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https://www.readbyqxmd.com/read/28803427/unknown-onset-ischemic-strokes-in-patients-last-seen-well-4-5%C3%A2-h-differences-between-wake-up-and-daytime-unwitnessed-strokes
#1
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...
August 12, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28792246/assessing-the-efficacy-of-endovascular-therapy-in-stroke-treatments-updates-from-the-new-generation-of-trials
#2
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...
August 9, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28752507/intravenous-alteplase-for-acute-ischemic-stroke-in-taiwan-can-we-expand-the-national-health-insurance-s-reimbursement-criteria
#3
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
https://www.readbyqxmd.com/read/28748752/toward-a-personalized-medicine-in-wake-up-stroke
#4
Burak Yulug, Lütfü Hanoglu, Ertugrul Kilic
No abstract text is available yet for this article.
July 27, 2017: CNS & Neurological Disorders Drug Targets
https://www.readbyqxmd.com/read/28747411/stroke-of-the-inferiomedial-temporal-lobe-causing-word-agnosia
#5
Hardi Hassan, Huq Ehsanula, Mahendra Pattanshetti
A 69-year-old man presented with sudden loss of ability to recognise written words and remember the meaning of words and names. He could not name the town he lived in nor name his children. It was difficult for him to remember the meaning of concrete and abstract nouns. His speech fluency and understanding of casual talks were normal. He remembered that he had a conversation with his family that morning, but not the exact content. He was referred to the transient ischaemic attack clinic by his general practitioner as he scored low on the abbreviated mental test score...
July 26, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28734791/association-between-nocturnal-blood-pressure-variation-and-wake-up-ischemic-stroke
#6
Hyuk Sung Kwon, Ji Young Kim, Hojin Choi, Seok Joon Lee, Seong-Ho Koh, Young Joo Lee, Hyun Young Kim, Hee-Tae Kim, Juhan Kim, Young Seo Kim
Ischemic stroke during nocturnal sleep, known as wake-up stroke (WUS), has been reported to have more severe symptoms and worse outcomes than non-WUS. However, studies on risk factors for WUS are scarce and the association between nocturnal blood pressure (BP) and WUS is unclear. In this study, we used ambulatory blood pressure monitoring (ABPM) to examine the association between WUS and variation in nocturnal BP. A total of 369 patients with ischemic stroke within one week were consecutively enrolled. ABPM was applied 1-2weeks after the ictus because of possible reactive increments of BP; antihypertensive medications were delayed until ABPM...
July 19, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28646892/effect-of-acupuncture-on-cerebrovascular-reserve-in-patients-with-acute-cerebral-infarction-protocol-for-a-randomized-controlled-pilot-study
#7
Shaosong Wang, Tingting Ma, Linpeng Wang, Lu Liu, Huilin Liu, Bin Li, Yuanbo Fu
BACKGROUND: The incidence of cerebral infarction has been growing year by year in China and around the world. According to clinical observation, acupuncture utilizing the "waking up the spirit" needling method is widely used in patients with cerebral infarction, though the underlying mechanisms remain unclear. Additionally, a number of studies have begun to focus on the relationship between cerebrovascular reserve (CVR) and cerebral infarction. The present study aims to investigate whether CVR is one of potential mechanisms underpinning this effect of acupuncture on patients with cerebral infarction...
June 24, 2017: Trials
https://www.readbyqxmd.com/read/28644924/intravenous-thrombolysis-for-acute-ischemic-stroke-a-bridge-between-two-centuries
#8
Georgios Tsivgoulis, Odysseas Kargiotis, Andrei Alexandrov
Intravenous tissue-plasminogen activator (tPA) remains the only approved systemic reperfusion therapy suitable for most patients presenting timely with acute ischemic stroke. Accumulating real-word experience for over 20 years regarding tPA safety and effectiveness lead to re-appraisal of original contraindications for intravenous thrombolysis (IVT). Areas covered: This narrative review focuses on fast yet appropriate selection of patients for safe administration of tPA per recently expanded indications. Novel strategies for rapid patient assessment will be discussed...
June 23, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/28625252/-cerebral-injury-induced-by-heat-stroke-and-the-therapeutic-effect-of-hyperbaric-oxygen-therapy
#9
Xiaoxiao Ni, Zhifeng Liu, Qiuyou Xie, Huasheng Tong, Lei Su, Ronghao Yu
With the global warming, the incidence of heat stroke was significantly higher than before. Severe heat stroke has a high mortality, high morbidity and consolidated central nervous system injury characteristics. The main features of severe heat stroke cerebral injury include cognitive impairment, delirium, convulsions and coma. Its mechanism is related with heat shock induced cerebral tissue ischemia and hypoxia, vascular dysfunction, secondary cascade inflammation and so on. Currently, the main treatment of heat stroke cerebral injury is the hypothermia therapy, dehydration for the reduction of intracranial pressure, naloxone and other cerebral protection and nutrition treatments...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28572764/the-effects-of-modified-constraint-induced-movement-therapy-in-acute-subcortical-cerebral-infarction
#10
Changshen Yu, Wanjun Wang, Yue Zhang, Yizhao Wang, Weijia Hou, Shoufeng Liu, Chunlin Gao, Chen Wang, Lidong Mo, Jialing Wu
Background: Constraint-induced movement therapy (CIMT) promotes upper extremity recovery post stroke, however, it is difficult to implement clinically due to its high resource demand and safety of the restraint. Therefore, we propose that modified CIMT (mCIMT) be used to treat individuals with acute subcortical infarction. Objective: To evaluate the therapeutic effects of mCIMT in patients with acute subcortical infarction, and investigate the possible mechanisms underlying the effect. Methods: The role of mCIMT was investigated in 26 individuals experiencing subcortical infarction in the preceding 14 days...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/28569123/diffusion-weighted-imaging-or-computerized-tomography-perfusion-assessment-with-clinical-mismatch-in-the-triage-of-wake-up-and-late-presenting-strokes-undergoing-neurointervention-with-trevo-dawn-trial-methods
#11
Tudor G Jovin, Jeffrey L Saver, Marc Ribo, Vitor Pereira, Anthony Furlan, Alain Bonafe, Blaise Baxter, Rishi Gupta, Demetrius Lopes, Olav Jansen, Wade Smith, Daryl Gress, Steven Hetts, Roger J Lewis, Ryan Shields, Scott M Berry, Todd L Graves, Tim Malisch, Ansaar Rai, Kevin N Sheth, David S Liebeskind, Raul G Nogueira
Rationale Efficacy of mechanical thrombectomy for acute stroke due to large vessel occlusion initiated beyond 6 h of time last seen well has not been demonstrated in randomized trials. Aim To establish whether subjects considered to have substantial areas of salvageable brain based on age-adjusted clinical core mismatch who can undergo endovascular treatment within 6-24 h from time last seen well (TLSW) have better outcomes at three months compared to subjects treated with standard medical therapy alone...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28468061/-distributions-and-associations-between-duration-of-sleep-daytime-naps-and-insomnia-symptoms-among-chinese-adults
#12
B Zheng, L L Lin, C Q Yu, J Lyu, Y Guo, Z Bian, Y L Tan, P Pei, J S Chen, Z M Chen, L M Li
Objective: To investigate the distribution of sleep duration, daytime naps habits, and insomnia-related symptoms among participants from the China Kadoorie Biobank (CKB) study, and to examine the associations between the sleep-associated factors. Methods: A self-designed computer-based questionnaire was adopted to collect social-demographic information and lifestyle-related factors of the participants. A total of 452 829 Chinese adults aged 30-79 years, without self-reported histories of coronary heart disease, stroke, chronic obstructive pulmonary diseases or cancer, were included in this study...
April 10, 2017: Zhonghua Liu Xing Bing Xue za Zhi, Zhonghua Liuxingbingxue Zazhi
https://www.readbyqxmd.com/read/28463224/wing-wake-interaction-destabilizes-hover-equilibrium-of-a-flapping-insect-scale-wing
#13
James Bluman, Chang-Kwon Kang
Wing-wake interaction is a characteristic nonlinear flow feature that can enhance unsteady lift in flapping flight. However, the effects of wing-wake interaction on the flight dynamics of hover are inadequately understood. We use a well-validated 2D Navier-Stokes equation solver and a quasi-steady model to investigate the role of wing-wake interaction on the hover stability of a fruit fly scale flapping flyer. The Navier-Stokes equations capture wing-wake interaction, whereas the quasi-steady models do not...
June 15, 2017: Bioinspiration & Biomimetics
https://www.readbyqxmd.com/read/28455315/wake-up-stroke-is-associated-with-greater-nocturnal-mean-arterial-pressure-variability
#14
Michelle D Lundholm, Melissa Rooney, Matthew B Maas, Hrayr Attarian, Shyam Prabhakaran
BACKGROUND AND PURPOSE: Wake-up strokes (WUS) account for ≈20% to 30% of ischemic strokes. Studies have shown that increased autonomic instability as measured by blood pressure variability (BPV) is greater in stroke patients than nonstroke patients, but no studies have compared BPV in WUS versus non-WUS patients. METHODS: From a single-center prospective registry, we identified consecutive ischemic stroke patients. BPV was calculated as the coefficient of variation of the mean arterial pressure during the first 24 hours after hospitalization...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28425349/clinical-characteristics-of-unknown-symptom-onset-stroke-patients-with-and-without-diffusion-weighted-imaging-and-fluid-attenuated-inversion-recovery-mismatch
#15
Götz Thomalla, Florent Boutitie, Jochen B Fiebach, Claus Z Simonsen, Salvador Pedraza, Robin Lemmens, Norbert Nighoghossian, Pascal Roy, Keith W Muir, Martin Ebinger, Ian Ford, Bastian Cheng, Ivana Galinovic, Tae-Hee Cho, Josep Puig, Vincent Thijs, Matthias Endres, Jens Fiehler, Christian Gerloff
Background Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28424312/archer-fish-jumping-prey-capture-kinematics-and-hydrodynamics
#16
Anna M Shih, Leah Mendelson, Alexandra H Techet
Smallscale archer fish, Toxotes microlepis, are best known for spitting jets of water to capture prey, but also hunt by jumping out of the water to heights of up to 2.5 body lengths. In this study, high-speed imaging and particle image velocimetry were used to characterize the kinematics and hydrodynamics of this jumping behavior. Jumping used a set of kinematics distinct from those of in-water feeding strikes and was segmented into three phases: (1) hovering to sight prey at the surface, (2) rapid upward thrust production and (3) gliding to the prey once out of the water...
April 15, 2017: Journal of Experimental Biology
https://www.readbyqxmd.com/read/28361615/unclear-onset-intracerebral-hemorrhage-clinical-characteristics-hematoma-features-and-outcomes
#17
Yasuteru Inoue, Fumio Miyashita, Masatoshi Koga, Kazuo Minematsu, Kazunori Toyoda
Background and purpose Although unclear-onset ischemic stroke, including wake-up ischemic stroke, is drawing attention as a potential target for reperfusion therapy, acute unclear-onset intracerebral hemorrhage has been understudied. Clinical characteristics, hematoma features, and outcomes of patients who developed intracerebral hemorrhage during sleep or those with intracerebral hemorrhage who were unconscious when witnessed were determined. Methods Consecutive intracerebral hemorrhage patients admitted within 24 hours after onset or last-known normal time were classified into clear-onset intracerebral hemorrhage and unclear-onset intracerebral hemorrhage groups...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28359617/fluid-attenuated-inversion-recovery-flair-signal-intensity-can-identify-stroke-within-6-and-8-hours
#18
John Legge, Ada Graham, Shailesh Male, David Copeland, Richard Lee, Nitin Goyal, Ramin Zand
BACKGROUND: Patients with wake-up or unknown time of onset stroke are usually excluded from recanalization. However, a few studies indicate that some magnetic resonance sequences can help predict time from symptom onset (SxO). Our goal was to assess the value of fluid-attenuated inversion recovery (FLAIR) signal intensity ratio (SIR) in identifying patients within 6 and 8 hours of stroke onset. MATERIALS AND METHODS: We studied consecutive acute stroke patients with known time of onset who underwent magnetic resonance imaging (MRI) within 48 hours of SxO...
March 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28343220/hemorrhagic-transformations-after-thrombectomy-risk-factors-and-clinical-relevance
#19
Johannes Kaesmacher, Mirjam Kaesmacher, Christian Maegerlein, Claus Zimmer, Alexandra S Gersing, Silke Wunderlich, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Hemorrhagic transformation (HT) is a major complication of acute ischemic stroke, potentially associated with clinical deterioration. We attempted to identify risk factors and evaluated clinical relevance of minor and major HTs following endovascular thrombectomy (ET) in isolated middle cerebral artery (MCA) occlusions. METHODS: This is a retrospective single-center analysis of 409 patients with isolated MCA occlusion treated with ET. Patients' and procedural characteristics, severity of HT according to the European Cooperative Acute Stroke Study criteria, and clinical outcomes were analyzed...
2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28318954/computed-tomography-perfusion-based-decision-making-for-acute-ischemic-stroke-missing-the-mismatch
#20
J A Molad, M Findler, E Auriel
The emerging use of mechanical thrombectomy for acute ischemic stroke treatment focuses on the importance of patient selection. Computed tomography perfusion (CTP) is one of widely used techniques. However, the accuracy and reliability of this modality is in debate among vascular neurologists. We present a case of an 80-year-old man admitted because of acute ischemic stroke. CT angiography demonstrated left proximal M2 occlusion. As CTP demonstrated signs of large ischemic core with no significant penumbra, mechanical thrombectomy was not performed following tPA administration...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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