{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:55:37Z","timestamp":1778162137738,"version":"3.51.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006390","name":"University of Lausanne","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006390","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A decreased level of consciousness (DLOC) at onset is infrequent in patients with acute ischemic stroke (AIS). We assessed stroke localization, patient and stroke characteristics, revascularization rates, and long-term outcome in consecutive AIS patients presenting with acute DLOC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed all AIS patients from 1\/2003\u20136\/2021 admitted to a single academic hospital. DLOC at stroke onset was defined as being described in the prehospital phase or being present on hospital arrival based. Using multivariable regression analyses, we compared patients with and without DLOC regarding anatomical stroke localization, baseline characteristics, frequency of revascularization, favourable functional 3-month outcome, and 12-month mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6491 consecutive AIS patients (median age\u2009=\u200974.8\u00a0years, IQR:20.2; 44.2% female), 778 (12%) had DLOC, representing 10.0% of patients from the primary catchment area. Strokes affecting the upper brainstem, thalamus or temporal lobes more frequently showed DLOC. DLOC was independently associated with multiple territory lesions, posterior circulation and right cerebral localization, unwitnessed stroke onset, stroke severity, initially missed stroke diagnosis (all adjusted\n                      <jats:italic>p<\/jats:italic>\n                      -values\u2009&lt;\u20090.05). Admission temperature and systolic blood pressure showed a U-shaped association with DLOC. After multiple adjustments, favourable 3-month outcome was less frequent (adjusted OR (ORadj):0.54,95%CI:0.43\u20130.69) and 12-month mortality rate higher in DLOC patients (ORadj:1.35 (95%CI:1.16\u20131.56). The latter difference disappeared after adjusting for change of goals of care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 10% of AIS patients with DLOC most often involve the upper brainstem, thalami and temporal lobes. DLOC patients have a higher likelihood of unwitnessed stroke onset and of their stroke being missed. Long-term functional outcome is clearly worse and mortality higher with DLOC even after adjustment for other prognostic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13548-5","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T05:57:16Z","timestamp":1766296636000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decreased level of consciousness in acute ischemic stroke: risk factors, territories, stroke mechanisms and outcome. A single-centre cohort study"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1907-0186","authenticated-orcid":false,"given":"P.","family":"Palazzo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Strambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Pistocchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Saliou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Puricel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Lambrou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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All data come from routine clinical and radiological management. Before analysis, the data were anonymized, i.e., the datasets did not contain any direct or unique identifiers such as a unique ID number or name, address or date of birth. This procedure respects the anonymization principles of the Swiss Human Research Ordinance from 2013 (HRO, Art. 25). Patients received written information from the hospital that their routinely collected clinical data may be used for quality and scientific purposes. However, there is no legal need for patient consent, for considering patient refusal to participate in quality control projects, for ethical commission approval for the use of such data in an anonymized form, or for quality assessment projects according to the Swiss Human Research Act (HRA, Art. 3) and the applicable data protection legislation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"We will make supplementary files and key datasets openly available in appropriate digital data repositories that conform to the Fair Data principles and maintained by a non-profit organisation to demonstrate reproducibility. Unstructured data will be shared via the H2020 data repository Zenodo-FBM\/CHUV community.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data Availability"}}],"article-number":"35"}}