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Stroke emergency

Kanchan Vats, Deepaneeta Sarmah, Harpreet Kaur, Madhuri Wanve, Kiran Kalia, Anupom Borah, Kunjan R Dave, Dileep R Yavagal, Pallab Bhattacharya
Stroke is devastating and a major cause of morbidity and mortality around the world. The innate immune response plays an important role in various brain injuries, including stroke, and targeting it for therapeutic interventions would likely prove beneficial. The panoply of inflammatory cells, which induce various cellular, hormonal, and biochemical alterations, mediates the rapid progression of injury in stroke. The inflammasome, a multiprotein oligomer and a key component of specific innate immune responses, contributes toward the worsening of stroke outcomes by activating inflammatory cytokines...
June 19, 2018: Annals of the New York Academy of Sciences
Beenish Fayyaz
Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality...
2018: Journal of Community Hospital Internal Medicine Perspectives
Cheryl Bushnell, Virginia J Howard, Lynda Lisabeth, Valeria Caso, Seana Gall, Dawn Kleindorfer, Seemant Chaturvedi, Tracy E Madsen, Stacie L Demel, Seung-Jae Lee, Mathew Reeves
With the greater availability of treatments for acute ischaemic stroke, including advances in endovascular therapy, personalised assessment of patients before treatment is more important than ever. Women have a higher lifetime risk of stroke; therefore, reducing potential sex differences in the acute stroke setting is crucial for the provision of equitable and fast treatment. Evidence indicates sex differences in prevalence and types of non-traditional stroke symptoms or signs, prevalence of stroke mimics, and door-to-imaging times, but no substantial differences in use of emergency medical services, stroke knowledge, eligibility for or access to thrombolysis or thrombectomy, or outcomes after either therapy...
July 2018: Lancet Neurology
Markus Reinthaler, Ann-Kathrin Ozga, David Sinning, Jonathan Curio, Haitham S Al-Hindwan, Johan Bäckemo Johansson, Friedrich Jung, Andreas Lendlein, Geraldine Rauch, Ulf Landmesser
BACKGROUND: Transcatheter foramen ovale closure (TPC) has emerged as a potential treatment option for patients with cryptogenic strokes and persistent foramen ovale (PFO). However, previous randomized controlled trials could hardly demonstrate any benefit compared to medical treatment (Med-Tx). Recently new data have become available which may change current practice of transcatheter PFO closure. METHODS: A systematic review and meta-analysis comparing TPC and Med-Tx based on all available multicentric randomized controlled trials was performed...
July 2018: American Heart Journal
Douglas T Hidlay, Ryan A McTaggart, Grayson Baird, Shadi Yaghi, Morgan Hemendinger, Eric L Tung, Eleanor L Dibiasio, Richard A Haas, Mahesh V Jayaraman
OBJECTIVES: Mechanical thrombectomy is the standard of care for stroke caused by an emergent large vessel occlusion in the anterior circulation, and the ability to rapidly review CTA is one hurdle in minimizing the time from diagnosis to intervention. We evaluated the diagnostic accuracy and confidence in review of stroke CTA for ELVO via a smartphone-based application as compared to PACS workstation. PATIENTS AND METHODS: Seventy-six head and neck CTA studies performed for stroke from one comprehensive and seven primary stroke centers were independently reviewed remotely on smartphone by two blinded interventional neuroradiologists in actual-use circumstances...
June 11, 2018: Clinical Neurology and Neurosurgery
Nitin Goyal, Konark Malhotra, Muhammad F Ishfaq, Georgios Tsivgoulis, Christopher Nickele, Daniel Hoit, Adam S Arthur, Andrei V Alexandrov, Lucas Elijovich
INTRODUCTION: Debate continues about the optimal anesthetic management for patients undergoing endovascular treatment (ET) of acute ischemic stroke due to emergent large vessel occlusion. OBJECTIVE: To compare, using current evidence, the clinical outcomes and procedural characteristics among patients undergoing general anesthesia (GA) and local or monitored anesthesia (non-GA). METHODS: We performed a systematic review and meta-analysis of all available studies that involved the use of stent retrievers for ET (stentriever group)...
June 15, 2018: Journal of Neurointerventional Surgery
John S Garrett, Steven Sonnamaker, Yahya Daoud, Hao Wang, Dion Graybeal
Background: The aim of the study was to determine the optimal set point for the critical event benchmarks described in stroke guidelines and validate the ability of these goals to predict successful administration of intravenous thrombolysis within 60 min of hospital arrival. Methods: This was a retrospective cohort analysis of patients with acute ischemic stroke who received intravenous thrombolysis following presentation to the emergency department. The national benchmarks for time intervals associated with the completion of critical events required to determine candidacy for thrombolysis were evaluated for the ability to predict successful administration of thrombolysis within 60 min of hospital arrival...
July 2018: Journal of Clinical Medicine Research
Yating Zhao, Yao Lu, Yue Qin
BACKGROUND: In patients undergoing atrial fibrillation (AF) ablation, despite uninterrupted oral anticoagulants (OACs) have been recommended, no consensus has emerged regarding to whether uninterrupted novel oral anticoagulants (NOACs) are superior to uninterrupted vitamin K antagonists (VKAs) for the periprocedural antithrombotic management. This meta-analysis aimed to compare the efficacy and safety of uninterrupted NOACs and uninterrupted VKAs in patients undergoing AF ablation. METHODS: Databases were searched for articles published up to March 20, 2018...
June 8, 2018: International Journal of Cardiology
Meghan Samantha Perkins, Renate Louw-du Toit, Donita Africander
Although hormone therapy is widely used by millions of women to relieve symptoms of menopause, it has been associated with several side-effects such as coronary heart disease, stroke and increased invasive breast cancer risk. These side-effects have caused many women to seek alternatives to conventional hormone therapy, including the controversial custom-compounded bioidentical hormone therapy suggested to not increase breast cancer risk. Historically estrogens and the estrogen receptor were considered the principal factors promoting breast cancer development and progression, however, a role for other members of the steroid receptor family in breast cancer pathogenesis is now evident, with emerging studies revealing an interplay between some steroid receptors...
June 13, 2018: Journal of Molecular Endocrinology
Dirk Bastian, Iftikhar O Ebrahim, Ju-Yi Chen, Mien-Cheng Chen, Dejia Huang, Jin-Long Huang, Vadim A Kuznetsov, Bärbel Maus, Ajay M Naik, Koen J P Verhees, Ahmed R Al Fagih
BACKGROUND: Currently, several geographies around the world remain underrepresented in medical device trials. The PANORAMA 2 study was designed to assess contemporary region-specific differences in clinical practice patterns of patients with cardiac implantable electronic devices (CIEDs). METHODS: In this prospective, multicenter, observational, multi-national study, baseline and implant data of 4,706 patients receiving Medtronic CIEDs (either de novo device implants, replacements, or upgrades) were analyzed, consisting of: 54% implantable pulse generators (IPGs), 20...
June 13, 2018: Pacing and Clinical Electrophysiology: PACE
Sheng Zhang, Jungen Zhang, Meixia Zhang, Genlong Zhong, Zhicai Chen, Longting Lin, Min Lou
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP)...
June 2018: Aging and Disease
Rosaleena Mohanty, Anita M Sinha, Alexander B Remsik, Keith C Dodd, Brittany M Young, Tyler Jacobson, Matthew McMillan, Jaclyn Thoma, Hemali Advani, Veena A Nair, Theresa J Kang, Kristin Caldera, Dorothy F Edwards, Justin C Williams, Vivek Prabhakaran
Interventional therapy using brain-computer interface (BCI) technology has shown promise in facilitating motor recovery in stroke survivors; however, the impact of this form of intervention on functional networks outside of the motor network specifically is not well-understood. Here, we investigated resting-state functional connectivity (rs-FC) in stroke participants undergoing BCI therapy across stages, namely pre- and post-intervention, to identify discriminative functional changes using a machine learning classifier with the goal of categorizing participants into one of the two therapy stages...
2018: Frontiers in Neuroscience
Gheorghe-Andrei Dan, Konstantinos Iliodromitis, Daniel Scherr, Francisco Marín, Radoslaw Lenarczyk, Heidi L Estner, Marcin Kostkiewicz, Nikolaos Dagres, Gregory Y H Lip
Despite the huge progress made in the both understanding the mechanisms and the management of atrial fibrillation (AF) this arrhythmia still represents an important health and social burden. Atrial fibrillation is increasing in frequency and is a major cause of death, stroke, heart failure, cognitive decline, and hospitalizations. New data have emerged emphasizing the multidisciplinary approach to better management of this common arrhythmia. Despite the availability of AF management guidelines, practice among European centres may differ from the current guideline recommendations...
June 8, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Teresa Connolly, Ellen Mahoney
AIMS AND OBJECTIVES: This study investigated the experiences of ischemic stroke survivors (ISSs) during the transitional period from the hospital through the first four weeks after discharge home. BACKGROUND: ISSs describe the transition from hospital to home as an important time in their recovery and describe various physical and cognitive concerns early within the recovery period. Adequate transitional care interventions should be informed by such experiences...
June 12, 2018: Journal of Clinical Nursing
András Folyovich, Anna Béres-Molnár K, Judit Gimesi-Országh, Lajos Katona, Dávid Biczó, Károly Vörös, Gábor Gőbl, András Ajtay, Dániel Bereczki
Background and purpose: The therapeutic time window of acute stroke is short. Decision on the use of intravenous thrombolysis is based on well-defined criteria. Any delay in the transport to a designated stroke centre decreases the odds of therapeutic success. In Hungary, the admission rate of stroke patients peaks on Monday, the number gradually decreasing by the end of the week. This phenomenon has long been suggested to be due to the lack of emergency care approach. According to the literature, however, returning to work following a holiday is a risk factor for acute stroke...
May 30, 2018: Ideggyógyászati Szemle
Louise Y Sun, Amy M Chung, Michael E Farkouh, Sean van Diepen, Jesse Weinberger, Michael Bourke, Marc Ruel
BACKGROUND: Stroke is a leading cause of morbidity, mortality, and disability in patients undergoing cardiac surgery. Identifying modifiable perioperative stroke risk factors may lead to improved patient outcomes. The association between the severity and duration of intraoperative hypotension and postoperative stroke in patients undergoing cardiac surgery was evaluated. METHODS: A retrospective cohort study was conducted of adult patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary center between November 1, 2009, and March 31, 2015...
June 8, 2018: Anesthesiology
Chuansheng Zhao, Mervi Könönen, Ritva Vanninen, Kauko Pitkänen, Sinikka Hiekkala, Jukka Jolkkonen
Recent advances in basic research have revealed the complex structural plasticity associated with the spontaneous motor recovery after stroke. Various rehabilitative interventions seem to act through the same repair mechanisms to further enhance recovery processes. In this review, we first summarize the current understanding on brain plasticity and repair after stroke. We then outline experimental approaches for studying stroke rehabilitation in rodents and review current rehabilitative practices in stroke patients...
June 6, 2018: Restorative Neurology and Neuroscience
Poornima Venkat, Jieli Chen, Michael Chopp
Ischemic stroke is caused by a regional interruption of cerebral blood flow to the brain. Rigorous pre-clinical and clinical research has made landmark progress in stroke treatment using thrombolytics and endovascular thrombectomy. Although numerous successful neuroprotective therapeutic agents for ischemic stroke have been reported in pre-clinical studies, most of them failed in clinical testing. Persistent pre-clinical research has demonstrated that the ischemic brain is not only passively dying but is also actively recovering...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
R Stolmeijer, H R Bouma, J G Zijlstra, A M Drost-de Klerck, J C Ter Maaten, J J M Ligtenberg
Introduction: Despite widespread and liberal use of oxygen supplementation, guidelines about rational use of oxygen are scarce. Recent data demonstrates that current protocols lead to hyperoxemia in the majority of the patients and most health care professionals are not aware of the negative effects of hyperoxemia. Method: To investigate the effects of hyperoxemia in acutely ill patients on clinically relevant outcomes, such as neurological and functional status as well as mortality, we performed a literature review using Medline (PubMed) and Embase...
2018: BioMed Research International
Deborah A Hall, Avram Fraint, Rima Dafer
Background: Fragile-X associated tremor/ataxia syndrome (FXTAS) is commonly associated with T2 hyperintensity in the middle cerebellar peduncles (MCP) on magnetic resonance imaging (MRI). However, ischemic stroke in the MCP in a patient with FXTAS has not previously been described. Case Description: A 61-year-old man with hypertension, sleep apnea, obesity, and FXTAS presented to the emergency department with 2 days of worsening balance and nausea which began 2 days after chiropractic neck manipulation. Examination revealed new nystagmus and worsening dysmetria...
2018: Frontiers in Genetics
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