Neurology

Long-term stroke risk after TIA or minor stroke is driven by vascular factors, imaging lesions, and stroke subtype

This meta-analysis pooled 28 cohorts with 86,810 patients with TIA or minor stroke followed for at least one year. Older age, male sex, atrial fibrillation, diabetes, hypertension, ischemic heart disease, and prior stroke/TIA independently increased long-term stroke risk. Clinical and imaging markers were influential: ABCD2 ≥4, acute infarct on neuroimaging, and minor stroke versus TIA carried substantial population-attributable fractions. Cardioembolic, large-artery, and small-vessel etiologies all conferred higher subsequent stroke risk than other subtypes. 1

Distinct 24-hour systolic blood pressure trajectories after ICH predict 90-day disability and death

This pooled analysis of 11,269 ICH patients from INTERACT and ATACH-II identified six systolic blood pressure trajectories over 24 hours. Compared with a consistently low SBP group, progressively higher or persistently severe hypertensive trajectories had higher odds of poor 90-day mRS outcomes. A severe hypertensive trajectory showed the highest adjusted odds of death or disability, regardless of BP-lowering strategy. Very large early reductions from >200 to <140 mm Hg within one hour attenuated or reversed benefits of intensive lowering. 2

Peri-ictal DWI/FLAIR abnormalities after de novo status epilepticus predict epilepsy-level seizure risk

Among 135 adults with first nonhypoxic status epilepticus and no prior epilepsy, 32% developed unprovoked seizures over median 23-month follow-up. Peri-ictal DWI/FLAIR abnormalities conferred a 4-year cumulative seizure probability above 60%, aligning with an epilepsy diagnosis threshold. Patients with only ASL hyperperfusion had low 4-year risk, whereas those without peri-ictal abnormalities had intermediate risk. In multivariable analysis, DWI/FLAIR abnormalities and remote etiology independently predicted higher seizure probability beyond clinical and EEG features. 3

Sleep EEG brain age index independently associates with incident dementia across diverse cohorts

This individual participant data meta-analysis pooled 7,105 dementia-free adults from five community cohorts with home polysomnography. A machine learning–derived brain age index quantified the gap between EEG-based brain age and chronological age from central sleep EEG channels. Across cohorts, each 10-year increase in brain age index was associated with a 39% higher risk of incident dementia. Dementia incidence and follow-up duration varied substantially across cohorts, but the association was consistent after accounting for death as a competing risk. 4