Simon Fandler-Höfler

Neurologist focussing on intracerebral haemorrhage, stroke and neurological emergency medicine @MedUniGraz, Austria and @UCLStrokeRes

[Simon Fandler-Höfler @SimonFaHo]

(1/3) In which patients with intracerebral hemorrhage should advanced work-up such as digital subtraction angiography be performed? The MACRO score may help - using a few simple MRI parameters it allows to reliably assess the risk of macrovascular causes: https://t.co/vG5bIj4WLq

[Amy Nelson @amypknelson]

New paper out today - 8 years of work! Prehospital emergency anaesthesia with intubation improves survival by 10.3% in high risk major trauma. Not only life-saving, it is so cost effective (£100m in DALYs/UK/year) it justifies NHS funding of air ambulances https://t.co/9TKzeJTg07

[Simon Fandler-Höfler @SimonFaHo]

On the other hand, patients with non-lobar ICH had a higher risk of recurrent ischaemic stroke — possibly due to multiple concurrent stroke mechanisms (AF + small vessel disease). Major limitations: modest sample size, few outcome events. Larger meta-analyses needed.

[Simon Fandler-Höfler @SimonFaHo]

Should patients with AF and history of ICH be treated with oral anticoagulation? A subanalysis of PRESTIGE-AF underlines individualised decisions (based on neuroimaging) - particular risk of recurrent ICH when cortical superficial siderosis and chronic ICH on MRI are present.

[Neurology Journal @GreenJournal]

In this study the authors assessed the role of neuroimaging in identifying patients with particular susceptibility to #IschemicStroke or intracerebral hemorrhage, with the potential to enable individualized risk stratification: https://t.co/RFLrVGrafe

#NeuroTwitter @SimonFaHo

[Simon Fandler-Höfler @SimonFaHo]

3/3 On the other hand, patients with non-lobar ICH had a higher risk of recurrent ischaemic stroke — possibly due to multiple concurrent stroke mechanisms (AF + small vessel disease).
Major limitations: modest sample size, few outcome events. Larger meta-analyses needed.

[Simon Fandler-Höfler @SimonFaHo]

1/3 Should patients with AF and history of intracerebral haemorrhage treated with oral anticoagulation? This subanalysis of PRESTIGE-AF provides new data, indicating that individualised decisions based on neuroimaging (+clinical profiles) might be prudent: https://t.co/8Lc4CyLRAX

[Simon Fandler-Höfler @SimonFaHo]

2/3 In this RCT (n=313) randomising patients with AF and prior ICH to anticoagulation vs not, cortical superficial siderosis and chronic intracerebral macrohaemorrhages on MRI strongly predicted recurrent ICH — potentially identifying patients at excess bleeding risk from OAC.

[International Journal of Stroke @IntJStroke]

#FlashbackFriday !
🌍🧠World Stroke Organization (WSO): Global intracerebral hemorrhage factsheet 2025

https://t.co/osRsPRvi0i @adrianpj1 @WorldStrokeOrg @WorldStrokeEd

[International Journal of Stroke @IntJStroke]

🧠Study of long-term outcome in young patients after ischemic stroke or TIA

⬆️Women had higher risk of post-stroke depression, anxiety & fatigue

🫀🚭Hypertension & smoking were modifiable risk factors contributing to worse outcome

Read more here!👇
https://t.co/d0nSsUHgHL

[Stephan A Mayer @stephanamayer]

This is a breakthrough study that forges a new future — POC biomarkers for identifying #ICH in the prehospital phase.

Rapid Diagnosis of ICH with GFAP Levels on a Point-of-Care Device (DETECT) @neurology #curingcoma https://t.co/ufpoN4aFhO

[Stroke AHA/ASA @StrokeAHA_ASA]

#STROKE: In patients with acute ischemic stroke, admission NT-proBNP may predict the in-hospital development of atrial fibrillation detected after stroke (AFDAS), and a threshold of 505 pg/ml confers good discriminatory value. #AHAJournals https://t.co/3IAFCL6Sc9

[Stroke Research Center Bern @StrokeBern]

How do chronic ischemic lesions differ in patients with #AtrialFibrillation and #SmallVesselDisease?
We compared MRIs from @ELAN_Trial and #SVD cohorts: whereas AF patients had mostly cortical cerebellar lesions, SVD patients had deep lesions
https://t.co/95gesP3RIV

[David Seiffge @DavidSeiffge]

EURECA: New data on recurrent ICH: every second recurrence is adjacent to index ICH. Those bleedings occur early and are strongly associated with CAA. Great collaboration lead by @mbgoeldlin @StrokeBern

Author interview podcast: https://t.co/wMxa6qUunG

https://t.co/OYyJ91A5rO

[Gargi Banerjee @DrGargiBanerjee]

New in @JNNP_BMJ - the next chapter in the story of iatrogenic CAA 📕 and it really does seem to be different to sporadic CAA. Presence of deep haemorrhagic pathology in particular is unexpected but persistent signal.

So what does this mean? … 1/3 🧵

https://t.co/WCTwDesW8W

[Hatice Ozkan @HOzkan92]

Our meta-analysis of 279 stroke studies over 24 years, with 117K+ participants, found that 1 in 2 stroke patients experience adverse non-motor outcomes. Adjusted meta-regression shows 8/10 domains persist more than 10-years. Time for change in stroke care. https://t.co/YAHCdsH9OX

[UCL Stroke Research @UCLStrokeRes]

Check out our latest paper providing the most comprehensive description of the phenotype and natural history of iatrogenic Cerebral #Amyloid Angiopathy. A great international collaboration thanks to @SimonFaHo @DrGargiBanerjee @KKaushikMD @LVpanteleenko and many others!

[Simon Fandler-Höfler @SimonFaHo]

4/4 This indicates that patients with iCAA appear to have distinctive MRI characteristics, which might differentiate iCAA from other CAA subtypes and provide new insights into disease mechanisms.
https://t.co/ZV9y4h8836
@DrGargiBanerjee @UCLStrokeRes @BenStorti @KKaushikMD

[Simon Fandler-Höfler @SimonFaHo]

1/4 Iatrogenic cerebral amyloid angiopathy (iCAA) is a scary rare disease affecting patients 30-50 years after possible CNS exposure to pathological amyloid-beta. In a large international collaboration, we investigated neuroimaging findings and clinical outcomes in 51 patients.

[Simon Fandler-Höfler @SimonFaHo]

3/4 Besides severe CAA on MRI, we found:
a) major progression of CAA markers over 4 years
b) ipsilateral-dominant spread of haemorrhagic lesions (from amyloid-beta exposure)
c) frequent deep microbleeds
d) frequent inflammatory changes
e) very frequent small intragyral ICH

[Neurology Journal @GreenJournal]

This case highlights the diagnostic approach and importance of thorough clinical evaluation of young patients with intracerebral hemorrhages.
https://t.co/D4nSxDi5cA

#NeurologyRF #NeuroTwitter