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wake up stroke

Ina Israel, Felix Fluri, Fabian Schadt, Adreas Buck, Samuel Samnick
BACKGROUND: P-selectin is activated early after stroke, followed by a rapid decline. This time course can be used to generate important information on stroke onset. The latter is crucial for therapeutic decision-making of wake-up strokes (i.e. thrombolysis or not). Here we evaluated the specific p-selectin inhibitor 68Ga-Fucoidan for assessing p-selectin activation after ischemic stroke using PET. METHODS: 68Ga-Fucoidan was investigated in rats brain at 2-5 h (n=16), and additionally at 24-26 h (n=9) and 48 h (n=3) after induction of photothrombic stroke or in sham operated animals (n=6)...
March 19, 2018: Current Neurovascular Research
Charlotte Spicher, Ruth Schneider, Peter Mönnings, Christiane Schneider-Gold, Dennis Kallenberg, Bilal Cevik, Carsten Lukas, Ralf Gold, Christos Krogias
Background: Duchenne muscular dystrophy (DMD) is an X-linked recessive skeletal muscle myopathy which is caused by mutations in the dystrophin gene. Lack of dystrophin also results to cardiomyopathy, which raises significantly the stroke risk in DMD-patients. However, data about therapeutic opportunities in the acute setting are scarce in literature. So far, only two cases receiving IV thrombolysis are described, one of them with fatal outcome. Method: Case report of a case of successful mechanical thrombectomy (MTE) in an acute ischemic stroke (AIS) patient with DMD and associated dilatative cardiomyopathy...
2018: Therapeutic Advances in Neurological Disorders
Devin L Brown, Chengwei Li, Ronald D Chervin, Erin Case, Nelda M Garcia, Susan D Tower, Lynda D Lisabeth
Background: We sought to investigate the frequency of wake-up stroke (WUS) and its association with sleep-disordered breathing (SDB) in women. Methods: Within a population-based study, women with acute ischemic stroke were asked about their stroke symptom onset time. SDB screening was performed with the well-validated ApneaLink Plus device; SDB was defined by a respiratory event index ≥10. Logistic regression was used to test the association between SDB presence and severity and WUS unadjusted and adjusted for potential confounders including prestroke depression and sleep duration...
February 2018: Neurology. Clinical Practice
Jin Soo Kim, Seongheon Kim, Seung Hwan Lee, Hee Young Lee, Seo Young Lee, Kyoung Bin Im
BACKGROUND AND PURPOSE: The literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke. METHODS: We investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke...
February 28, 2018: Journal of Clinical Neurology
P Bücke, M Aguilar Pérez, V Hellstern, M AlMatter, H Bäzner, H Henkes
BACKGROUND AND PURPOSE: Mechanical thrombectomy in acute ischemic stroke within 6 hours of symptom onset is effective and safe. However, in many patients, information on the beginning of symptoms is not available. Patients can be divided into those with wake-up stroke and daytime-unwitnessed stroke. Evidence on outcome and complications after mechanical thrombectomy in wake-up stroke and daytime-unwitnessed stroke is rare. A potential beneficial effect of mechanical thrombectomy in selected patients with wake-up stroke or daytime-unwitnessed stroke is suspected...
February 8, 2018: AJNR. American Journal of Neuroradiology
(no author information available yet)
No abstract text is available yet for this article.
February 2018: Stroke; a Journal of Cerebral Circulation
Simon Escalard, Benjamin Gory, Maéva Kyheng, Jean-Philippe Desilles, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Julien Labreuche, Mikael Mazighi, Michel Piotin, Raphaël Blanc, Bertrand Lapergue, Robert Fahed
BACKGROUND AND PURPOSE: The DAWN Trial recently showed compelling evidence in treating late window and wake-up stroke patients with thrombectomy using a clinical-imaging mismatch. We aimed to evaluate the results of thrombectomy for unknown-onset strokes (UOS) treated in our centers after a DWI-FLAIR mismatch based selection. METHODS: We performed a multicenter, cohort study of consecutive UOS treated by thrombectomy between 2012 and 2016. We compared UOS with proximal anterior circulation occlusion discovered beyond 6 hours from "last seen normal" with known-onset strokes (KOS) for whom thrombectomy was started within 6 hours from onset...
January 21, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Mark J Alberts, Martin D Ollenschleger, Amre Nouh
Until recently, the selection of patients with large artery occlusion and ischemic stroke for reperfusion therapy was based on time criteria (typically within 6 hours) and basic imaging protocols (head CT, CT angiogram, ASPECTS score). The recently published DAWN (DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) study has changed this paradigm by using a tissue-based selection criteria and a greatly expanded treatment time window (up to 24 hours)...
January 18, 2018: Circulation
Gustavo Saposnik, Daniel Strbian
No abstract text is available yet for this article.
February 2018: Stroke; a Journal of Cerebral Circulation
Koichiro Nagai, Junya Aoki, Yuki Sakamoto, Kazumi Kimura
BACKGROUND AND PURPOSE: Recent studies using magnetic resonance imaging (MRI) have reported that wake-up stroke (WUS) patients may be able to be treated using tissue-plasminogen activator (tPA) when showing no ischemia on fluid-attenuated inversion recovery (Negative-FLAIR). We investigated the frequency of WUS and calculated what percentage of WUS patients with Negative-FLAIR meets most of the conventional tPA criteria. We did not include a time parameter in this study. METHODS: Consecutive patients with acute stroke affecting the anterior circulation who presented within 12h of onset were enrolled...
November 15, 2017: Journal of the Neurological Sciences
Yuval Nir, Thomas Andrillon, Amit Marmelshtein, Nanthia Suthana, Chiara Cirelli, Giulio Tononi, Itzhak Fried
Sleep deprivation is a major source of morbidity with widespread health effects, including increased risk of hypertension, diabetes, obesity, heart attack, and stroke. Moreover, sleep deprivation brings about vehicle accidents and medical errors and is therefore an urgent topic of investigation. During sleep deprivation, homeostatic and circadian processes interact to build up sleep pressure, which results in slow behavioral performance (cognitive lapses) typically attributed to attentional thalamic and frontoparietal circuits, but the underlying mechanisms remain unclear...
December 2017: Nature Medicine
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
November 2017: Revue Neurologique
Victoria Ebiana, Sandeep Singh, Shaweta Khosa, Negar Moheb, Bhavesh Trikamji, Neal M Rao, Shri K Mishra
OBJECTIVE: This study aimed to discuss a case of a patient with a known diagnosis of Parry-Romberg syndrome (PRS) presenting with ischemic stroke, the second such reported case. BACKGROUND: PRS is a rare genetic disorder with progressive hemifacial atrophy, which usually presents within the first 2 decades of life. Neurologic manifestations include trigeminal neuralgia with associated deafness, hemifacial pain with associated migraine headaches, seizures, movement disorders, and neuropsychiatric symptoms...
January 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Diogo C Haussen, Shannon Doppelheuer, Kiva Schindler, Jonathan A Grossberg, Mehdi Bouslama, Meagan Schultz, Hilarie Perez, Alex Hall, Michael Frankel, Raul G Nogueira
BACKGROUND AND PURPOSE: The informed consent process is a major limitation for enrollment in acute stroke clinical investigations. We aim to describe the novel application of smartphone electronic informed consenting (e-Consent) in trials of cerebral thrombectomy. METHODS: The e-Consent tool consists of a secure/Health Insurance Portability and Accountability Act compliant smartphone platform based on REDCap (Research Electronic Data Capture; Vanderbilt University, TN) that uses a survey project located on a static webpage...
November 2017: Stroke; a Journal of Cerebral Circulation
L Pierot, M Gawlitza, S Soize
Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4...
November 2017: Revue Neurologique
Götz Thomalla, Florent Boutitie, Jochen B Fiebach, Claus Z Simonsen, Norbert Nighoghossian, Salvador Pedraza, Robin Lemmens, Pascal Roy, Keith W Muir, Christoph Heesen, Martin Ebinger, Ian Ford, Bastian Cheng, Tae-Hee Cho, Josep Puig, Vincent Thijs, Matthias Endres, Jens Fiehler, Christian Gerloff
OBJECTIVE: To determine whether the manner of consent, i.e., informed consent by patients themselves or informed consent by proxy, affects clinical characteristics of samples of acute stroke patients enrolled in clinical trials. METHODS: We analyzed the manner of obtaining informed consent in the first 1,005 patients from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset running in 6 European countries...
September 26, 2017: Neurology
Luuk Dekker, Hajo Hund, Robin Lemmens, Jelis Boiten, Ido van den Wijngaard
Patients with unknown time of stroke onset (UOS) represent around one-third of ischemic stroke patients. These are patients with wake-up stroke (WUS) or daytime-unwitnessed stroke (DUS), often presenting outside the time-window for reperfusion therapy. UOS patients presenting between 4.5 and 12 h after time of last-seen-well were included. Clinical and imaging characteristics were compared between WUS and DUS patients. Good functional outcome was defined as a modified Rankin scale of ≤2 at follow-up. Sixty-one UOS patients were included: 42 WUS and 19 DUS patients...
September 2017: Acta Neurologica Belgica
Gregory B Walker, Ashutosh P Jadhav, Tudor G Jovin
For the past 20 years, intravenous recombinant tissue plasminogen activator (rt-PA) has been the only proven treatment for acute ischemic stroke. Large arteries such as the internal carotid artery, the middle cerebral artery and the basilar artery supply blood to large volumes of brain tissue. When occluded, these vessels may have low response rates to rt-PA resulting in devastating injury and death. Areas covered: In 2013, three trials evaluating the efficacy of mechanical thrombectomy in acute stroke were neutral, however, lessons learned from these trials resulted in a second generation of five trials in 2015 and a sixth in 2016 which all demonstrated significant benefit for select patients...
October 2017: Expert Review of Cardiovascular Therapy
Cheng-Yang Hsieh
lization of intravenous thrombolysis with alteplase was very low in Taiwanese patients with acute ischemic stroke(1). One of the reasons is the strict reimbursement guideline made by the Bureau of National Health Insurance (NHI) in 2004(2). In this issue of the Acta Neurologica Taiwanica, Yu-Hsiang Su and co-authors(3) retrospectively evaluated outcomes of their thrombolysed stroke patients who were "mismatched" between updated clinical practice guideline and NHI reimbursement criteria. They concluded that the outcomes of patients treated according to guidelines were comparable between the reimbursement and non-reimbursement groups...
March 15, 2017: Acta Neurologica Taiwanica
Burak Yulug, Lütfü Hanoglu, Ertugrul Kilic
No abstract text is available yet for this article.
July 27, 2017: CNS & Neurological Disorders Drug Targets
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