Low plasma vitamin B6 levels are independently associated with ischemic stroke risk in young south Indian adults: A case-control study.

ABSTRACTBackgroundData on the association between physical activity (PA) and cryptogenic ischaemic stroke (CIS) in young adults are scarce. We investigated the relationship between PA levels and early‐onset CIS, stratified by the presence of a high‐risk patent foramen ovale (PFO).MethodsPatients aged 18–49 years with first‐ever CIS and sex‐ and age‐matched stroke‐free controls were recruited from 19 European centres. PA was assessed using the short International Physical Activity Questionnaire and expressed as Metabolic Equivalents, categorized into percentiles (bottom 10%, 10%–25%, 25%–75% [reference], 75%–90%, top 10%). Associations between PA and CIS were analyzed using conditional logistic regression adjusted for age, education level, traditional risk factors, and non‐traditional risk factors.ResultsAltogether, 533 patients (median age 41 [interquartile range 34–46]; 47.3% women) and 533 controls were included. Scoring in the top 10% of PA was independently associated with CIS: adjusted odds ratio 2.07; 95% confidence interval 1.22‐3.51. Comparing patients without high‐risk PFO to all controls, the top 10% PA category (1.78; 1.07‐2.94) and the bottom 10% category (1.76; 1.06‐2.92) were associated with CIS. No independent association was observed in patients with high‐risk PFO.ConclusionsPA in the top 10% was associated with an increased risk of early‐onset CIS in the overall study population. Among patients without a high‐risk PFO, both the bottom 10% and top 10% of PA were consistently associated with elevated CIS risk. These findings highlight the need to better understand the mechanisms through which both low and high activity levels may predispose to stroke.

Background and ObjectivesCervical artery dissection (CeAD) is a common cause of stroke in young adults. While the pathogenesis of CeAD remains poorly understood, clinical and genetic associations suggest a systemic arteriopathy at the early phase of CeAD. We hypothesize that individuals experiencing CeAD express a distinct gene expression profile at the early phase compared with (1) age-matched and sex-matched controls and (2) late-phase profiles within the same individual at a later time point.MethodsWe prospectively enrolled patients (n = 37) with CeAD with and without ischemic stroke (IS) from 2014 to 2016, excluding cases of significant trauma or known monogenic connective tissue disease. We compared CeAD cases with non-CeAD IS cases (n = 16) and healthy controls (n = 11). Study personnel collected blood samples within 4 weeks of the event and again at a 3–6-month follow-up. We assessed gene expression using microarray analysis at the time of CeAD, relative to controls and >3-month follow-up samples within CeAD cases. We applied a mixed-effects regression model that included covariates of age, sex, race/ethnicity, time of enrollment, and stroke occurrence. We used a false discovery rate (FDR) cutoff of 5% and a 1.5-fold change cutoff to identify robust differential expression.ResultsWithin early-phase CeAD cases, 1,238 genes showed differential expression at a 5% FDR compared with late-phase profiles, with 31 genes exhibiting at least a 1.5-fold change. We identified 538 differentially expressed genes between patients with CeAD and controls, of which 30 reached the 1.5-fold threshold. Comparison of late-phase profiles with controls revealed 11 differentially expressed genes. Gene ontology highlighted that 7 of the 11 genes were associated with hemoglobin metabolism.DiscussionIn this preliminary gene expression analysis of patients with CeAD, we identified a distinct gene expression profile associated with early-phase dissection. The predominance of differential gene expression related to hemoglobin metabolism warrants further study and replication in independent cohorts of patients with arterial dissection.

Ischemic stroke in young adults often occurs in the absence of advanced atherosclerosis, suggesting the involvement of nonatherosclerotic prothrombotic mechanisms. Factor VIII (FVIII) and von Willebrand factor (VWF) link endothelial activation, platelet adhesion, and coagulation; however, their integrated clinical and molecular relevance in early-onset stroke remains incompletely defined. We conducted a retrospective case-control study including 25 young adults with ischemic stroke and 26 age-matched controls. Plasma FVIII activity and VWF antigen levels were measured and analyzed using multivariable logistic regression and receiver operating characteristic curve analysis. To provide mechanistic context, FVIII-VWF pathway activity was assessed in three independent ischemic stroke transcriptomic datasets (GSE16561, GSE202518, and GSE22255; total n = 119) using single-sample gene set enrichment analysis and random effects meta-analysis. FVIII and VWF levels were significantly higher in patients with stroke than in controls, independently of age and sex, with expected modulation by ABO blood group. FVIII, but not VWF, remained independently associated with ischemic stroke (adjusted odds ratio: 1.05, 95% confidence interval: 1.01-1.09) and showed strong discriminatory performance (area under the curve: 0.86). Transcriptomic analyses revealed heterogeneous gene-level changes but consistent upregulation of the FVIII-VWF prothrombotic pathway across datasets. Meta-analysis confirmed a significant and homogeneous pooled effect for FVIII-VWF UP scores (Hedges' g = 0.76, p < 0.0001), whereas activation of the regulatory pathway was variable and nonsignificant. These findings provide complementary clinical and transcriptomic evidence supporting a central role for FVIII-driven FVIII-VWF axis activation in the prothrombotic milieu of early-onset ischemic stroke.

Cervical artery dissection (CeAD) is a common cause of stroke in young adults but is frequently misdiagnosed due to its nonspecific symptoms. This study examines factors associated with possible diagnostic error in CeAD and evaluates its impact on patient outcomes. We conducted a secondary analysis of the STOP-CAD (Antithrombotic Therapy for Stroke Prevention in Cervical Artery Dissection) study, which is a multicenter international study of adult patients admitted with CeAD. Possible diagnostic error was defined as the presence of CeAD symptoms within 30 days before the index CeAD diagnosis. The comparison group included patients diagnosed on their first medical encounter. Multivariable regression was used to identify factors associated with possible diagnostic error. Primary and secondary outcomes included ischemic stroke, death, and modified Rankin Scale score <2. Of 4012 patients (mean age 47.5 years, 44.6% female), 663 (16.5%) experienced possible diagnostic error. Among these, 224 (33.8%) reported to have ischemic stroke before CeAD diagnosis. Patients with possible diagnostic error were younger (odds ratio [OR], 0.89, P<0.001), more likely to have a history of migraines (OR, 1.35, P=0.007), and more likely to present with headaches (OR, 1.43, P<0.001), but less likely to show focal neurologic signs (OR, 0.68, P<0.001). There was no significant difference between groups in ischemic stroke after diagnosis (adjusted OR, 0.96, P=0.86), 90-day modified Rankin Scale score <2 (adjusted OR, 1.04, P=0.80), or death (adjusted OR, 0.58, P=0.34). One in 6 patients with CeAD experienced a possible diagnostic error, particularly those who were younger, had migraines, or presented with headaches and nonfocal symptoms.

Association Between Serum Atherogenic Index and Cardiovascular Disease in Early Adulthood: A Cohort Study.

ABSTRACTBackground and ObjectiveThe incidence of ischemic stroke (IS) in young adults (18–50 years) has been rising, in parallel with a growing prevalence of traditional vascular risk factors in this population. Understanding these trends critical for prevention and treatment strategies. This study aimed to analyze temporal trends in classical vascular risk factors among young adults hospitalized with IS in Spain between 2000 and 2022, and to forecast their prevalence through 2027.MethodsA retrospective analysis was conducted using hospital discharge data from the Spanish National Inpatient Database. Patients aged 18–50 years diagnosed with IS between 2000 and 2022 were included. Temporal trends were assessed using ordinary least squares regression and stationarity was evaluated with the Augmented Dickey–Fuller test. Short‐term forecasts (2023–2027) were generated using a cross‐validated time‐series framework comparing multiple univariate models. Model selection was based on out‐of‐sample root mean squared error.ResultsA total of 57,427 young adults with IS were identified. Incidence increased from 7 to 15 per 100,000 population between 2000 and 2022. Increases were observed in obesity (5.2%–15.2%), dyslipidemia (20.8%–29.7%), and illicit substance use (1%–13.5%). Obstructive sleep apnea, patent foramen ovale, and other congenital heart diseases also showed upward trends, while hypertension and diabetes remained relatively stable. Short‐term forecasts suggest a sustained burden through 2027.ConclusionsThe increasing burden of modifiable vascular risk factors and cardiac comorbidities among young IS patients underscores the urgent need for public health strategies focused on early detection, lifestyle modification, and prevention in this population.

Abstract Background and aims Stroke in young adults (patients under 60 years of age) represents 10–15% of all stroke cases. Carotid web accounts for a significant portion of cryptogenic ischemic strokes in this population, ranging from 9.4% to 37%. Although CaW is a treatable etiology of stroke in the young—with multimodality imaging techniques available for diagnosis—Brazilian data remain scarce. We evaluated the presence of CaW among young stroke patients at a tertiary university hospital in Brazil. Methods This is a retrospective, observational, single-center case series study using data from a local prospective registry. Until now, data were collected from patients presenting between October 2018 and November 2025. All images were evaluated by two fellowship-trained professionals (a neuroradiologist and a neurovascular specialist) and included after a consensus read. Results Among 2,400 patients admitted with stroke, 133 were initially suspected of having a carotid web based on admission computed tomographic angiography. 83 cases were analyzed until now. Fifty-eight patients were excluded after multimodality imaging analysis and review. Of the remaining cases, 25 were CaW-related (60% female, mean age 51 years). Almost one-fifth of the patients had bilateral carotid webs. Regarding interim treatment analysis, 80% of patients received aspirin and 40% underwent angioplasty. Conflict of interest Leticia Escorse Requiao. Nothing to disclose.

ObjectivesTo investigate the status of health behavior and its influencing factors in stroke among young adults.BackgroundPrevious research on young stroke patients has focused mainly on clinical risk factors, with limited attention paid to health behavior. Factors associated with health behavior in younger adults is unclear.MethodsA cross-sectional survey of 220 Chinese younger adults was conducted. A structural equation model(SEM) identified factors associated with health behavior and their effect magnitude.ResultsThe young adult participants had a mean age of 39.62 ± 4.85 years(18 to 44 years), with male accounting for the majority (74.5%, n = 164). Mean the Health Behavior Scale for Stroke Patients (HBS-SP) score was 65.64 (± 12.30). The results showed that personal mastery, social support, health literacy, self-efficacy, health belief, occupation and comorbidities were independently associated with HBS-SP(p < 0.05). SEM showed HBS-SP had the strongest association with personal mastery, followed by health literacy, Health belief, Self-efficacy, social support.ConclusionsFuture research on tailored health behavior interventions should prioritize the enhancement of personal mastery, health literacy, and health beliefs, alongside the strengthening of self-efficacy and the expansion of social support systems. These interconnected psychosocial and contextual factors serve as critical underpinnings for sustainable health behavior change, and targeted efforts to optimize them will likely yield more effective and equitable intervention outcomes in clinical, community, or public health settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12883-026-04842-4.

May-Thurner Syndrome as a Hidden Etiology of Ischemic Stroke in Young Adults.

Background: Routine fundus photography is widely accessible; however, its utility in stratifying systemic vascular risk in asymptomatic, general populations remains understudied. We utilized a large-scale health screening cohort in South Korea to evaluate the clinical validity of the retinal arteriosclerosis index (RAI) in a generally healthy population. Methods: We conducted a cross-sectional study of 74,608 adults who underwent routine health screening (2003–2010) at a tertiary center. Retinal arteriosclerosis was graded (0–4) by masked readers with a modified Scheie classification; a higher eye grade was defined as a person-level grade. High-grade RAI was prespecified as ≥2. Associations with systemic conditions (hypertension, type 2 diabetes, hyperlipidemia, metabolic syndrome, cardiovascular disease, and stroke) were examined by using multivariable logistic regression adjusted for demographic, lifestyle, and laboratory covariates; moreover, analyses were stratified by age and sex. Results: High-grade RAI was present in 4.5% of the participants and increased with age. After adjustment, high-grade RAI was associated with hypertension (OR, 2.97; 95% CI, 2.73–3.23), diabetes mellitus (OR, 1.35; 95% CI, 1.22–1.50), cardiovascular disease (OR, 1.46; 95% CI, 1.25–1.71), metabolic syndrome (OR, 1.63; 95% CI, 1.49–1.78), and stroke (OR, 1.98; 95% CI, 1.41–2.79) but not with hyperlipidemia. Sex-stratified analyses revealed broadly similar patterns, although high-grade RAI was associated with stroke in women and cardiovascular disease in men. Age-stratified analyses demonstrated consistent associations with hypertension, metabolic syndrome, and stroke across all age groups, with stronger effect sizes being observed in younger individuals. With respect to lifestyle factors, frequent alcohol consumption was associated with higher odds of high-grade RAI. Laboratory correlates included higher uric acid levels and lower red blood cell, albumin, and bilirubin levels (all p < 0.001). Conclusions: Fundus-defined arteriosclerotic changes were independently associated with multiple systemic vascular and metabolic conditions. An association with stroke in adults younger than 40 years of age was also observed, although this finding should be interpreted with caution given the cross-sectional design and limited number of events. These findings support the potential role of retinal vascular changes as cross-sectional correlates of systemic vascular health. Longitudinal studies are needed to clarify temporal relationships and causality.

Carotid webs are increasingly recognized as a significant cause of cryptogenic stroke in young adults, yet they remain frequently underdiagnosed due to their subtle radiographic appearance and atypical presentations. The natural history of untreated carotid webs includes high rates of recurrent ipsilateral ischemic events despite optimal medical therapy. The authors present the case of a 44-year-old man with four recurrent right hemispheric ischemic events over 5 years. Despite multiple angiographic studies, an underlying carotid web was initially misinterpreted. Digital subtraction angiography ultimately revealed a subtle posterolateral carotid web. Prior to endarterectomy, intraoperative ultrasound uniquely visualized a large thrombus adherent to the web, a critical finding not appreciated on preoperative angiography. Successful en bloc removal of the web and thrombus was performed with histopathological confirmation. The patient remained stroke free at the 1-year follow-up. Atypical carotid webs may lack classic radiographic features and can be misclassified on noninvasive imaging. Intraoperative ultrasound provides real-time assessment of thrombus burden not visible on preoperative angiography, allowing for improved surgical planning. This case demonstrates that web-associated thrombi are dynamic and may not be apparent even on high-resolution angiography performed shortly before surgery. Surgical intervention with intraoperative ultrasound guidance offers definitive treatment and excellent long-term outcomes. https://thejns.org/doi/10.3171/CASE2610.

Recurrent cervical internal carotid artery vasospasm (RCICAV) is a rare cause of ischemic stroke in young adults. However, its pathophysiology remains largely unknown. RCICAV is a life-threatening condition, sometimes accompanied by coronary spasmodic angina in addition to severe stroke, highlighting the need for further investigation of its etiology and therapeutic approaches. This study aimed to identify the genetic basis of Japanese families harboring RCICAV. Whole-exome and Sanger sequencing analyses were performed in five Japanese patients from four families (two affected siblings and three unrelated sporadic patients) and seven unaffected members from three families enrolled from October 2016 to May 2025. RCICAV was diagnosed using magnetic resonance angiography, which demonstrated vasospasm of the cervical portion of the internal carotid artery during the event and normalization during remission. In vitro and ex vivo analyses of the detected variants were performed to verify functional deficiencies. RCICAV was found to be an autosomal recessive disorder caused by biallelic loss-of-function variants in the PTGIS gene, which encodes the prostacyclin synthase. Three splice-site and nonsense variants, c. 1358 + 2T > C, p.W39X, and p. E314X, were identified in five patients from four families in either homozygous or compound heterozygous states. The c.1358 + 2T > C variant caused exon 9 skipping (p.V403Ifs*24), which was confirmed by a minigene assay and reverse transcription polymerase chain reaction using RNA extracted from peripheral blood leukocytes of a homozygous patient. Human carotid artery endothelial cells expressing these truncated variants exhibited markedly reduced PTGIS protein and prostacyclin metabolite production. The results indicate that prostacyclin synthase deficiency is the core pathology of RCICAV. Given that prostacyclin is a potent vasodilator, impaired biosynthesis is consistent with the disease mechanism and may serve as a promising therapeutic target to prevent life-threatening events, including severe stroke and angina.

Ischemic strokes in young adults are often classified as cryptogenic when standard evaluation fails to identify an underlying cause. Growing evidence connects systemic inflammatory diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), to early-onset atherosclerotic cardiovascular disease (ASCVD) that is driven by proinflammatory cytokines and endothelial dysfunction. Hidradenitis suppurativa (HS), a chronic inflammatory skin condition marked by recurrent abscesses and sinus tracts, shares similar inflammatory pathways but remains underrecognized as a cardiovascular risk factor. We report the case of a 28-year-old active-duty service member who presented with acute ischemic stroke after prior transient visual disturbances. Initial evaluation, including vascular imaging, echocardiography, telemetry, autoimmune and coagulation testing, was unrevealing, and the stroke was labeled cryptogenic. At follow-up, advanced HS (Hurley stage III) was diagnosed, and treatment with adalimumab led to both dermatologic improvement and absence of further neurologic events. This case emphasizes HS as a possible cause of cryptogenic ischemic stroke because of chronic systemic inflammation. Recognizing HS as a systemic disease with cardiovascular and neurological effects is critical. Early diagnosis and prompt treatment may lower long-term morbidity, especially in young military populations where early vascular events have major personal and occupational consequences.

Carotid webs are an underrecognized cause of ischemic stroke in young adults and are associated with a high risk of recurrence when managed with medical therapy alone. Although carotid endarterectomy (CEA) is increasingly performed, histopathological confirmation remains infrequently reported, and the underlying pathological substrate of symptomatic carotid webs is not well defined. In this study, we present the largest pathologically confirmed series of symptomatic carotid webs treated with CEA, providing a comprehensive clinicopathological characterization and evaluation of long-term surgical outcomes. Patients with symptomatic carotid webs were retrospectively identified from institutional databases encompassing both inpatient and outpatient encounters. Clinical features, imaging characteristics, surgical findings, and histopathological results from CEA specimens are presented. Among 39 patients with symptomatic carotid web, 34 underwent CEA with histopathological confirmation of the diagnosis, characterized by focal eccentric intimal fibromyxoid tissue, fibromuscular dysplasia, hyperplasia, or thickening. Notably, concurrent atheromatous changes were noted in 6 patients. All webs were located within 3 cm of the carotid bifurcation, and most (76%) were localized on the posterior wall. Competing stroke mechanisms were identified in 15% of patients. Two-thirds of patients presented with a large or medium vessel occlusion and over half received acute reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy). Two patients experienced transient, minor cranial nerves injuries (hypoglossal nerve and marginal mandibular branch) after CEA. At a median follow-up of 29 months, no patients experienced recurrent stroke (95% CI: 0%-10%), and the median modified Rankin Scale score was 1 (0-1). This study supports CEA as a safe and effective therapeutic option for patients with symptomatic carotid webs and demonstrates its diagnostic value through direct histopathological confirmation. By presenting the largest pathologically validated series to date, our findings further define the vascular pathology underlying carotid webs and underscore the diagnostic value of surgical resection for definitive diagnosis.

Background: Stroke in young adults is increasingly recognized as a significant cause of morbidity and disability. The clinical presentation and radiological characteristics of stroke in individuals aged 15–45 years differ from those observed in older populations. Aim: This study aimed to identify the clinical presentation and radiological profile of patients presenting with stroke between the ages of 15 and 45 years. Methods: A prospective observational study was conducted on 120 patients diagnosed with stroke in the age group of 15–45 years. Detailed clinical evaluation and neurological examination were performed, and radiological assessment using CT scan of the brain was carried out to determine the type and location of stroke. Results: Seizures were observed in 23.3% of patients, while decreased level of consciousness was present in 38.3%. Dysphasia was noted in 30% of patients, and cranial nerve deficits were seen in 61.7% of cases. Motor deficits were the most common neurological manifestation, with hemiparesis occurring in 58.3% of patients. Radiological findings showed that infarction was the most common CT finding (70%), followed by hemorrhage (20%) and venous thrombosis (10%). Overall, ischemic stroke accounted for 80% of cases, whereas hemorrhagic stroke accounted for 20%. Conclusion: Stroke in young adults commonly presents with motor weakness, speech disturbances, and cranial nerve deficits. Ischemic stroke is the predominant subtype observed in this age group. Early recognition of clinical features combined with prompt radiological evaluation is essential for effective diagnosis and management.

PurposeThe incidence of ischemic stroke in young adults has been increasing. However, there is a lack of in-depth understanding of relevant clinical features, particularly in specific geographic and climatic settings. This study aimed to comprehensively investigate the clinical features, including etiology and characteristics, of ischemic stroke in young adults compared with elderly patients from an island population characterized by a subtropical monsoon climate.Patients and MethodsA total of 1,010 patients with ischemic stroke were included and divided into a young group (454 patients, aged 18–50 years) and an elderly group (556 patients, aged >50 years). Clinical and radiological data were collected and compared between the two groups. Continuous and categorical variables were compared using the t-test (or non-parametric tests) and chi-square test, respectively. Binary logistic regression analyses were used to investigate differences between the two groups.ResultsBody mass index, leukocyte count, lymphocyte count, uric acid, and triglyceride levels were higher in the young group than in the elderly group, whereas vitamin B12 levels were lower. In addition, the proportions of cardiogenic embolism, other etiologies and unexplained strokes, and infarcts in the basal ganglia region were significantly higher in the young group. These results suggest age-related differences in clinical characteristics within this island study population.ConclusionHigh body mass index, leukocyte count, uric acid, triglyceride levels, and low vitamin B12 levels are associated with ischemic stroke in young adults. Young adult patients had a higher prevalence of basal ganglia infarction, with a different subtype distribution from elderly patients. These findings highlight the importance of considering geographic specificity and age-related differences when developing stroke prevention and management strategies, formulating public health policies, and allocating medical resources for ischemic stroke.

Stroke is traditionally considered a disease of older adults; however, its incidence among young adults aged 18-45 years is increasing globally. In sub-Saharan Africa, stroke burden remains high, yet data on its risk factors in young adults are limited. This study aimed to identify and determine the predominant risk factors for stroke among young adults in Northern Nigeria. A hospital-based retrospective study was conducted at Federal Teaching Hospital Katsina. Medical records of patients aged 18-45 years with brain imaging-confirmed stroke from January 2023 to December 2025 were reviewed. Demographic and clinical data, including stroke subtype and risk factors, were extracted. Descriptive statistics summarized the distribution of risk factors and stroke subtypes. Age differences between stroke types were analyzed using the Mann-Whitney U test, and associations between risk factors and stroke subtype were assessed using Fisher's exact test. A total of 36 young adults met the inclusion criteria. Females accounted for 21 (58.3%) cases, while males accounted for 15 (41.7%) cases. The mean age was 40.5±4.7 years for males and 35.3±7.7 years for females. Ischemic stroke was the predominant subtype, 25 (69.4%), with hemorrhagic stroke accounting for 11 (30.6%) cases. Hypertension was the most common risk factor, occurring in 19 (52.8%) cases and being more frequent in females than in males. Other risk factors included cardiac disease in three (8.3%) cases, diabetes mellitus in three (8.3%) cases, smoking in three (8.3%) cases, HIV infection in two (5.6%) cases, and illicit drug use in two (5.6%) cases. Most risk factors were restricted to one stroke subtype. No significant associations were found between individual risk factors and stroke subtypes (all p>0.05), likely due to the small sample size. Hypertension is the predominant and clinically significant risk factor for stroke among young adults in Northern Nigeria, with ischemic stroke being the most common subtype. The predominance of modifiable risk factors underscores the need for early detection, routine blood pressure screening, lifestyle modification, and public health interventions targeting young adults. Larger multicenter studies are warranted to further characterize stroke epidemiology and guide preventive strategies in sub-Saharan Africa.

Background/Objectives: Takayasu arteritis is an important non-atherosclerotic cause of ischemic stroke in young adults. However, the relative contribution of systemic inflammation, inherited thrombophilia, and supra-aortic hemodynamic impairment to cerebrovascular events in these patients remains insufficiently defined. This study aimed to evaluate the relative impact of systemic inflammatory activity, hereditary and acquired thrombophilia markers, and supra-aortic vascular involvement on cerebrovascular ischemic events in patients with digital subtraction angiography (DSA) confirmed supra-aortic Takayasu arteritis. Methods: A retrospective cross-sectional analysis was conducted in consecutively evaluated patients with non-atherosclerotic inflammatory stenosis or occlusion of the carotid, subclavian, or vertebral arteries confirmed by digital subtraction angiography. Age- and sex-matched hospital-based individuals without autoimmune, thrombotic, or cerebrovascular diseases served as controls. Laboratory assessments including erythrocyte sedimentation rate, lipoprotein(a), homocysteine, antinuclear antibody, rheumatoid factor, antiphospholipid antibodies, and a hereditary thrombophilia panel were obtained 4-6 weeks after clinical presentation during a stable clinical phase. Results: Among 46 patients with Takayasu arteritis, 21 patients presented with ischemic stroke. The stroke-positive subgroup demonstrated higher inflammatory activity and a slightly greater prevalence of supra-aortic occlusive lesions, particularly involving the common carotid, internal carotid, and subclavian arteries. Although lipoprotein(a) levels showed statistical differences between groups, mean values remained within reference ranges and were not clinically elevated. The distribution of hereditary thrombophilia variants and the prevalence of elevated homocysteine levels did not differ significantly between groups. Clinical outcomes were favorable overall, with no mortality and functional independence achieved in the majority of stroke-positive patients. Conclusions: These findings suggest that systemic inflammation and supra-aortic hemodynamic impairment may play a more prominent role than inherited thrombophilia in the development of cerebrovascular ischemic events in patients with Takayasu arteritis. Selective rather than routine thrombophilia testing may therefore be appropriate in selected clinical contexts, while careful control of inflammatory activity and continuous vascular monitoring remain essential components of management.

Cerebral venous thrombosis (CVT) is a major cause of stroke in young adults, but existing prognostic scores rely only on clinical and radiologic data and may not reflect brain function. We evaluated the use of noninvasive multimodal brain monitoring (MBM) in moderate-to-severe CVT and its added prognostic value over the Cerebral Venous Thrombosis-Grading Scale (CVT-GS). In this prospective observational study, 53 patients with moderate-to-severe CVT admitted to a tertiary neurosciences center (September 2021 to March 2023) underwent bedside MBM within 24 hours of admission. Tools included transcranial Doppler (TCD) for flow velocities, pulsatility index (PI), and autoregulation (transient hyperemic response ratio [THRR]); ultrasound for optic nerve sheath diameter (ONSD); bispectral index (BIS); and regional cerebral oxygen saturation (rSO₂). Neurological outcome was assessed at 1 month using the modified Rankin Scale (mRS). Predictors were analyzed using correlation and logistic regression. ROC curves were compared with the DeLong test. At 1 month, 27 patients (50.9%) had a poor outcome (mRS ≥3), including 12 deaths (22.6%). Raised ONSD, elevated PI, impaired autoregulation (THRR ≤1.02), and reduced BIS were significantly associated with poor outcome and mortality, while rSO₂ and most TCD velocities were not. Adding MBM to CVT-GS improved accuracy: for mortality: adding ONSD and PI increasedAUC from 0.74 to 0.91; for poor outcome: addingTHRR and BIS increasedAUC from 0.76 to 0.92 (both P<0.05). Noninvasive MBM can be used in patients with CVT. Integrating noninvasive surrogates of ICP, autoregulation, and brain electrical activity with CVT-GS improves outcome prediction.