Ischaemic stroke in adults under 55 nearly doubled over 27 years in one US region

The edition in brief

A population-based US study of 2,076 first strokes in adults aged 20 to 54 found incidence rose from 34 to 62 per 100,000 person-years between 1993/4 and 2020, driven by ischaemic stroke, which nearly doubled, while incidence in older adults fell. Hypertension, diabetes, atrial fibrillation and substance use all became more common in young patients; 30-day case fatality fell modestly, from 11.7% to 9.4%. A post hoc analysis of the ATTENTION trial in 340 patients with basilar artery occlusion found baseline MRI did not improve 90-day outcomes over CT (OR 0.99) and did not significantly delay treatment. A network meta-analysis of 173 randomised trials in Parkinson disease found mind–body exercise had the largest effect on motor scores and more planned weekly exercise was associated with better motor scores and balance, though confidence was low. A meta-analysis of four trials of tolebrutinib suggested reduced disability progression in non-relapsing secondary progressive multiple sclerosis, but the authors describe the evidence as preliminary.