The Stroke-CORE cohort aims to provide a comprehensive and up-to-date understanding of stroke care in Germany. To achieve this, patients are followed along the entire continuum of care-from initial management before hospital admission, through acute treatment, rehabilitation, and follow-up care, to the prevention of recurrent strokes. Strokes occurring in childhood are also included in this cohort study.

In addition, the study seeks to establish effective structures for the early identification and inclusion of patients in clinical research (screening). In this context, structured screening processes are being implemented across all levels of care at participating sites within the Network University Medicine (NUM), a collaboration of German university hospitals. At the same time, the cohort serves as a platform within this network to systematically address open research questions in various areas of stroke care and to support the targeted planning and conduct of future clinical studies.

The study includes patients with ischemic stroke (caused by a blocked blood vessel) or intracerebral hemorrhage (bleeding within the brain). Participation takes place in different thematic modules, each focusing on specific aspects of the disease course and its management. These modules address, among other topics, acute hospital treatment, measures to prevent recurrent strokes (secondary prevention), possible complications, pre-hospital care, rehabilitation, follow-up care, and long-term outcomes such as physical recovery, independence in daily life, and cognitive functions including memory and concentration.

As part of the study, a range of data is collected. This includes sociodemographic information (such as age and living situation) as well as medical data, for example on prior conditions, diagnoses, treatments, and comorbidities. In addition, patients' health status is assessed at multiple time points in order to better understand the course of the disease. Depending on the level of participation, data collection may be complemented by the collection of biological samples, such as blood. These are obtained either during routine clinical procedures or through simple, minimally burdensome (non-invasive) methods.

The study is structured into several levels that differ in the scope and depth of data collection. The basic level includes essential information, while higher levels involve more detailed assessments. In addition, some levels include the collection of biological samples, and there are optional supplementary modules in which patients may participate voluntarily. This tiered approach allows participation to be flexibly adapted to the individual situation while contributing to a nuanced and comprehensive understanding of stroke care.

Inclusion Criteria:

• Diagnosis of AIS or ICH; the AIS diagnosis may be diagnosed clinically or radiologically (i.e., focal neurological impairment of sudden onset, lasting more than 24 hours and of presumed vascular origin, or with proof of cerebral ischaemia corresponding to the clinical symptoms in neuroimaging); for ICH diagnosis requires clinical symptoms and radiological diagnosis of ICH
• Hospital admission <24h after symptom onset
• Age 18+ years for the basic Modules AIS and ICH; age <18 years for the basic Module paediatric stroke patients
• Informed consent: Signed IC from patients capable of giving consent and understanding all content of the IC or IC of an appropriate patient representative or deferred consent, if patients are unable to consent themselves
• Additional inclusion criteria are defined by the individual Modules

Exclusion Criteria:

• In-hospital stroke
• TIA
• SAH
• Stroke as a complication of a medical procedure
• Enrolment in a randomised placebo-controlled interventional trial
• Already enrolled in the SN STROKE base cohort

Stroke patients with criteria defined in each individual Module (IS, ICH, peadiatric stroke) who are admitted to one of the participating university hospitals in Germany within 24 hours of symptom onset.

General inclusion and exclusion criteria:

• Fulfilment of all inclusion and no exclusion criteria for at least one Module
• Signed IC from patients capable of giving consent and understanding all content of the IC or IC of an appropriate patient representative, if patients are unable to provide consent themselves.

All collected IPD-including medical, biosamples, and imaging data as well as their analysis results-will be shared under strict governance. Secondary use is managed through defined Dynamic Use & Access (DUA) procedures, aligned with the NUM Publication Policy and Terms of Use, ensuring recognition of contributing sites and researchers while maintaining high data protection standards.

Applications must be submitted via a central application platform offering all required information and application documents. The DUA procedure includes:

• Application submission
• Formal review
• Technical, scientific, and methodological evaluation
• Decision by the relevant UA Committees
• Data provision via a data transfer office following approval of the application.

Data and biosamples are only released following rigorous review, ensuring compliance with ethical, legal, and data protection requirements. Use is limited to the analyses specified in the application.

At the earliest, following the first interim analysis, which is currently scheduled for mid-2027. Subject to future funding opportunities, the study itself and data sharing is planned to be conducted over the long term.

Data, imaging data and biosamples of stroke patients may be requested by any natural or legal person. A request must be submitted in accordance with the procedures described above, must be scientifically justified, and must fit within the framework established by this protocol and, more importantly, the scope of the ICF signed by the patients in the study. Before data and biosamples of accepted applications are transferred, the applicant or someone from the application team must provide a positive vote or a waiver from the Ethics Committee responsible for the applicant.