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Cerebrovascular Diseases

Matthias Eckert, Philipp Gölitz, Hannes Lücking, Tobias Struffert, Frauke Knossalla, Arnd Doerfler
BACKGROUND: Using flat-detector CT (FD-CT) for stroke imaging has the advantage that both diagnostic imaging and endovascular therapy can be performed directly within the Angio Suite without any patient transfer and time delay. Thus, stroke management could be speeded up significantly, and patient outcome might be improved. But as precondition for using FD-CT as primary imaging modality, a reliable exclusion of intracranial hemorrhage (ICH) has to be possible. This study aimed to investigate whether optimized native FD-CT, using a newly implemented reconstruction algorithm, may reliably detect ICH in stroke patients...
October 18, 2016: Cerebrovascular Diseases
Søren Due Andersen, Torben Bjerregaard Larsen, Anders Gorst-Rasmussen, Yousef Yavarian, Gregory Y H Lip, Flemming W Bach
BACKGROUND: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous...
October 18, 2016: Cerebrovascular Diseases
Roderick Wondergem, Martijn F Pisters, Eveline J Wouters, Nick Olthof, Rob A de Bie, Johanna M A Visser-Meily, Cindy Veenhof
BACKGROUND: Stroke is not only an acute disease, but for the majority of patients, it also becomes a chronic condition. There is a major concern about the long-term follow-up with respect to activities of daily living (ADL) in stroke survivors. Some patients seem to be at risk for decline after a first-ever stroke. The purpose of this study was to determine the course of ADL from 3 months after the first-ever stroke and onward and identify factors associated with decline in ADL. METHODS: A systematic literature search of 3 electronic databases through June 2015 was conducted...
October 18, 2016: Cerebrovascular Diseases
Peter Appelros, Maria Háls Berglund, Jakob O Ström
BACKGROUND: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context. METHODS: Riksstroke is the national stroke registry in Sweden...
October 18, 2016: Cerebrovascular Diseases
Willeke F Westendorp, Jan-Dirk Vermeij, Matthijs C Brouwer, Y B W E M Roos, Paul J Nederkoorn, Diederik van de Beek
BACKGROUND: Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections. AIM: This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial...
October 5, 2016: Cerebrovascular Diseases
Christina A Hamisch, Anastasios Mpotsaris, Marco Timmer, Michael Reiner, Pantelis Stavrinou, Gerrit Brinker, Roland Goldbrunner, Boris Krischek
OBJECTIVE: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. METHODS: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database...
September 7, 2016: Cerebrovascular Diseases
Paola Forti, Fabiola Maioli, Michele Domenico Spampinato, Carlotta Barbara, Valeria Nativio, Maura Coveri, Marco Zoli, Luigi Simonetti, Giuseppe Di Pasquale, Gaetano Procaccianti
BACKGROUND: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years)...
September 6, 2016: Cerebrovascular Diseases
Güliz Acker, Susanne Goerdes, Peter Schmiedek, Marcus Czabanka, Peter Vajkoczy
BACKGROUND: Moyamoya disease (MMD) associated with a potentially underlying disease, such as genetic disorders or other coexisting hematological pathologies, is called quasi-MMD. This very rare disease has been characterized mainly in Asian countries, so far. As MMD reveals several significant ethnic differences, the question is raised whether characteristics of quasi-MMD would also vary among different ethnic backgrounds. Here, we report a series of 61 patients with quasi-MMD and highlight the specific clinical features of this rare disease among European Caucasians...
August 27, 2016: Cerebrovascular Diseases
Shoujiang You, Luyao Shi, Chongke Zhong, Jiaping Xu, Qiao Han, Xia Zhang, Huihui Liu, Yanlin Zhang, Jijun Shi, Zhichao Huang, Yongjun Cao, Chunfeng Liu
BACKGROUND: The effects of the estimated glomerular filtration rate (eGFR) and cystatin C on clinical outcomes on intracerebral hemorrhage (ICH) remain unclear. We investigated the associations of eGFR and cystatin C with 3-month functional outcome and all-cause mortality in acute ICH patients. METHODS: A total of 365 patients with acute ICH were enrolled. Serum creatinine and cystatin C levels were measured within 24 h of admission. Outcomes at 3-month were evaluated by interviews with patients or their family members...
August 27, 2016: Cerebrovascular Diseases
Zeljka Calic, Cecilia Cappelen-Smith, Craig S Anderson, Wei Xuan, Dennis J Cordato
BACKGROUND AND PURPOSE: The diagnosis of cerebellar infarction (CBI) is often challenging due to non-specific or subtle presenting symptoms and signs. We aimed to determine whether a common syndromic cluster of symptoms, signs or vascular risk factors were associated with delayed presentation or misdiagnosis to an Emergency Department (ED). The degree of misdiagnosis between ED and neurology physicians and the influence of delayed presentation or misdiagnosis on outcome were also investigated...
August 27, 2016: Cerebrovascular Diseases
Mona Laible, Ekkehart Jenetzky, Christopher Beynon, Oliver Josef Müller, Peter Sander, Svenja Schüler, Jan Purrucker, Markus Möhlenbruch, Thorsten Steiner, Roland Veltkamp, Peter Arthur Ringleb, Timolaos Rizos
BACKGROUND: Prothrombin complex concentrates (PCCs) are frequently used to reverse the effect of vitamin K antagonists (VKAs) in patients with non-traumatic intracerebral hemorrhage (ICH). However, information on the rate of thromboembolic events (TEs) and allergic events after PCC therapy in VKA-ICH patients is limited. METHODS: Consecutive VKA-ICH patients treated with PCC at our institution between December 2004 and June 2014 were included into this retrospective observational study...
August 19, 2016: Cerebrovascular Diseases
Gerben J J Plas, Heleen A Booij, Paul J A M Brouwers, Marjolein Brusse-Keizer, Peter J Koudstaal, Diederik W J Dippel, Heleen M den Hertog
BACKGROUND: Transient ischemic attacks (TIAs) accompanied by nonfocal symptoms are associated with a higher risk of cardiovascular events, in particular cardiac events. Reported frequencies of TIAs accompanied by nonfocal symptoms range from 18 to 53%. We assessed the occurrence of nonfocal symptoms in patients with TIA or minor ischemic stroke in a neurological outpatient clinic in terms of clinical determinants, cardiac history, and atrial fibrillation (AF). METHODS: We included 1,265 consecutive patients with TIA or minor stroke who visited the outpatient clinic...
August 10, 2016: Cerebrovascular Diseases
Philip Masson, Sradha Kotwal, Patrick J Kelly, Jonathan C Craig, Richard I Lindley, Martin Gallagher, Alan Cass, Angela C Webster
BACKGROUND: It is unclear how traditional cardiovascular risk factors and different treatment modalities for end-stage kidney disease (ESKD) affect stroke risk in people with ESKD. We aimed to identify the risk factors for stroke (ischemic and hemorrhagic) in people with ESKD. METHODS: We conducted a retrospective cohort study using data linkage between the Australian and New Zealand Dialysis and Transplant Registry, clinical and administrative datasets. Using Cox proportional hazards models, we estimated the magnitudes of risk of hospitalization with different subtypes of strokes associated with traditional cardiovascular risk factors and ESKD treatment modalities (hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation)...
August 10, 2016: Cerebrovascular Diseases
Andrey Lima, Diogo C Haussen, Leticia C Rebello, Seena Dehkharghani, Jonathan Grossberg, Mikayel Grigoryan, Michael Frankel, Raul G Nogueira
BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) in the elderly encompasses approximately one-third of all AIS cases. Outcome data have been for the most part discouraging in this population. We aim to evaluate the outcomes in a large contemporary series of elderly patients treated with thrombectomy. METHODS: Retrospective analysis of a single-center endovascular database for consecutive elderly (≥80 years) patients treated for anterior circulation large vessel occlusion AIS between September 2010 and April 2015...
July 26, 2016: Cerebrovascular Diseases
Waltraud Pfeilschifter, Dana Farahmand, Daniela Niemann, Benno Ikenberg, Carina Hohmann, Mario Abruscato, Sven Thonke, Adam Strzelczyk, Günther Hedtmann, Tobias Neumann-Haefelin, Rainer Kollmar, Oliver C Singer, Andreas Ferbert, Thorsten Steiner, Helmuth Steinmetz, Anke Reihs, Björn Misselwitz, Christian Foerch
BACKGROUND: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit...
July 21, 2016: Cerebrovascular Diseases
Marie-Christine Alessi, Christophe Gaudin, Philippe Grosjean, Valérie Martin, Serge Timsit, Marie-Hélène Mahagne, Vincent Larrue, Igor Sibon, Mathieu Zuber, Raf Brouns, Joan Montaner, Mar Castellanos, Yves Donazzolo, Tae-Hee Cho, Laurent Suissa, Laura Mechtouff, Laurent Derex, Pierre Suchon, Anna Mezzapesa, Norbert Nighoghossian
BACKGROUND AND PURPOSE: Thrombin-activatable fibrinolysis inhibitor (TAFI) activation following thrombolysis may affect thrombolysis effectiveness in acute ischemic stroke (AIS). To support this hypothesis, we propose to study the relationship between TAFI consumption, activated/inactivated TAFI (TAFIa/ai) and stroke severity and outcome in 2 groups of AIS patients, one treated and one untreated with intravenous recombinant tissue type plasminogen activator (rt-PA). METHODS: In this prospective, longitudinal, multicenter, observational study, we aimed to study the association between TAFIa/ai and stroke outcome...
July 8, 2016: Cerebrovascular Diseases
Hiromi Ishikawa, Yoshinobu Wakisaka, Ryu Matsuo, Noriko Makihara, Jun Hata, Junya Kuroda, Tetsuro Ago, Jiro Kitayama, Hiroshi Nakane, Masahiro Kamouchi, Takanari Kitazono
BACKGROUND: Statins have neuroprotective effects against ischemic stroke. However, associations between pre-stroke statin treatment and initial stroke severity and between the treatment and functional outcome remain controversial. This study aimed at determining these associations in ischemic stroke patients. METHODS: Among patients registered in the Fukuoka Stroke Registry from June 2007 to October 2014, 3,848 patients with ischemic stroke within 24 h of onset, who had been functionally independent before onset, were enrolled in this study...
July 5, 2016: Cerebrovascular Diseases
Jeong-Ho Hong, Sung-Il Sohn, Jihoon Kang, Min Uk Jang, Beom Joon Kim, Moon-Ku Han, Tai Hwan Park, Sang-Soon Park, Kyung Bok Lee, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Jun Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jong-Moo Park, Kyusik Kang, Yong-Jin Cho, Keun-Sik Hong, Ki-Hyun Cho, Joon-Tae Kim, Jay Chol Choi, Juneyoung Lee, Ji-Sung Lee, Philip B Gorelick, Hee-Joon Bae
BACKGROUND: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. METHODS: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4...
July 1, 2016: Cerebrovascular Diseases
Bernt Harald Helleberg, Hanne Ellekjaer, Bent Indredavik
BACKGROUND AND PURPOSE: Early neurological deterioration (END) occurs in 10-40% of acute ischemic stroke (AIS) patients and has been associated with worse outcome. Recent improvements in treatment may have reduced the prevalence of END. A single early control or repeated observations have been applied to detect END close to occurrence, in order to improve the poor outcome associated with END, as clinical interventions may still be effective. Deterioration detected through repeated observations may be transitory or lead to END...
June 29, 2016: Cerebrovascular Diseases
John Adam Oostema, Trevor Carle, Nadine Talia, Mathew Reeves
BACKGROUND: Emergency dispatchers represent the first point of contact for patients activating an acute stroke response. Accurate dispatcher stroke recognition is associated with faster emergency medical services response time; however, stroke is often unrecognized during initial emergency calls. Stroke screening tools such as the Cincinnati Prehospital Stroke Scale have been shown to improve on-scene stroke recognition and thus have been proposed as a means to improve dispatcher accuracy...
June 28, 2016: Cerebrovascular Diseases
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