 (OR 12.07, 95% CI 2.526-57.669; p = 0.002) in patients with sICH. In a prospective observational cohort study of patients with sICH, FXIII deficiency was found to be associated with HE and poor prognosis.

Rationale:Coagulation factor deficiencies can lead to hemorrhagic syndromes of varying severity and bleeding manifestations. Intracranial hemorrhage (ICH) associated with coagulation factor XIII (FXIII) deficiency is particularly challenging because its clinical presentation closely mimics spontaneous ICH, often occurring without apparent triggers. Routine coagulation tests (prothrombin time and activated partial thromboplastin time) are typically normal, contributing to diagnostic difficulties and frequent underdiagnosis or misclassification. As the management of this condition differs from other ICH types, replacement therapy with cryoprecipitate or fresh frozen plasma is crucial beyond surgical intervention. This case report highlights this rare, life-threatening condition to enhance clinical recognition.Patient concerns:A 53-year-old Chinese male presented with recurrent ICH over a 20-day period and underwent 2 intracerebral hematoma evacuation surgeries. Postoperative head computed tomography (CT) revealed persistent rebleeding at the site of original hemorrhage.Diagnoses:Congenital FXIII deficiency, intracerebral hemorrhage, and cerebral herniation.Interventions:The patient underwent surgical hematoma evacuation followed by allogeneic blood transfusion therapy, and received 10 units of cryoprecipitate daily.Outcomes:After 35 days of treatment, the patient regained full consciousness with normal cognitive and neurological responsiveness. Follow-up CT imaging revealed significant resolution of the hematoma. He was discharged in stable condition. Post-discharge management included weekly infusions of 6 to 10 units of cryoprecipitate at local medical facilities along with routine monitoring of coagulation profiles and cranial CT scans.Lessons:Intracranial hemorrhage secondary to FXIII deficiency is exceedingly rare. Clinicians should consider FXIII deficiency when recurrent ICH occurs with normal routine coagulation tests, to enable early diagnosis and life-saving replacement therapy. Early identification of the underlying etiology through comprehensive diagnostic evaluation is essential to guide effective and timely interventions, particularly in the context of increasing ICH incidence and healthcare resource utilization.

Introduction: Spontaneous intracranial hemorrhage is the presence of a parenchymal bleed in the absence of trauma or surgery in brain. The original Intracerebral hemorrhage score utilizes the cut-off age of 80 years, whereas the modified Intracerebral hemorrhage score used a lower cut-off age which may better prognosticate the outcome of Intracerebral hemorrhage in the populations with shorter life expectancy. The primary objective of this study was to compare the original with modified intracerebral hemorrhage scores in predicting mortality in Nepalese population with intracerebral hemorrhage. Materials and Methods: Patients ≥16 years, with spontaneous Intracerebral hemorrhage, who were admitted in Tribhuvan University Teaching Hospital in the Department of Neurosurgery and Neurology between 15th March, 2019 and 30th November, 2019, were included in the study. Original and modified Intracerebral hemorrhage scores were recorded separately at the time of admission. The outcome was measured using the modified Rankin Scale at 6 months. To compare the predictive ability of original and modified Intracerebral hemorrhage for mortality and outcome, receiver-operating characteristics curves were compared; and areas under the curve was calculated. DeLong’s test was used to compare the area under the Receiver Operating Characteristic. Sensitivity and specificity were calculated for the diagnostic accuracy; and were plotted in Receiver Operating Characteristic. Youden's index was calculated to determine the discrimination ability of both scores. Result: A total of 89 patients were enrolled in the study. Only thirteen patients (14.6%) were ≥80 years. The 30-day and 6-month mortality was 24.7% and 33.7% respectively. Hosmer-Lemeshow test showed a good model fit for both the scores for mortality and good outcome at 6 months. Conclusion: Prediction of 30-day mortality by modified intracerebral hemorrhage score is similar to the original intracerebral hemorrhage score. However, there was a slight trend of better prediction for good outcome at 6 months, using the modified score.

Spontaneous Intracranial Hemorrhage in Brazil: Trends, Seasonality, Pandemic Disruption, and Cost Burden.

Introduction: Elevated blood pressure following spontaneous intracranial hemorrhage (ICH) can drive hematoma expansion and prolong intensive care unit (ICU) length of stay (LOS). Although intravenous (IV) nicardipine effectively controls blood pressure, its cost and intensive monitoring are limiting factors to its use. This study assessed whether transitioning from IV to enteral antihypertensives within 48 hours of admission can reduce ICU LOS without compromising patient safety, compared to a later transition. Methods: Adults with spontaneous ICH who received at least one dose of enteral antihypertensive were stratified by time from admission to first enteral dose (early vs late). The primary endpoint was ICU LOS. Secondary safety and efficacy outcomes included hypotension, vasopressor use, change in National Institutes of Health Stroke Scale (NIHSS) ≥ 4 points, mortality, number of as-needed IV antihypertensive bolus doses, duration of IV nicardipine, and hospital LOS. Continuous data were analyzed with the Mann-Whitney U or t-test and categorical data with Fisher’s exact test. Results: Eighty-three encounters met criteria (n=76 early group vs n=7 late group). More of the late transition patients were female (57% vs 16%, p = 0.023) and had higher median [IQR] NIHSS scores on admission (16 [10,21] vs 7 [2,15], p = 0.042). Other baseline characteristics were comparable. Median [IQR] ICU LOS was three days [2,6] in the early group and seven days [4,11] in the late group (p = 0.073). The early group required fever as-needed IV boluses of antihypertensive medications (6 [3,13] vs 13 [11,17], p = 0.042). Duration of IV nicardipine was similar between groups. Safety outcomes such as incidence of hypotension, vasopressor use, NIHSS at discharge, and in-hospital mortality did not differ between groups. Conclusions: Initiating enteral antihypertensives within 48 hours of admission was associated with fewer as-needed IV antihypertensives boluses and similar safety outcomes. Larger studies are needed to confirm if an ICU LOS reduction can be attributed to earlier enteral antihypertensive administration.

Cerebral amyloid angiopathy is a vascular disorder involving deposition of toxic β-amyloid proteins in brain blood vessel walls. Cerebral amyloid angiopathy affects older people and dogs with similar histopathologic features. Cerebral amyloid angiopathy is implicated in the pathogenesis of cognitive decline in people with Alzheimer's disease but is also responsible for hemorrhagic strokes without preexisting cognitive impairment. Cerebral amyloid angiopathy is a major cause of spontaneous intracranial hemorrhage in elderly people. Clinical reports of senior dogs presented for acute neurologic dysfunction with MRI evidence of spontaneous intracranial hemorrhage are limited. This article is intended to provide a comparative overview of cerebral amyloid angiopathy in dogs and humans and propose the concept that cerebral amyloid angiopathy in senior dogs represents an underrecognized clinical entity.

Basilar artery occlusion (BAO), a rare and severe stroke, causes high morbidity and mortality. This meta-analysis aims to compare bridging therapy, including endovascular thrombectomy (EVT) with intravenous thrombolysis (IVT), versus EVT alone in BAO. PubMed, Cochrane Central, and ScienceDirect were searched until May 2025. The risk ratios (RRs) and 95% confidence intervals (CIs) were combined using a random effects model in Review Manager software. The quality assessment was conducted using the Cochrane Risk of Bias (RoB 2.0) and the Newcastle-Ottawa scale. Publication bias was assessed visually via funnel plots and statistically using Egger's regression test. This review's protocol was registered on PROSPERO with the ID: CRD420251108752. A total of 14 studies, including 11 observational studies and 3 randomized controlled trials, with 3745 participants, were analyzed. Bridging therapy was associated with a significantly higher likelihood of achieving functional independence (modified Rankin Scale (mRS) ≤ 2) (RR=1.27; 95%CI: [1.13, 1.43]; p<0.0001; I2=23%) and independent ambulation (mRS≤3) (RR=1.10; 95%CI: [1.01, 1.20]; p=0.02; I2=0%). The mortality risk was also significantly lower in bridging therapy (RR=0.83; 95%CI: [0.75, 0.93]; p=0.001; I2=0%). The successful recanalization endpoint was found to be comparable between the bridging therapy and EVT alone arms (RR=1.00; 95%CI: [0.97, 1.03]; p=0.99; I2=0%). Similarly, there was no significant difference between the intervention and control groups in spontaneous intracranial hemorrhage (sICH) (RR=0.99; 95%CI: [0.71, 1.39]; p=0.97; I2=0%). Our meta-analysis supports administering IVT before EVT for BAO, showing benefits in functional outcomes and mortality without increasing hemorrhage risk, although successful recanalization was similar in both groups.

Introduction: Spontaneous intracerebral hemorrhage (sICH) is a neurological condition associated with poor functional outcomes and high mortality. The role of surgical intervention is an area of ongoing research, with several trials showing mixed results. We conducted a meta-analysis to investigate the effectiveness of surgery compared to best medical management (BMM) in patients with sICH. Methods: We analyzed randomized controlled trials found through PubMed, Embase, and Cochrane databases. Studies that were not randomized control trials or included the pediatric population were excluded. Studies that investigated other causes of ICH such as vascular malformations or sinus thrombosis were also excluded. We used modified Rankin Scale (mRS) score of 0-3 at 180 days as the efficacy outcome. Mortality at 90 days was evaluated as the safety outcome. We assessed heterogeneity using a restricted maximum-likelihood estimator, along with the Q-test and I 2 statistic. Results: Four clinical trials, namely STICH-I, STICH-II, MISTIE, III and ENRICH, were included. STICH-II only enrolled patients with lobar sICH, while the other studies included lobar, basal ganglia, and thalamic hemorrhages. STICH-I and STICH-II trials randomized patients to BMM or invasive surgery (e.g., craniotomy, stereotactic and burr hole surgery). MISTIE-III and ENRICH trials randomized patients between BMM and minimally invasive surgery (MIS). When analyzed separately, invasive surgical intervention (OR 1.20, 95% CI [0.97, 1.48]) and MIS (OR 1.32, 95%CI [0.98, 1.76]) did not show any benefit over BMM. However, there was a higher likelihood of a favorable outcome (OR 1.24, 95% CI [1.05, 1.47]) and improved mortality (OR 0.79, 95% CI [0.63, 0.99]) with any surgical intervention (invasive or MIS) when compared to BMM. Conclusion: Our results showed better functional outcomes and improved mortality with surgical intervention in patients with sICH. Further research is warranted to elucidate these findings.

Background: The decision to resume oral anticoagulation in patients with atrial fibrillation after an intracranial hemorrhage remains a significant clinical challenge due to competing risks of ischemic stroke and recurrent bleeding. Objective: To evaluate the benefits and risks of restarting oral anticoagulation in patients with atrial fibrillation who have experienced a spontaneous intracranial hemorrhage. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing long-term use of any oral anticoagulant to no anticoagulation (placebo, standard care, or open control) in patients with atrial fibrillation following an intracranial hemorrhage. We searched MEDLINE (PubMed), Embase, CENTRAL, ClinicalTrials.gov, WHO ICTRP, EUCTR, and grey literature through March 2025. The primary outcomes were ischemic stroke and recurrent intracranial hemorrhage. Secondary outcomes included major adverse cardiovascular events, major bleeding, cardiovascular mortality, and all-cause mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using standard meta-analytic techniques. Results: Five randomized controlled trials with a total of 733 patients were included. Compared to no anticoagulation, restarting oral anticoagulation significantly reduced the risk of ischemic stroke (RR 0.20; 95% CI: 0.05–0.75) and major adverse cardiovascular events (RR 0.59; 95% CI: 0.37–0.94). However, it was associated with increased risks of recurrent intracranial hemorrhage (RR 3.51; 95% CI: 1.50–8.22) and major bleeding (RR 2.22; 95% CI: 1.06–4.62). There were no significant differences in cardiovascular mortality (RR 1.00; 95% CI: 0.44–2.28) or all-cause mortality (RR 0.94; 95% CI: 0.65–1.37). Conclusions: In patients with atrial fibrillation who have survived an intracranial hemorrhage, resuming oral anticoagulation appears to significantly reduce the risks of ischemic stroke and major cardiovascular events, but increases the likelihood of recurrent hemorrhage and major bleeding. No survival benefit was observed. These findings highlight the need for individualized decision-making based on patient-specific risk profiles.

Hereditary Hemorrhagic Telangiectasia is an autosomal dominant vascular disorder with clinical features of recurrent epistaxis, mucocutaneous telangiectasias, or visceral arteriovenous malformations, yet its early signs may be overlooked in children. We report a family in which a fifteen-year-old boy and his mother presented for genetic evaluation of recurrent epistaxis, after his previously well seven-year-old sister demised suddenly from likely spontaneous atraumatic intracranial hemorrhage (diagnosed clinically without confirmatory post-mortem imaging), following a brief history of headache and vomiting. The mother had a background of infrequent nosebleeds and a family history of recurrent epistaxis in multiple maternal relatives. Genetic testing identified heterozygosity for NM_001114753.3(ENG): c.1134G > A (p.Ala378=), a ClinVar classified pathogenic variant, confirming the diagnosis of hereditary hemorrhagic telangiectasia. Cascade testing for her two surviving children was done. Her fifteen-year-old son tested positive and was found on subsequent screening to have intracranial vascular malformations which were treated presymptomatically with gamma knife surgery. Her other son tested negative. This case emphasizes the importance of prompt recognition of hereditary hemorrhagic telangiectasia in children presenting with recurrent epistaxis and highlights the need for thorough family history. Pediatricians play a crucial role in early diagnosis and referral for genetic testing with subsequent surveillance imaging. Early identification may possibly reduce the risk of unfavorable outcomes such as intracranial hemorrhage. This case emphasizes the need for heightened awareness of hereditary hemorrhagic telangiectasia in pediatric practice and supports the value of integrating genetic cascade testing and organ-specific screening in at-risk children, even before symptoms appear.

Background: The management of spontaneous intracerebral hemorrhage (ICH) has centered around controlling blood pressure in order to prevent hematoma expansion (HE). Rate-pressure product (RPP) has emerged as a hemodynamic marker that accounts for heart rate (HR) and systolic blood pressure (SBP), both of which are crucial in modifying shear stress to the vasculature. We hypothesized that RPP in the pre-hospital hyperacute phase is positively associated with initial hematoma volume and HE. Methods: We analyzed 263 patients with primary ICH from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) study with initial and interval neuroimaging. RPP was calculated as the product of HR and SBP in pre-hospital and pre-treatment phases, stratified into quintiles. HE was defined by volume expansion of >6 mL or >33% from baseline volume on repeat neuroimaging performed within 48 h of the first scan. The primary outcome was the initial hematoma volume by quintiles of hyperacute RPP. The secondary outcome was the occurrence of HE across RPP quintiles. Multivariable logistic regression was used to assess the degree to which RPP affects HE. Results: Of the 263 patients analyzed, 116 (44%) had HE. The proportion of patients with HE or the initial hematoma volume was not statistically significant across RPP quintiles overall. HE was significantly more common in female patients or patients on anticoagulation. Conclusions: Elevated RPP was not associated with increased initial hematoma volume or subsequent HE in the hyperacute period after spontaneous ICH. Future research is necessary to determine the clinical importance of RPP as a biomarker in the clinical outcome of ICH.

Intracranial hemorrhage in patients with primary brain cancer receiving anticoagulation∗

PurposeSpontaneous intracerebral hemorrhage (ICH) has a poor prognosis. Early imaging <72 hours is essential for etiological and prognosis assessment. We aimed to describe early imaging practices and evaluate their etiological relevance, before adopting standardized protocols.MethodsAcute spontaneous ICH patients from two university centers (2021-2022) were retrospectively included. Data included imaging, lesion, and associated vascular lesions parameters. Etiologies were classified into six categories based on imaging and clinical criteria: arteriolosclerosis, cerebral amyloid angiopathy (CAA), mixed cerebral small vessel disease (cSVD: arteriolosclerosis + CAA), vascular malformation, tumor, or undetermined.ResultsAmong 450 patients (71 ± 16 years; 52% male), initial imaging was CT in 58.5%; 53% had MRI <72hours. 46% of baseline imaging comprised contrast-injection. CT-only patients were older, with larger hematomas and higher in-hospital mortality (all<0.05). ICH (48 ± 47mL) was predominantly supratentorial (90%), with deep (52%) or lobar (frontal 28%) locations. MRI detected white matter hyperintensities (76%), lacunes (43%), infarcts (14%), acute ischemias (6%), and microbleeds (65%). CT identified an etiology in 50% vs. 80% for MRI (p < .001), mainly mixed cSVD (34%), arteriolosclerosis (23%), CAA (14%), and vascular malformations (7%) when based on MRI. Follow-up imaging <72 h was done in 42%, mostly CT.ConclusionsAlthough CT was more frequent, MRI was superior for early etiological assessment of spontaneous ICH, mainly identifying cSVD-related causes. Broader use of early cerebral MRI could contribute to optimizing ICH care by improving identification of mixed cSVD patients and might help prevent secondary bleeding. Prospective and standardized MRI use in the early phase of ICH will clarify its role.

Background: inherited fibrinogen disorders are characterized by a spectrum of quantitative or qualitative fibrinogen deficiency associated with both a hemorrhagic and thrombotic risk.Methods: a nationwide survey was conducted in 19 Italian Hemophilia Treatment Centers in order to investigate current diagnostic and management practices for inherited fibrinogen disorders (afibrinogenemia, hypofibrinogenemia, and dysfibrinogenemia).Results: the survey revealed a strong consensus (95% of centers) on the necessity of both functional and antigenic fibrinogen assays for diagnosis, and a preference for fibrinogen concentrate-based treatment (used by &gt;85% of centers). However, significant heterogeneity was observed in critical areas: for hypofibrinogenemia, the definition of a «severe» form varied among centers, and the perceived risk of spontaneous intracranial hemorrhage remained a major point of uncertainty (up to 47% of respondents answered ‘don’t know’ for this risk in hypofibrinogenemia and dysfibrinogenemia). Furthermore, intervention thresholds for major surgical procedures showed a high degree of variability across all three disorders.Conclusions: the findings highlight areas of consistent practice alongside those requiring further standardization and collaborative research to optimize the care of individuals with these rare bleeding and thrombotic conditions.

ObjectiveThe objective of this article is to evaluate the clinical characteristics of spontaneous intracranial hemorrhages occurring in the post–COVID-19 (post-coronavirus disease 2019) period in patients without classical risk factors (hypertension, anticoagulant therapy, or vascular malformations) and to assess the concordance of these findings with the existing literature.Materials and MethodsBetween 2020 and 2024, 36 patients with a prior history of COVID-19 who presented with spontaneous intracerebral hemorrhage were retrospectively reviewed. Cases were evaluated for age, sex, Glasgow Coma Scale (GCS), international normalized ratio (INR), hemorrhage type and anatomical location, modified Rankin Scale (mRS), rebleeding, and overall clinical outcomes. Patients with any macroscopic vascular pathology were excluded from the study.ResultsThe mean age of the patients was 52.0 years, and 61.1% were male. The overall mortality rate was 47.2%. Parenchymal hemorrhages comprised 55.6% of cases, subarachnoid hemorrhages 22.2%, and subdural hemorrhages 22.2%. Subarachnoid hemorrhages exhibited the highest mortality rate (87.5%). The mean GCS score was 8.2, and the mean modified Rankin Scale score at one year was 4.3. The GCS score was significantly associated with mortality (p=0.0001), whereas INR and age showed no significant relationship (p=0.2923 and p=0.6003, respectively).ConclusionIn the post–COVID-19 period, intracerebral hemorrhages occurring in patients without classical etiological factors represent a notable clinical entity. The high mortality and rates of functional dependency observed indicate that this patient group requires novel strategies for early diagnosis and long-term monitoring.

Tranexamic acid (TXA), a synthetic lysine analogue, is an effective antifibrinolytic agent widely used for controlling excessive bleeding. Introduced in the 1960s, TXA competitively inhibits plasminogen activation, stabilizing fibrin clots. Large randomized trials, including CRASH-2 (trauma) and WOMAN (obstetric hemorrhage), demonstrated reduced mortality when TXA is administered early, within three hours of bleeding onset. Consequently, TXA is recommended globally for severe trauma and postpartum hemorrhage. It is also widely employed perioperatively in cardiac and orthopedic surgery, significantly reducing blood loss and transfusion requirements. In congenital bleeding disorders such as hemophilia and von Willebrand disease, TXA effectively controls mucosal and procedural bleeding alongside standard therapies. However, routine TXA use in spontaneous intracranial hemorrhage or gastrointestinal bleeding is unsupported due to insufficient evidence and potential thrombotic risks. Recent studies suggest TXA possesses additional benefits beyond hemostasis, including anti-inflammatory and immunomodulatory effects, neuroprotection in traumatic brain injury and stroke, muscle regeneration promotion, and therapeutic potential in hereditary angioedema (HAE). TXA modulates inflammation via inhibition of plasminmediated complement activation, reduces neuronal apoptosis, supports muscle tissue repair through extracellular matrix remodeling, and reduces bradykinin generation in HAE patients. TXA generally exhibits an excellent safety profile, though caution for patients at elevated thrombotic risk or impaired renal function. Further research into patient selection and individualized dosing strategies is warranted. This review summarizes TXA’s mechanisms, diverse clinical applications, dosage recommendations, therapeutic outcomes, and safety considerations to support evidence-based practice.

The disguise of dyscrasia: Hereditary von Willebrand disease unmasked by MGUS-associated acquired VWD