Stroke rising in young adults, levodopa cleared of freezing, and a new antithrombotic

The edition in brief

Five findings for the neurology desk. A US population-based study spanning three decades found stroke incidence in adults aged 20 to 54 nearly doubled, from 33.9 to 62.2 per 100,000 person-years, driven by ischaemic stroke and rising hypertension, diabetes, atrial fibrillation and substance use, while 30-day case fatality fell modestly. Pooled cohorts of more than 27,000 patients with Parkinson disease found no consistent association between levodopa exposure and freezing of gait after adjusting for disease duration and severity, which were the real drivers. A commentary argues that CREST-2 now makes carotid stenting an evidence-based adjunct to intensive medical therapy in selected high-grade asymptomatic stenosis, with shared decision-making. A pearl covers the workup of stroke in a young adult. The practice-changer is a meta-analysis of three randomised trials and 14,239 patients: adding a factor XIa inhibitor to antiplatelet therapy after noncardioembolic stroke or TIA reduced any stroke (risk ratio 0.75) and ischaemic stroke (0.74) without a significant increase in major bleeding, though the estimate rests heavily on a single phase 3 trial of an as-yet-unapproved class.