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Stroke , ischemic stroke , intracerebral

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https://www.readbyqxmd.com/read/28210988/real-life-experience-with-the-specific-reversal-agent-idarucizumab-for-the-management-of-emergency-situations-in-dabigatran-treated-patients-a-series-of-11-cases
#1
Milan R Vosko, Christof Bocksrucker, Rafał Drwiła, Petr Dulíček, Tomas Hauer, Johannes Mutzenbach, Christoph J Schlimp, David Špinler, Thomas Wolf, Daša Zugwitz
Non-vitamin K antagonist oral anticoagulants (NOACs) have a favorable benefit-risk profile compared with vitamin K antagonists. However, the lack of specific reversal agents has made the management of some patients receiving long-term treatment with NOACs problematic in emergency situations such as major bleeding events or urgent procedures. Idarucizumab, a fully humanized Fab antibody fragment that binds specifically and with high affinity to dabigatran, was recently approved for use in adult patients treated with dabigatran when rapid reversal of its anticoagulant effect is required...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28208130/factors-related-to-cardioembolism-as-major-predictors-of-poor-survival-after-first-ever-middle-cerebral-artery-stroke-treated-with-thrombolysis
#2
Renata Dal-Prá Ducci, Marcos Christiano Lange, Viviane de Hiroki Flumignan Zétola, Tatjana Rundek
BACKGROUND AND PURPOSE: Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). METHODS: A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015...
February 17, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28203558/cerebral-monitoring-during-carotid-endarterectomy-by-transcranial-doppler-ultrasonography
#3
Woo-Sung Yun
PURPOSE: To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA). METHODS: From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials...
February 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28193834/genome-wide-analysis-of-the-circulating-mirnome-after-cerebral-ischemia-reveals-a-reperfusion-induced-microrna-cluster
#4
Stefan Uhlmann, Eva Mracsko, Ehsan Javidi, Sarah Lamble, Ana Teixeira, Agnes Hotz-Wagenblatt, Karl-Heinz Glatting, Roland Veltkamp
BACKGROUND AND PURPOSE: Circulating microRNAs (miRNAs) are emerging biomarkers for stroke because of their high stability in the bloodstream and association with pathophysiologic conditions. However, the circulating whole-genome miRNAs (miRNome) has not been characterized comprehensively in the acute phase of stroke. METHODS: We profiled the circulating miRNome in mouse models of acute ischemic and hemorrhagic stroke by next-generation sequencing. Stroke models were compared with sham-operated and naive mice to identify deregulated circulating miRNAs...
February 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28188404/-direct-oral-anticoagulants-and-acute-stroke-insights-into-translational-research-studies
#5
C Foerch, J H Schäfer, W Pfeilschifter, F Bohmann
In recent years a considerable number of translational research studies on intracerebral hemorrhage and ischemic stroke have been published, which are characterized by a particular proximity to practical clinical questions. Animal research has provided insights into the pathophysiological processes and therapy effects, which have so far only been insufficiently investigated in clinical studies. This includes the effectiveness of a rapid reversal of anticoagulation in cases of anticoagulation-associated intracerebral hemorrhage and the safety of thrombolytic treatment in ischemic stroke occurring during treatment with anticoagulants...
February 10, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28179050/cerebral-amyloid-angiopathy-in-stroke-medicine
#6
Frank Block, Manuel Dafotakis
BACKGROUND: Cerebral amyloid angiopathy (CAA) is a degenerative vasculopathy that is classically associated with lobar intracerebral or sulcal hemorrhage. Its prevalence is estimated at 30% in the seventh decade and 50% in the eighth and ninth decades. In this review, we summarize the risks linked to CAA with respect to the treatment and prevention of stroke. METHODS: This review is based on pertinent publications retrieved by a selective search employing the terms "amyloid cerebral angiopathy," "stroke," "intra - cerebral bleeding," and "acute stroke therapy...
January 20, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28174326/intravenous-thrombolysis-in-unknown-onset-stroke-results-from-the-safe-implementation-of-treatment-in-stroke-international-stroke-thrombolysis-registry
#7
Laura Dorado, Niaz Ahmed, Götz Thomalla, Manuel Lozano, Branko Malojcic, Mushtaq Wani, Mònica Millán, Ales Tomek, Antoni Dávalos
BACKGROUND AND PURPOSE: Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS: Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014...
February 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28170316/medical-university-of-south-carolina-telestroke-a-telemedicine-facilitated-network-for-stroke-treatment-in-south-carolina-a-progress-report
#8
Sami Al Kasab, Robert J Adams, Ellen Debenham, David J Jones, Christine Ann Holmstedt
BACKGROUND: Patients in rural communities lack access to acute stroke therapies. Rapid administration of lytic therapy increases the likelihood of favorable functional outcome in acute ischemic stroke (AIS). At the Medical University of South Carolina (MUSC), we implemented a Web-based telestroke program that allows patients presenting with AIS at a rural hospital to receive expert stroke consultation within minutes. This increases their chances of receiving lytic therapy, and therefore increases the likelihood of good functional outcome...
February 7, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28166784/randomized-controlled-trial-of-a-coordinated-care-intervention-to-improve-risk-factor-control-after-stroke-or-transient-ischemic-attack-in-the-safety-net-secondary-stroke-prevention-by-uniting-community-and-chronic-care-model-teams-early-to-end-disparities
#9
Amytis Towfighi, Eric M Cheng, Monica Ayala-Rivera, Heather McCreath, Nerses Sanossian, Tara Dutta, Bijal Mehta, Robert Bryg, Neal Rao, Shlee Song, Ali Razmara, Magaly Ramirez, Theresa Sivers-Teixeira, Jamie Tran, Elizabeth Mojarro-Huang, Ana Montoya, Marilyn Corrales, Beatrice Martinez, Phyllis Willis, Mireya Macias, Nancy Ibrahim, Shinyi Wu, Jeremy Wacksman, Hilary Haber, Adam Richards, Frances Barry, Valerie Hill, Brian Mittman, William Cunningham, Honghu Liu, David A Ganz, Diane Factor, Barbara G Vickrey
BACKGROUND: Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease...
February 6, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28156174/seasonal-variation-in-spontaneous-intracerebral-hemorrhage-in-northern-israel
#10
G Telman, G E Sviri, E Sprecher, Y Amsalem, R Avizov
The incidence of spontaneous intracerebral hemorrhage (sICH) and ischemic stroke vary across seasons. Most studies examining seasonal variation in sICH have been conducted in countries with significant climatic changes across seasons, whereas studies from the Mediterranean region, which has a relatively mild winter, are limited in number and have produced inconsistent results. Further studies from the region are called for, especially from countries where sICH seasonality has not yet been explored. A total of 974 patients with sICH between 1 January 2000 and 31 December 2014 were included in this study...
February 3, 2017: Chronobiology International
https://www.readbyqxmd.com/read/28143920/proportional-motor-recovery-after-stroke-implications-for-trial-design
#11
Cathy M Stinear, Winston D Byblow, Suzanne J Ackerley, Marie-Claire Smith, Victor M Borges, P Alan Barber
BACKGROUND AND PURPOSE: Recovery of upper-limb motor impairment after first-ever ischemic stroke is proportional to the degree of initial impairment in patients with a functional corticospinal tract (CST). This study aimed to investigate whether proportional recovery occurs in a more clinically relevant sample including patients with intracerebral hemorrhage and previous stroke. METHODS: Patients with upper-limb weakness were assessed 3 days and 3 months poststroke with the Fugl-Meyer scale...
January 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28143898/a-multicenter-study-of-the-safety-and-effectiveness-of-mechanical-thrombectomy-for-patients-with-acute-ischemic-stroke-not-meeting-top-tier-evidence-criteria
#12
Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T Froehler, J Mocco, Jay Vachhani, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D Turner, Justin Mascitelli, Kiersten Espaillat, Andrei V Alexandrov, Anne W Alexandrov, Adam S Arthur
BACKGROUND: While mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC). METHODS: We conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers...
January 31, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28130468/leukoaraiosis-intracerebral-hemorrhage-and-functional-outcome-after-acute-stroke-thrombolysis
#13
Kannikar Kongbunkiat, Duncan Wilson, Narongrit Kasemsap, Somsak Tiamkao, Fatima Jichi, Vanessa Palumbo, Michael D Hill, Alastair M Buchan, Simon Jung, Heinrich P Mattle, Nils Henninger, David J Werring
OBJECTIVE: To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome. METHODS: We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI)...
February 14, 2017: Neurology
https://www.readbyqxmd.com/read/28127492/renal-dysfunction-is-an-independent-risk-factor-for-poor-outcome-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-new-cutoff-value
#14
Elyar Sadeghi-Hokmabadi, Demet Funda Baş, Mehdi Farhoudi, Aliakbar Taheraghdam, Daryoush Savadi Oskouei, Mohammad Yazdchi, Maziyar Hashemilar, Nevzat Uzuner, Reshad Mirnour, Ertugrul Colak, Atilla Özcan Özdemir
Objective. This study was set to assess the effect of renal dysfunction on outcome of stroke patients treated with intravenous thrombolysis (IVT). Methods. This multicenter research involved 403 patients from January 2009 to March 2015. Patients were divided into two groups: (1) control group with GFR ≥ 45 mL/min/1.73 m(2) and (2) low GFR group with GFR < 45 mL/min/1.73 m(2). Outcome measurements were poor outcome (mRS 3-6) and mortality at 3 months and symptomatic intracerebral hemorrhage (SICH) within the first 24-36 hours...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28116631/translational-initiatives-in-thrombolytic-therapy
#15
REVIEW
Melvin E Klegerman
Once thrombi have formed as part of the pathology defining myocardial infarction, ischemic stroke, peripheral arterial disease, deep venous thrombosis or other embolic disorders, the only clinically meaningful thrombolytic agents available for reversing the thrombogenic process are various plasminogen activators. These agents are enzymes that reverse fibrin polymerization underlying the coagulation process by converting endogenous plasminogen to plasmin, which cleaves the fibrin network to form increasingly smaller protein fragments, a process known as fibrinolysis...
January 23, 2017: Frontiers of Medicine
https://www.readbyqxmd.com/read/28114647/clinical-characteristics-risk-factors-and-outcomes-associated-with-neonatal-hemorrhagic-stroke-a-population-based-case-control-study
#16
Lauran Cole, Deborah Dewey, Nicole Letourneau, Bonnie J Kaplan, Kathleen Chaput, Clare Gallagher, Jacquie Hodge, Amalia Floer, Adam Kirton
Importance: Hemorrhage into the brain of term newborns often results in major injury and lifelong disability. The clinical epidemiology of neonatal hemorrhagic stroke (NHS) remains undefined, hindering the development of strategies to improve outcomes. Objective: To characterize the incidence, types, presentations, associated factors, and outcomes of neonatal hemorrhagic stroke. Design, Setting, and Participants: Population-based, nested case-control study...
January 17, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28111008/primary-intraventricular-hemorrhage-clinical-characteristics-and-outcomes
#17
Rachel Weinstein, Kathryn Ess, Bilaal Sirdar, Sarah Song, Shawna Cutting
BACKGROUND: Primary intraventricular hemorrhage (IVH) in adults is a rare neurologic disorder. The typical course, etiology, complications, and outcomes have not been well established. MATERIALS AND METHODS: Consecutive patient records with a diagnosis of intracerebral hemorrhage admitted between May 2009 and June 2014 at a tertiary care center were retrospectively reviewed. Subjects were included in the study cohort if all neurologists and the radiology report agreed that the subject had an isolated IVH...
January 19, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28110890/safety-of-endovascular-intervention-for-stroke-on-therapeutic-anticoagulation-multicenter-cohort-study-and-meta-analysis
#18
Donna Kurowski, Karin Jonczak, Qaisar Shah, Shadi Yaghi, Randolph S Marshall, Haroon Ahmad, James McKinney, Jose Torres, Koto Ishida, Brett Cucchiara
INTRODUCTION: Intravenous (IV) tissue plasminogen activator (tPA) is contraindicated in therapeutically anti-coagulated patients. Such patients may be considered for endovascular intervention. However, there are limited data on its safety. PATIENTS AND METHODS: We performed a multicenter retrospective study of patients undergoing endovascular intervention for acute ischemic stroke while on therapeutic anticoagulation. We compared the observed rate of National Institute of Neurological Disorders and Stroke defined symptomatic intracerebral hemorrhage (sICH) with risk-adjusted historical control rates of sICH after IV tPA using weighted averages of the hemorrhage after thrombolysis (HAT) and Multicenter Stroke Survey (MSS) prediction scores...
January 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28110888/cerebral-salt-wasting-is-the-most-common-cause-of-hyponatremia-in-stroke
#19
Jayantee Kalita, Rajesh Kumar Singh, Usha Kant Misra
OBJECTIVE: The study aimed to evaluate the frequency, severity, and causes of hyponatremia in stroke and its influence on outcome. MATERIALS AND METHODS: Consecutive computed tomography- or magnetic resonance imaging-proven stroke patients within 7 days of stroke were included. Severity of stroke was assessed using the National Institute of Health Stroke Scale and consciousness using the Glasgow Coma Scale. Hyponatremia was defined if 2 consecutive serum sodium levels were <135 mEq/L and hypernatremia if >145 mEq/L...
January 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28109273/blocking-of-platelet-glycoprotein-receptor-ib-reduces-thrombo-inflammation-in-mice-with-acute-ischemic-stroke
#20
Michael K Schuhmann, Josua Guthmann, Guido Stoll, Bernhard Nieswandt, Peter Kraft, Christoph Kleinschnitz
BACKGROUND: Ischemic stroke causes a strong inflammatory response that includes T cells, monocytes/macrophages, and neutrophils. Interaction of these immune cells with platelets and endothelial cells facilitates microvascular dysfunction and leads to secondary infarct growth. We recently showed that blocking of platelet glycoprotein (GP) receptor Ib improves stroke outcome without increasing the risk of intracerebral hemorrhage. Until now, it has been unclear whether GPIb only mediates thrombus formation or also contributes to the pathophysiology of local inflammation...
January 21, 2017: Journal of Neuroinflammation
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