Ischemic stroke is a leading cause of death and disability. Fear of intracranial hemorrhage (ICH) has been the primary reason for withholding tissue plasminogen activator (tPA) and thrombectomy, the only two widely accepted treatments for ischemic stroke. Thrombolysis treatment is only allowed in a very narrow time window (within 4.5–6 h). However, so far, other than the time window guideline, there is no reliable indicator available in the clinic to predict ICH before thrombolysis treatment. Recently, extensive research efforts have been devoted to the development of reliable indicators to predict ICH and safely guide the thrombolysis treatment. Accumulating evidence suggests that ischemic brain regions with a compromised blood–brain barrier (BBB) before tPA treatment develop ICH at the later time during thrombolytic reperfusion. Assessing BBB damage before thrombolysis could potentially help predict the risk of ICH after thrombolysis. This article reviews the literature reports on BBB damage biomarkers that have been developed in recent years, including biochemical markers such as BBB structural proteins, circulating brain microvascular endothelial cells, plasma albumin, and brain parenchyma proteins, as well as image markers such as magnetic resonance imaging assessment for BBB damage.

The treatment of acute ischemic stroke patients with a proximal large vessel occlusion (LVO) in the anterior circulation has seen tremendous advances initially with the demonstration of the substantial benefit of thrombectomy within 6-h of stroke onset and then with the demonstration of thrombectomy in carefully selected patients up to 24-h from onset. In both the early and late time windows, imaging played an important role in patient selection, especially in the later time window trials where very strict imaging inclusion criteria were employed to identify patients with a small/moderate sized ischemic core on computed tomography perfusion scanning and diffusion-weighted magnetic resonance imaging. In clinical practice, it is important to identify LVO patients quickly so several scoring scales have been developed to help route appropriate patients to a thrombectomy capable center. The recently reported thrombectomy trials left many unanswered questions such as do patients with more distal vessel occlusions benefit, do patients with LVO and mild clinical deficits benefit from thrombectomy, what is the largest extent of baseline ischemic core that still benefits from thrombectomy and what is the best approach to anesthesia with thrombectomy. These questions and other are being addressed in ongoing and future clinical trials that will likely expand the indications and safety for this powerfully effective therapy and also determine if neuroprotection is synergistic with thrombectomy.

Stroke is a leading cause of disability in the United States and current treatment for stroke is limited to two modalities with well-defined time restraints. The prehospital setting is a significant and relatively easy setting for innovation in stroke care, as the most clinical decisions are made within the first several hours of symptom onset. In this review, we look at recent innovations in improving prehospital care for acute stroke including the conception of mobile stroke units, the ongoing development of stroke models for emergency providers, barriers to prehospital care, and the innovation of new telephone applications. Although there are notable improvements in acute stroke care, additional research is needed to further improve on current models and technologies.

Stroke leads to inflammatory and immune response in the brain and immune organs. The gut or gastrointestinal tract is a major immune organ equipped with the largest pool of immune cells representing more than 70% of the entire immune system and the largest population of macrophages in the human body. The bidirectional communication between the brain and the gut is commonly known as brain–gut or gut–brain axis. Stroke often leads to gut dysmotility, gut microbiota dysbiosis, “leaky” gut, gut hemorrhage, and even gut-origin sepsis, which is often associated with poor prognosis. Emerging evidence suggests that gut inflammatory and immune response plays a key role in the pathophysiology of stroke and may become a key therapeutic target for its treatment. Ischemic brain tissue produces damage-associated molecular patterns to initiate innate and adaptive immune response both locally and systemically through the specialized pattern-recognition receptors (e.g., toll-like receptors). After stroke, innate immune cells including neutrophils, microglia or macrophages, mast cells, innate lymphocytes (IL-17 secreting γδ T-cell), and natural killer T-cell respond within hours, followed by the adaptive immune response through activation of T and B lymphocytes. Subpopulations of T-cells can help or worsen ischemic brain injury. Pro-inflammatory Th1, Th17, and γδ T-cells are often associated with increased inflammatory damage, whereas regulatory T-cells are known to suppress postischemic inflammation by increasing the secretion of anti-inflammatory cytokine IL-10. Although known to play a key role, research in the gut inflammatory and immune response after stroke is still in its initial stage. A better understanding of the gut inflammatory and immune response after stroke may be important for the development of effective stroke therapies. The present review will discuss recent advances in the studies of the brain–gut axis after stroke, the key issues to be solved, and the future directions.

As the worldwide population ages, the morbidity of neurodegenerative, cardiovascular, cerebrovascular, and endocrine diseases, such as diabetes and osteoporosis, continues to increase. The etiology of geriatric diseases is complex, involving the interaction of genes and the environment, which makes effective treatment challenging. Traditional Chinese medicine, unlike Western medicine, uses diverse bioactive ingredients to target multiple signaling pathways in geriatric diseases. Radix puerariae is one of the most widely used ancient traditional Chinese medicines and is also consumed as food. This review summarizes the evidence from in vivo and in vitro studies of the pharmacological effects of the main active components of the tuber of Radix puerariae on geriatric diseases.

Solitaire FR device is a Food and Drug Administration-approved device for mechanical thrombectomy. It has been tested in various clinical trials for its safety and efficacy. We report a case of inadvertent detachment of the Solitaire FR device at stent–stent wire interface while performing mechanical thrombectomy. We review a rare phenomenon of retained Solitaire FR stent retriever in situ and discuss technique of avoidance and its management.

Emergency department visits for a headache are relatively common, and in most cases, the etiologies of the headache are typically benign. We present a case of a patient who presented to the emergency room for new onset of unremitting unilateral headache. She subsequently had two hospital visits and three separate imaging modalities to identify vein of Labbe thrombosis. The vein of Labbe is a relatively smaller vein which runs superficially and laterally. In our patient, a cerebral venous thrombosis (CTV) was unable to identify vein of Labbe thrombosis, requiring eventually a magnetic resonance imaging (MRI) with and without contrast to identify the culprit etiology. CTV is frequently used in the acute setting due to its speed of acquisition and shorter wait times in the hospital. For patients that fit criteria for venous sinus thrombosis, we caution the use of CTV in identifying the causative etiology, and would consider the MRI as a better imaging modality for these patients.