Search Results (450)

Computed tomography (CT) scan is a widely used, non-invasive, sensor-based imaging technique that provides critical intracranial information for rapid stroke assessment. Accurate segmentation of intracerebral hemorrhage (ICH) in sensor-derived CT images is vital for clinical decision-making. Effective intelligent analysis of CT images is key to achieving reliable computer-aided diagnosis. However, existing deep learning methods struggle with complex ICH lesions characterized by blurred boundaries, irregular shapes, and large-scale variations. To address these challenges, this paper proposes TransAMGNet, a hybrid U-shaped network with Transformer integration for ICH CT image segmentation. The network is built on a residual U-Net backbone and introduces a Transformer encoder to strengthen global context modeling, thereby improving the representation of complex lesion morphology. Specifically, in the encoding stage, we design an Adaptive Dual-branch Channel Attention Module (ADCAM), which jointly models global and local channel information to enhance the model’s sensitivity to important feature responses. In the skip-connection pathway, we introduce a Multi-scale Feature Enhancement Module (MFEM), which preserves high-resolution spatial details while supplementing multi-scale contextual information to improve shallow-deep feature fusion. During decoding, a Gate-enhanced Dynamic Upsampling Module (GDUM) is constructed to improve the recovery of lesion boundaries and fine-grained structures through the synergy of gated recalibration and content-aware upsampling. The proposed method is systematically evaluated through comparative experiments and ablation studies. Experimental results show that TransAMGNet outperforms competing methods across multiple evaluation metrics, achieving Dice, Recall, IoU, Precision, and HD95 values of 90.47 ± 0.58%, 87.83 ± 3.71%, 81.26 ± 0.78%, 91.13 ± 0.95%, and 32.94 ± 1.1, respectively. The ablation studies further verify the effectiveness of each module. These results demonstrate that TransAMGNet can effectively improve segmentation performance for complex ICH lesions. Full article

Background/Objectives: To evaluate the discriminative value of perilesional microstructural alterations assessed by diffusion tensor imaging (DTI) parameters in differentiating malignant and benign causes of intracerebral hemorrhage. Methods: This retrospective study included patients with intracerebral hemorrhage classified as benign or malignant based on follow-up findings and histopathological diagnosis. Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), lesion-to-normal (L/N) ratios, and perilesional edema index (PEI) were extracted from standardized perilesional regions. Diffusion parameters were compared between groups, and their discriminative performance was assessed using ROC analysis and logistic regression. Results: A total of 41 patients (20 benign, 21 malignant) were included. Malignant cases demonstrated significantly greater PEI and distinct diffusion abnormalities, with markedly higher AD, RD, and MD values, as well as elevated L/N ratios (all p < 0.001). FA was significantly reduced in malignant cases (p = 0.016). Conclusions: Diffusivity metrics—particularly AD, RD, and MD values and their L/N ratios—demonstrated excellent diagnostic performance in differentiating malignant from benign causes of intracerebral hemorrhage, further informed by the PEI, and may support clinical decision-making in diagnostically challenging cases. Full article

Blood-based biomarkers offer a promising “biochemical imaging” approach for acute ischemic stroke (AIS) management, providing objective and accessible tools to complement conventional neuroimaging. This narrative review synthesizes recent advances in biomarkers derived from multiple neurovascular unit (NVU) compartments, including glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neuron-specific enolase (NSE), neurofilament light chain (NfL), matrix metalloproteinase-9 (MMP-9), Claudin-5, Occludin, brain-derived neurotrophic factor (BDNF), interleukin-33 (IL-33), tumor necrosis factor-alpha (TNF-alpha), PARK7/DJ-1, glycogen phosphorylase BB (GP-BB), and circulating microRNAs. We focus on their stage-specific clinical utility across three scenarios: (1) ultra-early differentiation between ischemic stroke and intracerebral hemorrhage in prehospital and emergency settings; (2) dynamic prediction and monitoring of hemorrhagic transformation after reperfusion therapies; and (3) assessment of infarct burden, neurorepair potential, and long-term functional outcomes. Despite their promise, clinical translation remains hindered by assay platform heterogeneity, lack of standardized cut-off values, limited cost-effectiveness data, and insufficient prospective validation adjusted for key covariates such as age and renal function. We further discuss multi-marker panel construction, including strategies to address biomarker collinearity and overfitting. Future directions emphasize stage-specific panels, point-of-care testing devices, and artificial intelligence algorithms to advance precision medicine in stroke care. Full article

Herpes simplex virus encephalitis (HSVE) is the most common infectious encephalitis and is associated with high morbidity and mortality when not treated in time. Symptoms include fever, headache, fatigue, neurological deficits such as aphasia and epileptic seizures. While hemorrhagic transformation is a common complication in HSVE, intracerebral hematoma (ICH) as the initial or main presentation is rare. We present two patients with HSVE who displayed a large temporal hematoma as the main finding on cerebral imaging. We further conducted a systematic literature review to identify all published cases of ICH in HSVE. Forty-nine publications met the inclusion criteria, describing a total of 55 patients. In 38 of these, HSVE could be definitely confirmed by brain biopsy, autopsy or PCR. We analyzed these cases according to age, gender, lag from symptom onset to hospital admission, lag from hospital admission to detection of hemorrhage, location of encephalitis and hemorrhage, received treatment and outcome. With a median age of 45 years, this cohort is significantly younger than general HSVE populations described previously. In conclusion, our review shows that, albeit rare, awareness about ICH complicating HSVE is highly relevant as failure to recognize an atypical course of HVSE may result in a delay of effective antiviral treatment, which is related to an unfavorable or even fatal outcome. Full article

Background and Clinical Significance: Cerebral amyloid angiopathy (CAA) is a neurovascular disorder characterized by the deposition of amyloid beta (Aβ) peptides within the walls of small-to-medium-sized cerebral vessels, leading to vascular fragility and an increased risk of lobar intracerebral hemorrhage (ICH), cognitive decline, and recurrent stroke. CAA is an important cause of spontaneous ICH in elderly patients and may be underrecognized, particularly when presenting with acute neurologic symptoms that mimic ischemic stroke. Early identification has significant implications for management, prognosis, and secondary prevention. Case Presentation: An 80-year-old male presented to the emergency department with incoherent speech, rambling, and severe headache concerning for acute stroke. His medical history was notable for a prior cerebrovascular accident, hypertension, diabetes mellitus, benign prostatic hyperplasia, and recent evaluation for dementia-like symptoms. Initial neuroimaging revealed a 3.2 cm intraparenchymal hemorrhage in the left occipital lobe with surrounding edema. Subsequent MRI demonstrated a lobar hemorrhage pattern suggestive of CAA based on imaging findings and clinical context. The patient was admitted to the intensive care unit (ICU) for close neurologic monitoring. He remained hemodynamically stable with no new motor or sensory deficits. Over a three-day hospital course, his speech and visual deficits improved. Blood pressure was carefully controlled, and repeat imaging demonstrated stable hemorrhage without progression. He was diagnosed with probable CAA and discharged home with supportive services. Conclusions: This case highlights the importance of considering cerebral amyloid angiopathy in elderly patients presenting with spontaneous lobar intracerebral hemorrhage and cognitive symptoms. Prompt recognition and appropriate neuroimaging are critical for diagnosis, risk stratification, and guiding management. Full article

Background: Hypertrophic olivary degeneration (HOD) is a rare neurological condition resulting from trans-synaptic degeneration of the inferior olivary nucleus (ION) following disruption of the dentato-rubro-olivary pathway, also known as the Guillain–Mollaret triangle (GMT). Although the clinical and radiologic features of HOD have been previously described, the precise temporal correlation between clinical symptom onset and manifestations on magnetic resonance imaging (MRI) remains difficult to establish, and the factors contributing to accelerated disease progression are poorly understood. Case Presentation: A 43-year-old male presented with intracerebral hemorrhage involving the left midbrain, bilateral pons, and cerebellum. Serial MRI was prospectively performed starting four weeks post-hemorrhage, at which time no signal abnormalities were detected in the ION. However, at 9 weeks, T2 hyperintensity first emerged in the bilateral ION. Approximately 2 weeks after this finding, the patient developed characteristic palatal and lingual tremors, accompanied by a dissociated vertical pendular nystagmus that was predominantly monocular (right eye). In addition, severe dysphagia was also noted, with videofluoroscopic swallowing study (VFSS) showing aspiration across all diets. A subsequent MRI obtained at 13 weeks post-insult (two weeks after tremor onset) revealed newly developed bilateral ION hypertrophy, with the maximal diameter increasing from a 5 mm baseline to 7 mm. Follow-up MRI at 17 weeks post-hemorrhage revealed further progression with increased hypertrophy and signal intensity. Dysphagia persisted throughout the clinical course, ultimately necessitating percutaneous endoscopic gastrostomy (PEG) tube insertion. Conclusions: This case provides rare, longitudinal documentation of the clinico-radiologic progression of HOD, facilitated by a pre-insult baseline MRI and prospective serial imaging. Our findings provide a detailed timeline of the transition from signal abnormality to hypertrophy in correlation with clinical symptom emergence. Full article

Background and Purpose: Tenecteplase (TNK) within 4.5 h from symptom onset is not inferior to alteplase in treating ischemic stroke. In recent years, some randomized controlled trials (RCTs) have investigated the efficacy of extending the therapeutic window up to 24 h. This updated meta-analysis aims to synthesize the results of these RCTs comparing TNK to the best medical treatment (BMT) with or without endovascular thrombectomy. Methods: In accordance with PRISMA guidelines, all RCTs comparing TNK with BMT in adult patients between 4.5 and 24 h were systematically searched. The primary endpoint was good functional outcome at 90 days (mRS 0–2). Secondary endpoints included excellent outcome (mRS 0–1), symptomatic intracerebral hemorrhage (sICH), 90-day mortality, complete reperfusion at 24 h. Odd and Hazard ratios (ORs; HRs) were pooled using meta-analytic methods. Results: A total of seven RCTs involving 1754 patients were included. The rates of the primary endpoint were higher in TNK-treated patients (HR: 1.15; 95% CI: 1.03–1.27), as were rates of excellent functional outcome (HR: 1.29; 95% CI: 1.08–1.55). In the subgroup receiving intravenous therapy (IVT) alone, the primary endpoint was significantly more frequent in the TNK group than in the BMT group (OR: 1.47; 95% CI: 1.17–1.84; p for heterogeneity < 0.0001). TNK treatment was also associated with higher reperfusion rates compared with BMT, reflecting a greater proportion of saved ischemic penumbra as assessed via perfusion imaging. Although symptomatic intracranial hemorrhage (sICH) occurred more frequently in TNK-treated patients, the difference did not reach statistical significance, and mortality rates were comparable between treatment groups. Conclusions: Tenecteplase administered between 4.5 and 24 h is associated with improved rates of both good and excellent functional outcomes compared with BMT, especially in patients treated with IVT alone. Additionally, TNK is linked to higher rates of reperfusion. Full article

Background/Objectives: The FIB-4 index is a laboratory test for predicting liver fibrosis. The aim of this study was to investigate the association between FIB-4 index and hematoma expansion in patients with intracerebral hemorrhage (ICH). Methods: A retrospective review was made of the records of 98 consecutive patients with ICH, separated into two groups according to the FIB-4 index: Group 1 (FIB-4 ≤ 2.67) and Group 2 (FIB-4 > 2.67). The demographic data, admission National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume on admission and follow-up cranial computed tomography (CT) within 72 h of admission, hematoma extension, mortality, and modified Rankin Scale (mRS) scores at discharge and the first follow-up visit were recorded. Results: Group 1 (FIB-4 ≤ 2.67) included 75 patients (28 (37.3%) females, 47 (62.7%) males) and Group 2 (FIB-4 > 2.67) included 23 patients (6 (26.1%) females, 17 (73.9%) males). The results of multivariable regression analysis to evaluate predictors of hematoma expansion showed an independent association of age and FIB-4 index > 2.67 with hematoma expansion. Increasing age was associated with a lower likelihood of hematoma expansion (OR 0.941, 95% CI 0.901–0.983, p = 0.012). A FIB-4 index > 2.67 indicated a markedly increased predisposition to hematoma expansion compared to a FIB-4 index ≤ 2.67 (OR 4.12, 95% CI 1.215–13.980, p = 0.032). Conclusions: The results of this study showed that an elevated FIB-4 index was associated with hematoma expansion. Large-scale prospective studies are needed to confirm this relationship and provide valuable insights for clinical practice. Full article

Objective: On 28 February 2026, Israel entered direct large-scale hostilities with Iran under Operation Roaring Lion. The opening phase was characterized by repeated missile alerts, civilian protected-space instructions, and rapid reorganization of hospital activity into protected areas. We observed an apparent increase in strict spontaneous intracerebral hemorrhage admissions during March 2026 within our linked neurology/neurosurgery services dataset. The aim of this preliminary single-center study was to determine whether March 2026 was temporally associated with a higher proportional burden of strict spontaneous intracerebral hemorrhage admissions compared with March cohorts from the preceding decade and whether this pattern was also observed for acute ischemic stroke or non-traumatic subarachnoid hemorrhage. Methods: We performed a retrospective observational cohort study of all unique March admissions captured within a linked neurology/neurosurgery services dataset from 2016 through 2026. Hospitalizations were deduplicated by admission number. March 2026 was treated as the first full March occurring after the onset of direct Israel–Iran hostilities on 28 February 2026. Strict spontaneous ICH was defined using diagnosis-text phenotyping that included intraparenchymal or intracerebral hemorrhage terminology while excluding trauma, subarachnoid hemorrhage, subdural hematoma, aneurysm, arteriovenous malformation, tumor-related hemorrhage, cavernoma, venous sinus thrombosis, dissection, and other clearly secondary etiologies. Comparator phenotypes included acute ischemic stroke and non-traumatic subarachnoid hemorrhage (SAH). Results: Across 3855 unique March admissions, 68 met criteria for strict spontaneous ICH. In March 2026, 9 of 223 admissions (4.0%) were classified as strict spontaneous ICH, compared with 59 of 3632 admissions (1.6%) across March 2016–2025, yielding a rate ratio of 2.48 (95% CI 1.25–4.94; p = 0.015). Patients with strict spontaneous ICH in March 2026 were older (mean age 72.3 vs. 65.8 years), and 7 of 9 cases (77.8%) occurred in patients aged ≥70 years compared with 25 of 59 (42.4%) historically (p = 0.073). Acute ischemic stroke did not increase in March 2026 (7.6% vs. 9.4%; p = 0.475), and non-traumatic SAH showed only a non-significant numerical increase (2.7% vs. 1.4%; p = 0.147). Sensitivity analyses showed a directionally consistent but statistically non-significant increase when March 2026 was compared with March 2025 alone (4.0% vs. 1.2%; rate ratio 3.36, 95% CI 0.92–12.27; p = 0.076) and with a rolling 3-year March baseline from 2023 through 2025 (4.0% vs. 2.1%; rate ratio 1.93, 95% CI 0.88–4.23; p = 0.143). In-hospital mortality among strict spontaneous ICH patients was 1 of 9 (11.1%) in March 2026 versus 4 of 59 (6.8%) in March 2016–2025. Conclusions: In this preliminary single-center neurology/neurosurgery services cohort, March 2026 showed a higher proportional burden of strict spontaneous intracerebral hemorrhage admissions than March cohorts from the preceding decade, while acute ischemic stroke did not increase. Sensitivity analyses using March 2025 alone and a rolling 3-year March baseline were directionally consistent but did not reach statistical significance. These findings should therefore be interpreted as a hypothesis-generating temporal association rather than evidence of causality or population-level incidence. Wartime-related psychological stress, sleep disruption, altered healthcare access, blood pressure dysregulation, and medication nonadherence are biologically plausible contributors, but individual-level blood pressure, medication exposure, body mass index, time-to-admission, direct stress exposure, and detailed outcome data were not available in the present dataset. Multicenter, hospital-wide, and registry-based validation with seasonal and systems-level sensitivity analyses is required. Full article

Post-transplant lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare but serious life-threatening complication seen in recipients of solid organ transplant. Primary CNS encompasses 5–15% of all types of PTLD diagnoses, and heart transplant recipients represent 3–5% of those reported cases. Diagnosis is often delayed due to the highly variable presentation, with some cases remaining undiagnosed for years. Multidisciplinary collaboration is crucial for early diagnosis and management. A 53-year-old woman patient presented with altered mental status. MRI revealed nodular ventriculitis and bilateral periventricular hyperdense infiltrates. CSF studies demonstrated lymphocytic pleocytosis, elevated protein, and EBV-PCR-positive results. A stereotactic brain needle biopsy confirmed the presence of EBV-positive diffuse large B-cell lymphoma, consistent with primary CNS PTLD, 14 months after her heart transplant. Despite appropriate management, the patient experienced progressive neurological decline and ultimately suffered a fatal intracerebral hemorrhage. We demonstrate the importance of the early diagnosis and variable presentation of post-heart-transplant PTLD. The importance of surveillance regardless of EBV status and close monitoring of disease progression due to potential life-threatening complications, such as fatal hemorrhages. Therefore, primary CNS-PTLD remains a challenging disease and is being increasingly recognized with improved transplant recipient survival and prolonged exposure to chronic immunosuppression. Full article

Background: Acute neurosurgical emergencies during pregnancy are rare but pose significant challenges due to the need for simultaneous management of two interdependent patients. Evidence remains limited, and standardized multidisciplinary protocols are lacking. Case Presentation: A 38-year-old woman at 32 + 4 weeks of gestation presented with acute left hemiparesis secondary to right capsulo-insular intracerebral hemorrhage with mass effect. Following initial conservative management, neurological deterioration and hematoma expansion necessitated emergency craniotomy. A structured multidisciplinary approach was implemented involving neurosurgery, anesthesiology, obstetrics, and neonatology, with predefined roles, continuous intraoperative fetal monitoring, and readiness for emergency cesarean delivery. Anesthetic management balanced maternal neuroprotection with preservation of uteroplacental perfusion. Surgery was completed without fetal compromise. The patient demonstrated neurological improvement and was transferred on postoperative day 13. Elective cesarean delivery was performed at 36 weeks. Conclusions: This case illustrates that emergency neurosurgery during pregnancy may be feasible in selected settings when supported by structured multidisciplinary coordination. Key practical elements included continuous fetal monitoring, predefined team roles, and immediate availability of obstetric and neonatal support. In this individual case, these components facilitated intraoperative decision-making and were associated with favorable maternal and fetal outcomes; however, their individual contribution cannot be determined from a single clinical experience. Further evidence is needed to assess the applicability of this approach across different clinical scenarios. Full article

Background: Intracranial hypertension is a critical complication of acute intracerebral hemorrhage (ICH), contributing to high early mortality and poor functional outcomes. Invasive intracranial pressure (ICP) monitoring remains the gold standard but carries procedural risks and is resource-intensive. This study evaluated the diagnostic and prognostic utility of optic nerve sheath diameter (ONSD) ultrasonography and transcranial Doppler (TCD)-derived pulsatility index (PI) as non-invasive ICP surrogates in patients with severe ICH. Methods: A prospective observational study was conducted in 42 patients with acute ICH who underwent concurrent invasive ICP monitoring and serial ONSD/PI measurements at 10 time points (T0–T9) between October 2021 and August 2024. Diagnostic performance was assessed using measurement-level receiver operating characteristic (ROC) curve analysis. Exploratory early mortality prediction was evaluated using random forest machine learning models incorporating ONSD, PI, age, and sex. Results: A total of 274 paired ONSD–PI–ICP measurements were obtained. Both ONSD and PI showed moderate positive correlations with invasive ICP (rho = 0.49 and 0.43, respectively; p < 0.001). ONSD demonstrated superior diagnostic accuracy for detecting ICP ≥ 20 mmHg (AUC = 0.83; optimal threshold: 5.88 mm; sensitivity: 81%; specificity: 82%) compared to PI (AUC = 0.75). In exploratory random forest analyses, the combined ONSD–PI model showed high apparent discrimination for elevated ICP detection (AUC = 0.98), while the model incorporating ONSD, PI, age, and sex showed promising but potentially optimistic discrimination for early mortality prediction (AUC = 0.95). These machine learning results should be interpreted cautiously because of the small sample size, repeated-measurement structure, measurement-level data partitioning, and limited number of early deaths. Conclusions: ONSD ultrasonography and TCD-derived PI showed promising performance as non-invasive ICP markers in severe acute ICH. However, because of the small sample size, repeated-measurement design, measurement-level analyses, and exploratory nature of the machine learning models, these findings require validation in larger external cohorts before routine clinical implementation. Full article

Background: Stroke is the most common neurological disorder in adults and a leading cause of mortality and disability. Intracerebral hemorrhage (ICH), although less frequent than ischemic stroke, is associated with higher morbidity and mortality and often requires ICU admission. Predicting mortality remains challenging due to disease heterogeneity. Objectives: This study evaluated the prognostic value of the modified Nutrition Risk in Critically Ill (mNUTRIC) and Controlling Nutritional Status (CONUT) scores, along with conventional severity scores (GCS, APACHE II, SOFA), in ICU patients with ICH. Methods: This retrospective cohort study included 347 ICU patients with ICH admitted between January 2019 and June 2025. Patients were stratified by survival status and nutritional and conventional severity scores were analyzed. Subgroup analysis was performed in patients with GCS ≤ 12 and APACHE II ≥ 17 (n = 96). Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed predictive performance. Results: ICU mortality was 24.2%. Deceased patients had lower GCS and higher APACHE II, SOFA, mNUTRIC, and CONUT scores (p < 0.001). Subgroup analysis showed higher mortality in patients with elevated mNUTRIC and CONUT scores (p = 0.038 and p = 0.005). Multivariate analysis identified GCS (OR = 0.675, p < 0.001) and CONUT (OR = 1.174, p = 0.040) as independent predictors; mNUTRIC was not significant. ROC analysis demonstrated good discrimination (AUC 0.818 for mNUTRIC and 0.81 for CONUT), with mNUTRIC being more specific and CONUT more sensitive. Optimal cut-off values were >3 for mNUTRIC and >4 for CONUT. Conclusions: Both mNUTRIC and CONUT scores are associated with mortality in ICU patients with ICH, with CONUT showing independent prognostic value. Their combined use may aid clinical decision-making. Full article

Introduction: Hyponatremia is common after nontraumatic intracerebral hemorrhage (ICH) and has been associated with worse outcomes, although prior studies have been limited by smaller sample sizes and heterogeneous exposure definitions. This study evaluated the association between severity-stratified hyponatremia and mortality, survival, and complication rates following nontraumatic ICH. Methods: A retrospective cohort study was performed using the TriNetX database. Patients with nontraumatic ICH were stratified by serum sodium measurements obtained within 7 days of diagnosis. Two separate propensity score-matched analyses were conducted: moderate hyponatremia versus normonatremia (17,547 patients per cohort) and severe hyponatremia versus normonatremia (5010 patients per cohort). The primary outcome was 30-day mortality. Secondary outcomes included seizures, cerebral edema, hydrocephalus, external ventricular drain placement, tracheostomy, percutaneous endoscopic gastrostomy (PEG) placement, pulmonary embolism, deep vein thrombosis, ischemic stroke, and myocardial infarction. Statistical significance was set at p < 0.05. Results: Moderate hyponatremia was associated with increased 30-day mortality (17.5% vs. 13.3%; HR 1.324, 95% CI 1.255–1.398; p < 0.001), while severe hyponatremia demonstrated a greater increase in mortality (18.7% vs. 12.9%; HR 1.473, 95% CI 1.332–1.628; p < 0.001). Both cohorts had higher rates of seizures, cerebral edema, hydrocephalus, tracheostomy, PEG placement, deep vein thrombosis, and myocardial infarction compared with matched normonatremic controls. External ventricular drain placement was also more frequent in both cohorts. Pulmonary embolism increased in moderate hyponatremia but was not significantly different in severe hyponatremia. Ischemic stroke occurred less frequently in both cohorts. Conclusions: Moderate and severe hyponatremia were associated with increased mortality and complications in patients with nontraumatic ICH, with stronger associations observed in severe hyponatremia. These findings support serum sodium as a clinically relevant marker for risk stratification and monitoring during acute ICH care. However, causality cannot be established, and whether correction of hyponatremia improves outcomes requires prospective studies. Full article

Ferroptosis is a form of regulated cell death driven by iron-dependent phospholipid peroxidation and has emerged as a key mechanism of neuronal injury across a broad spectrum of neurological disorders. MicroRNAs (miRNAs), which function primarily as post-transcriptional regulators of gene expression, are increasingly recognized as important modulators of the regulatory networks governing ferroptosis and as potential therapeutic targets in these conditions. In this review, we synthesize current advances in miRNA-mediated regulation of ferroptosis in neurological disorders. We first outline the core molecular pathways governing ferroptosis, with particular emphasis on antioxidant defense, lipid peroxidation, and iron metabolism. We then integrate evidence from ischemic stroke, intracerebral hemorrhage, epilepsy, toxic encephalopathy, spinal cord injury, Parkinson’s disease, and Alzheimer’s disease, to illustrate how disease-specific miRNA regulatory axes shape ferroptotic vulnerability and its pathological consequences in distinct neurological settings. Importantly, we highlight exosome-based strategies targeting ferroptosis-related miRNA networks as a promising therapeutic approach for neurological disorders, with demonstrated neuroprotective and functional benefits in preclinical studies. Collectively, current evidence supports miRNA-mediated regulation of ferroptosis as an important mechanistic framework and a promising therapeutic target in neurological disorders. Full article