Iain McGurgan presents the fourth episode of the Back to Bedside programme.

In acute stroke care, decisions that shape long-term outcomes must be made within minutes. This case examines the complexity of acute treatment when risk factors and potential contraindications lie within the gray areas of existing guidelines, underscoring the challenges of translating evidence-based recommendations into individualised decision-making at the patient’s bedside.

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In the third episode of the Back to Bedside programme, Ellis van Etten presents a case of a basilar artery occlusion presenting with amnesia, highlighting the diagnostic challenges of strokes in the posterior circulation. The presentation walks participants through key clinical clues.

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In an era overflowing with neuroimaging, vascular studies, lab tests, and AI-powered diagnostics, it’s easy to forget the value of simply looking at the patient. But when it comes to clinical reasoning, no algorithm can replace a skilled clinician.

This monthly case series is here to sharpen your bedside techniques, challenge your diagnostic thinking, and help you stay grounded in what matters most: the patient.

Back to Bedside reminds us why bedside neurology still matters greatly. From asking the right questions to interpreting subtle signs and deciding what really needs to be tested, clinical skills remain at the heart of good stroke care.

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As 2025 has drawn to a close, the ESO YSPR committee reflects on a productive and inspiring year and looks forward to launching exciting initiatives throughout 2026.

A major highlight of 2025 was ESOC in Helsinki, Finland. Once again, the conference provided an excellent platform for scientific exchange and networking among stroke professionals from across Europe and beyond. The YSPR Research Design Workshop was well received, giving young researchers the opportunity to present their study ideas and receive structured, constructive feedback from experienced mentors.

Together with the European Stroke Journal (ESJ), the YSPR Young Reviewer Programme continued successfully in 2025. The participants for the current round have been selected, and this cycle will conclude in April 2026. Building on the strong interest and engagement seen so far, the call for new candidates for the ESJ Young Reviewer Programme will open after ESOC 2026.

The Department to Department Programme continued to offer valuable opportunities for young stroke physicians to experience different clinical and research environments across Europe. Those interested in applying are encouraged to read the previous participant reports published on the ESO blog, which provide insightful first-hand perspectives on the programme.

The ESO blog continues to be an important platform for presenting current topics and sharing perspectives. Working on the blog remains a great part of our committee work. We would like to thank everyone who contributed over the past year, and we are always happy to welcome new guest bloggers with fresh views on timely and relevant stroke-related topics.

Looking ahead to 2026

The coming year will mark the start of a new YSPR initiative: Back to Bedside. This programme aims to present short, focused clinical vignettes with clear take-home messages, highlighting the importance of clinical reasoning and bedside neurology in everyday stroke care. In case you have missed the first episodes, you can listen here to Episode 1 and Episode 2

Finally, we would like to thank all ESO members, collaborators, mentors, and participants for their continued support and engagement.

We wish everyone a successful 2026 and look forward to seeing you in person in Maastricht at the 12^th ESOC!

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In the second episode of the Back to Bedside programme, Bogdan Ciopleias presents a compelling case of a stroke mimic, highlighting the diagnostic challenges encountered in acute neurovascular care. The presentation walks participants through key clinical clues.

Learn more and listen to the presentation

In an era overflowing with neuroimaging, vascular studies, lab tests, and AI-powered diagnostics, it’s easy to forget the value of simply looking at the patient. But when it comes to clinical reasoning, no algorithm can replace a skilled clinician.

This monthly case series is here to sharpen your bedside techniques, challenge your diagnostic thinking, and help you stay grounded in what matters most: the patient.

Back to Bedside reminds us why bedside neurology still matters greatly. From asking the right questions to interpreting subtle signs and deciding what really needs to be tested, clinical skills remain at the heart of good stroke care.

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Save the best for last! The final session of the successful ESWW 2025 was dedicated to the award ceremony for the two best mid-career elevator pitches and the best poster. Meanwhile, the sun began to gleam above the snowy mountains surrounding the picturesque Eibsee.

The recipients of the best mid-career elevator pitch awards were Jatinder Minas (Leicester, United Kingdom) and Nina Halkes (Rotterdam, the Netherlands). Both honorees were invited to present their pitches to the entire ESWW audience.

Jatinder Minas’s presentation focused on protective and reparative processes following acute intracerebral haemorrhage (ICH). He discussed the relationship between remote diffusion-weighted imaging (DWI) lesions and poor functional outcomes in acute ICH patients and considered whether these DWI lesions represent collateral damage or indicate an overactivation of reparative mechanisms.

Nina Halkes called for a reevaluation of the duration of antiplatelet therapy (AP) in young stroke patients. She emphasised that most supporting evidence for lifelong AP stems from studies conducted in elderly populations. In younger individuals, the benefits remain uncertain and potential complications may outweigh advantages. This clinical dilemma forms the basis for the newly launched STOP trial.

The award for best mid-career poster went to Bernhard Matthias Siepen from Bern, Switzerland. In his poster, he elaborated on a phase II randomised clinical trial assessing the efficacy of a care bundle for ICH patients. The care bundle includes intensive blood pressure control, reversal of anticoagulant drugs, administration of tranexamic acid, admission to a stroke unit / ICU and neurosurgical evaluation.

During the poster presentations, senior attendees were challenged to answer questions regarding the mid-career candidates presenting their posters. Daniel Strbian from Helsinki, Finland, distinguished himself by correctly answering the majority of these questions and received the Mid-career researcher engagement award as well.

The final closing remarks were given by Rustam Al Shahi Salman, reassuring all attendees that this year, everyone could make a safe trip home.

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The session “Looking to the Future” focused on the emerging and expanding capabilities of AI along the entire stroke care pathway.

It opened with a keynote debate on the question: “Will AI in stroke care always need human oversight?”

• Carlos Molina (Vall d’Hebron University Hospital, Barcelona, Spain) argued in favour of continued human oversight. He emphasised that oversight is not only a legal requirement but also essential because AI systems still fail in critical ways. He highlighted the risks of automation bias and underscored the ongoing need for effective human supervision—both now and in the future.
• Pietro Caliandro (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy) argued against, emphasising the potential for rigorously validated AI tools to operate safely and effectively without continuous human oversight. He pointed to the breadth of applications across the stroke care pathway where such tools may, after stringent evaluation, function autonomously.

The result was a spirited and humorous exchange that captured both the promises and challenges of AI in modern stroke care.

Minna Pikkarainen (Norway) presented on “AI Virtual Reality Solutions for Stroke Rehabilitation,” outlining ongoing efforts to integrate AI, virtual reality, and care networks to enable personalised, home-based rehabilitation.

Susanne Wegener (Switzerland) followed with “AI Support Tools for Treatment Decisions in Stroke Patients.” She demonstrated that AI models can match or outperform stroke neurologists in predicting functional outcomes based on acute imaging. Current work includes improving outcome prediction using posture and movement recordings, integrating patient-related factors such as frailty, and developing models for treatment response and atrial fibrillation detection.

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The “Stroke Rarities” session brought together four outstanding speakers who shed light on uncommon but clinically significant conditions that challenge our daily practice.

Alex Leff (UK) opened the session with an engaging overview of cognitive rehabilitation, reminding us that cognitive and language impairments remain some of the most disabling yet undertreated consequences of stroke. Aphasia, despite its profound impact, is still not adequately represented in core outcome measures such as the mRS. Alex emphasised that effective, guided rehabilitation—whether via intensive programs like ICAP or digital tools like iTalkBetter—can make a substantial difference in recovery. His central message was clear: high-quality, consistent cognitive rehabilitation is rare, but it should not be.

Arvind Chandratheva (UK) followed with a highly practical guide to thrombophilia screening in young or otherwise atypical stroke patients. He highlighted patient groups in whom screening is most relevant—those with young or cryptogenic stroke, stroke in pregnancy, or stroke linked to unusual thrombosis. A focused panel should include antiphospholipid antibodies and JAK2 V617F, with extended testing (e.g. PNH, protein C/S, antithrombin levels, genetic testing) reserved for specific cases. Arvind also pointed out the unresolved question of optimal timing: acute-phase testing may produce misleading results, including false negatives for factor VIII and false positives driven by inflammation.

Tim Magnus (Germany) provided a compelling clinical-to-experimental perspective on cerebral vasculitis, a condition that remains difficult to diagnose due to its heterogeneous presentation, lack of targeted biomarkers, and the limited sensitivity and specificity of biopsy – still considered the “gold standard.” Tim presented emerging mechanistic data from mouse models suggesting T-cell–mediated pathways and highlighted consistent PD-L1 upregulation in both human and experimental disease. These findings open doors for future targeted therapeutic strategies.

Kristiina Rannikmäe (UK) closed the session with a deep dive into rare monogenic cerebral small vessel diseases. She emphasised that these conditions are uncommon but often under-recognised, heavily dependent on how many genes are tested and how patients are selected. COL4A1/2-related disease exemplifies their wide phenotypic range, spanning from early cataracts to severe stroke. She reminded us that patients require careful counselling: avoiding strenuous physical activity and anticoagulants, screening for multiorgan involvement, and planning delivery via C-section in pregnancy. Kristiina highlighted key red flags for monogenic SVD, including family history, young age of onset, systemic features, atypical imaging, or consanguinity.

Overall, the session underscored how rare conditions can illuminate fundamental mechanisms of cerebrovascular disease—and how improved recognition, diagnostics, and targeted interventions can meaningfully change patient outcomes.

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