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Stroke TIA

Joan Porter, Luke Mondor, Moira K Kapral, Jiming Fang, Ruth E Hall
BACKGROUND/AIMS: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. METHODS: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors...
October 18, 2016: Cerebrovascular Diseases Extra
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
Tuba Akinci, Eda Derle, Seda Kibaroğlu, Ali Harman, Feride Kural, Pınar Cınar, Munire Kilinc, Hakki T Akay, Ufuk Can, Ulku S Benli
OBJECTIVE: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). METHODS: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (>/=70%) or symptomatic stenosis (>/=50%). Demographic data, procedural details, and clinical outcomes were recorded...
October 2016: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Andrea Duca, Andy Jagoda
The definition of a transient ischemic attack (TIA) has evolved over the past decade from a clinical diagnosis to a tissue-based definition based on neuroimaging results. TIA shares the same pathophysiology as stroke, which occurs in up to 5% of patients within 48 hours of the TIA and 10% within 90 days. This rate is decreasing, likely due to improved diagnostic and management strategies. Decision support scores have been developed to risk stratify patients, which include clinical and radiological elements...
November 2016: Emergency Medicine Clinics of North America
Fadar Oliver Otite, Priyank Khandelwal, Seemant Chaturvedi, Jose G Romano, Ralph L Sacco, Amer M Malik
OBJECTIVE: To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States. METHODS: We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n = 4,355,140) and TIA (n = 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost. RESULTS: From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%)...
October 12, 2016: Neurology
Shawna Cutting, Elizabeth Regan, Vivien H Lee, Shyam Prabhakaran
BACKGROUND AND PURPOSE: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. METHODS: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h...
October 8, 2016: Cerebrovascular Diseases Extra
Mark I Boulos, Sara Elias, Anthony Wan, James Im, Fadi Frankul, Mina Atalla, Sandra E Black, Vincenzo S Basile, Arun Sundaram, Julia J Hopyan, Karl Boyle, David J Gladstone, Richard H Swartz, Brian J Murray
BACKGROUND: Home sleep apnea testing (HSAT) is an alternative to polysomnography for the detection of obstructive sleep apnea (OSA). We assessed the feasibility of HSAT as an unattended screening tool for patients with a stroke or transient ischemic attack (TIA). AIMS: The primary outcome was the feasibility of unattended HSAT, as defined by analyzability of the data. Secondary outcomes included determining (1) predictors of obtaining nonanalyzable sleep data and (2) time to OSA detection and continuous positive airway pressure (CPAP) initiation...
October 4, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Lixia Zong, Ming Yao, Jun Ni, Lixin Zhou, Jing Yuan, Bin Peng, Yi-Cheng Zhu, Liying Cui
BACKGROUND: Previous studies suggested the potential interactions between cerebrovascular diseases and impaired renal function. However, the relationship between renal function and white matter hyperintensity (WMH), marker of cerebral small vessel disease, in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. METHODS: We consecutively enrolled 1632 subjects with AIS or TIA who underwent brain MRI for this analysis. The severity of WMH in both of periventricular (PVH) and deep subcortical white matter (SDWMH) was evaluated using Fazekas scale...
October 6, 2016: BMC Neurology
William K Karlsson, Caspar G Sørensen, Christina Kruuse
Endothelial dysfunction (ED), in particular cerebral ED, may be an essential biomarker for ischemic cerebrovascular disease. However, there is no consensus on methods to best estimate cerebral ED. In this systematic review, we evaluate the use of L-arginine and N(G) -monomethyl-L-arginine (L-NMMA) for assessment of cerebral ED. A systematic search of PubMed, EMBASE and the Cochrane Library was done. We included studies investigating cerebrovascular response to L-arginine or L-NMMA in human subjects with vascular risk factors or ischemic cerebrovascular disease...
October 5, 2016: Clinical and Experimental Pharmacology & Physiology
Giancarlo Nicosia, Domenico Cicala, Giuseppe Mirone, Pietro Spennato, Vincenzo Trischitta, Claudio Ruggiero, Gianluigi Guarneri, Mario Muto, Giuseppe Cinalli
INTRODUCTION: Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents...
October 4, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Liesl Zühlke, Ganesan Karthikeyan, Mark E Engel, Sumathy Rangarajan, Pam Mackie, Blanche Cupido, Katya Mauff, Shofiqul Islam, Rezeen Daniels, Veronica Francis, Stephen Ogendo, Bernard Gitura, Charles Mondo, Emmy Okello, Peter Lwabi, Mohammed M Al-Kebsi, Christopher Hugo-Hamman, Sahar S Sheta, Abraham Haileamlak, Wandimu Daniel, Dejuma Yadeta Goshu, Senbeta G Abdissa, Araya G Desta, Bekele A Shasho, Dufera M Begna, Ahmed ElSayed, Ahmed S Ibrahim, John Musuku, Fidelia Bode-Thomas, Christopher C Yilgwan, Ganiyu A Amusa, Olukemi Ige, Basil Okeahialam, Christopher Sutton, Rajeev Misra, Azza Abul Fadl, Neil Kennedy, Albertino Damasceno, Mahmoud U Sani, Okechukwu S Ogah, Taiwo Olunuga, Huda ElHassan, Ana Olga Mocumbi, Abiodun M Adeoye, Pindile S Mntla, Dike B Ojji, Joseph Mucumbitsi, Koon Teo, Salim Yusuf, Bongani M Mayosi
BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia. METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE)...
October 4, 2016: Circulation
Christopher W L Armstrong, Erika Bosio, Claire Neil, Simon G A Brown, Graeme J Hankey, Daniel M Fatovich
We previously reported on a 26-year-old patient who presented early during a large and eventually fatal cerebral infarct. Microarray analysis of blood samples from this patient demonstrated initially up-regulated and subsequently down-regulated Granzyme B (GzmB) expression, along with progressive up-regulation of genes for S100 calcium binding protein A12 (S100A12) and matrix metalloproteinase 9 (MMP-9). To confirm these findings, we investigated these parameters in patients with suspected stroke presenting within 6h of symptom onset to a single centre...
September 30, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
David J Seiffge, Christopher Traenka, Alexandros Polymeris, Lisa Hert, Nils Peters, Philippe Lyrer, Stefan T Engelter, Leo H Bonati, Gian Marco De Marchis
OBJECTIVE: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non-vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. METHODS: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs)...
September 30, 2016: Neurology
Thomas Monks, David Worthington, Michael Allen, Martin Pitt, Ken Stein, Martin A James
BACKGROUND: Mathematical capacity planning methods that can take account of variations in patient complexity, admission rates and delayed discharges have long been available, but their implementation in complex pathways such as stroke care remains limited. Instead simple average based estimates are commonplace. These methods often substantially underestimate capacity requirements. We analyse the capacity requirements for acute and community stroke services in a pathway with over 630 admissions per year...
September 29, 2016: BMC Health Services Research
Eleni Korompoki, Angela Del Giudice, Steffi Hillmann, Uwe Malzahn, David J Gladstone, Peter Heuschmann, Roland Veltkamp
BACKGROUND AND PURPOSE: The detection rate of atrial fibrillation has not been studied specifically in transient ischemic attack (TIA) patients although extrapolation from ischemic stroke may be inadequate. We conducted a systematic review and meta-analysis to determine the rate of newly diagnosed atrial fibrillation using different methods of ECG monitoring in TIA. METHODS: A comprehensive literature search was performed following a pre-specified protocol the PRISMA statement...
September 28, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Ji-Heng Hao, Li-Yong Zhang, Kai Lin, Wei-Dong Liu, Shi-Gang Zhang, Ji-Yue Wang, Gang Li, Le-Xin Wang
OBJECTIVE: To evaluate the safety and outcomes of surgical revascularization for patients with symptomatic kinking of the internal carotid artery (ICA). METHODS: Twenty-five consecutive patients presented with symptomatic kinking of the ICA and a history of transient ischemic attack (TIA) or stroke were prospectively enrolled in this study. All patients were treated with ICA transection and end-to-side reimplantation at the level of the carotid bulb. Patients were followed up for a median of 32 months...
October 2016: Vascular and Endovascular Surgery
J Faulkner, Y-C Tzeng, D Lambrick, B Woolley, P D Allan, T O'Donnell, J Lanford, L Wong, L Stoner
Early exercise engagement elicits meaningful changes in peripheral blood pressure in patients diagnosed with transient ischaemic attack (TIA) or minor stroke. However, central hemodynamic markers may provide clinicians with important diagnostic and prognostic information beyond that provided by peripheral blood pressure readings. The purpose of this single-centre, randomized, parallel-group clinical trial was to determine the effect of a 12-week aerobic exercise intervention on central and peripheral hemodynamic variables in patients with TIA or minor stroke...
September 29, 2016: Journal of Human Hypertension
Lucas Ramirez, May A Kim-Tenser, Nerses Sanossian, Steven Cen, Ge Wen, Shuhan He, William J Mack, Amytis Towfighi
BACKGROUND: Transient ischemic attack (TIA) is a major predictor of subsequent stroke. No study has assessed nation-wide trends in hospitalization for TIA in the United States. METHODS AND RESULTS: Temporal trends in hospitalization for TIA (International Classification of Diseases, Ninth Revision code 435.0-435.9) from 2000 to 2010 were assessed among adults aged ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific TIA hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US population as the denominator...
2016: Journal of the American Heart Association
Md Asiful Islam, Fahmida Alam, Mohammad Amjad Kamal, Kah Keng Wong, Teguh Haryo Sasongko, Siew Hua Gan
Neurological manifestations or disorders associated with central nervous system (CNS) are one of the most common as well as important clinical characteristics of antiphospholipid syndrome (APS). Although in the last updated (2006) classification criteria of APS its neurological manifestations encompassed only transient ischemic attack (TIA) and stroke, diverse 'non-criteria' neurological disorders or manifestations (headache, migraine, bipolar disorder, transverse myelitis, dementia, chorea, epileptic seizures, multiple sclerosis, psychosis, cognitive impairment, Tourette's syndrome, parkinsonism, dystonia, transient global amnesia, obsessive compulsive disorder and leukoencephalopathy) have been observed in APS patients...
September 20, 2016: CNS & Neurological Disorders Drug Targets
Joan Martí-Fàbregas, Sebastián Figueroa, Eva Martínez-Lizana, Irati Zubizarreta, David Carrera, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Pol Camps-Renom, Elena Jiménez-Xarrié, Raquel Delgado-Mederos
Chronic hypoperfusion may hinder the washout of emboli coming from the heart and facilitate the formation of intra-cavitary thrombi. We investigated whether a decreased total cerebral blood flow (tCBF) resulted in recurrence of stroke and other vascular events in consecutive patients with cardioembolic stroke. We excluded patients with extra-cranial carotid or vertebral stenosis. The recorded tCBF was the sum of blood flow in both the carotid and vertebral extra-cranial arteries as measured with ultrasonography...
September 17, 2016: Ultrasound in Medicine & Biology
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