Objective To identify relationships between skull fracture (SF) and hyperfibrinolysis (HF) among patients with isolated traumatic brain injury (TBI). Methods This was a retrospective cohort study based on a nationwide neurotrauma database in Japan. Adult patients with isolated TBI (head Abbreviated Injury Scale [AIS] >2, any other AIS <3) and who were registered in the multicenter neurotrauma registry from 2015 to 2017 were included. To examine the relationship between SF and HF, we conducted multivariable logistic regression analyses to calculate the adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) for HF. HF was defined as a D-dimer level ≥38 mg/L on arrival based on a previous study. Results A total of 335 patients were enrolled and the median age of the cohort was 64 years (interquartile range, 44–76 years). HF was observed in 161 patients (48.1%). The association of SF with HF yielded an aOR of 4.78 (95% CI, 2.71–8.42) compared to non-SF in multivariable logistic regression analysis. In addition, the associations of skull base fracture, skull vault fracture, and combination of skull base and vault fracture with HF yielded the corresponding aORs of 3.60 (95% CI, 1.20–10.81), 4.99 (95% CI, 2.63–9.44), and 4.84 (95% CI, 2.41–9.72), respectively, relative to non-SF. Conclusion This multicenter observational study demonstrated the association of SF with HF in patients with isolated TBI.
Objective Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not well understood, and its relationship with the functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes. Methods In this multicenter cohort study, we retrospectively analyzed data from 27 hospitals that contributed to the Saiseikai Stroke Database (2013–2021). We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of BAD compared with lacunar infarction (LI) for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included, and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI. Results Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (aOR, 2.77; 95% CI, 2.42–3.17; relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients. Conclusion BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.
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Predicting early neurological deterioration in acute branch atheromatous disease without reperfusion therapy: a machine learning model Li Zeng, Wei He, Xiuxiu Lu, Liangbing Zhang Frontiers in Neuroscience.2026;[Epub] CrossRef
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