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https://www.readbyqxmd.com/read/28229398/stroke-chameleons-and-stroke-mimics-in-the-emergency-department
#1
REVIEW
Ava L Liberman, Shyam Prabhakaran
PURPOSE OF REVIEW: We discuss the frequency of stroke misdiagnosis in the emergency department (ED), identify common diagnostic pitfalls, describe strategies to reduce diagnostic error, and detail ongoing research. RECENT FINDINGS: The National Academy of Medicine has re-defined and highlighted the importance of diagnostic errors for patient safety. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics")...
February 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28215748/long-non-coding-rna-snhg14-promotes-microglia-activation-by-regulating-mir-145-5p-pla2g4a-in-cerebral-infarction
#2
Xu Qi, Ming Shao, Hongjing Sun, Yue Shen, Delong Meng, Wei Huo
Activated microglia cells (MCs) are able to release a large amount of inflammatory cytokines after ischemic stroke, which exacerbates neuron damage. In this study, we explored the functional involvement of lncRNA SNHG14 and its potential regulatory mechanism in the activation of MCs. The mouse model of middle cerebral artery occlusion (MCAO) and microglia cell model of oxygen/glucose deprivation were made. The expression of SNHG14, miR-145-5p and PLA2G4A protein expression was determined by quantitative real time PCR and western blot, respectively...
February 16, 2017: Neuroscience
https://www.readbyqxmd.com/read/28202820/-clinical-manifestations-of-spinal-epidural-hematoma-stroke-mimic-and-pitfalls-in-diagnosis
#3
Masaru Kuriyama
Clinical manifestations of spinal epidural hematoma are presented, and the cases mimicking acute ischemic stroke have been reviewed from the literature. Many reports described the cases of spinal epidural hematoma with acute hemiparesis mimicking ischemic stroke in which intravenous thrombolytic treatment with recombinant tissue plasminogen activator was considered. A correct diagnosis of acute ischemic stroke must be made within 4.5 hours from the onset of symptoms, a relatively short window period. A spinal epidural hematoma is a potentially important stroke mimic in a wide variety of conditions that mimic a stroke...
February 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28202285/decreased-mir-146a-expression-in-acute-ischemic-stroke-directly-targets-the-fbxl10-mrna-and-is-involved-in-modulating-apoptosis
#4
Sheng-Hua Li, Lan Chen, Xiao-Min Pang, Sheng-You Su, Xia Zhou, Chun-Yong Chen, Li-Gang Huang, Jing-Pin Li, Jing-Li Liu
BACKGROUND: miR-146a, a strong pro-apoptotic factor in some pathophysiological processes, is reported to be involved in ischemic stroke (IS), though its role remains unclear. Fbxl10 is an active anti-apoptotic factor and a predicted target of miR-146a. We hypothesized that dysregulation of miR-146a contributes to ischemic injury by targeting Fbxl10. METHODS: Circulating miRNAs were detected by miRNA microarray and qRT-PCR. miR-146a targets were predicted using bioinformatics and confirmed with a dual luciferase reporter assay...
February 12, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28201864/recurrent-contrast-induced-encephalopathy-following-coronary-angiography
#5
Roberto Spina, Neil Simon, Romesh Markus, David W M Muller, Krishna Kathir
Contrast-induced encephalopathy (CIE) is an acute and reversible neurological disturbance associated with the intra-arterial administration of iodinated contrast medium during cardiac catheterisation. It may manifest with encephalopathy, motor and sensory disturbances; vision disturbances, including cortical blindness, ophthalmoplegia, aphasia; and seizures. Disruption of the blood-brain barrier and direct neuronal toxicity are believed to be implicated in the pathophysiology of the syndrome. Symptoms appear soon after contrast administration and resolve completely within 24-48 h...
February 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28195514/blood-brain-barrier-on-a-chip-microphysiological-systems-that-capture-the-complexity-of-the-blood-central-nervous-system-interface
#6
Duc Tt Phan, R Hugh F Bender, Jillian W Andrejecsk, Agua Sobrino, Stephanie J Hachey, Steven C George, Christopher Cw Hughes
The blood-brain barrier is a dynamic and highly organized structure that strictly regulates the molecules allowed to cross the brain vasculature into the central nervous system. The blood-brain barrier pathology has been associated with a number of central nervous system diseases, including vascular malformations, stroke/vascular dementia, Alzheimer's disease, multiple sclerosis, and various neurological tumors including glioblastoma multiforme. There is a compelling need for representative models of this critical interface...
January 1, 2017: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/28169020/description-of-stroke-mimics-after-complete-neurovascular-assessment
#7
C Avellaneda-Gómez, A Rodríguez Campello, E Giralt Steinhauer, A Gómez González, M Serra Martínez, P de Ceballos Cerrajería, A Zabalza de Torres, E Cuadrado-Godia, A Ois Santiago, J Jiménez-Conde, J Roquer
INTRODUCTION: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. OBJECTIVE: The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis...
February 4, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28157745/diagnosis-and-management-of-transient-ischemic-attack
#8
Shelagh B Coutts
PURPOSE OF REVIEW: This article reviews the diagnosis, investigation, and recommended management after a transient ischemic attack (TIA) and discusses how to make an accurate diagnosis, including the diagnosis of mimics of TIAs. RECENT FINDINGS: Up to a 10% risk of recurrent stroke exists after a TIA, and up to 80% of this risk is preventable with urgent assessment and treatment. Imaging of the brain and intracranial and extracranial blood vessels using CT, CT angiography, carotid Doppler ultrasound, and MRI is an important part of the diagnostic assessment...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28157743/clinical-evaluation-of-the-patient-with-acute-stroke
#9
Andrew M Southerland
PURPOSE OF REVIEW: This article reviews the clinical evaluation of the patient with acute stroke, including key questions in the focused stroke history, important aspects of the National Institutes of Health Stroke Scale and focused neurologic examination, and the significance of the basic head CT scan in informing a timely treatment decision. RECENT FINDINGS: Advances in both stroke treatment and enhanced diagnostics support an evolving paradigm for acute stroke care, ranging from the prehospital setting to the rehabilitative setting...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28148593/stroke-mimic-diagnoses-presenting-to-a-hyperacute-stroke-unit
#10
Oscar Mp Jolobe
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28113622/investigation-of-crossbeam-multi-receiver-configurations-for-accurate-3d-vector-doppler-velocity-estimation
#11
Bushra Hussain, Billy Yiu, Alfred C H Yu, James C Lacefield, Tamie L Poepping
Accurate estimation of low blood velocities whose Doppler shifts span the wall filter cut-off, such as near the wall in recirculation or disturbed flow regions, is important for accurate mapping of velocities to achieve improved estimations of wall shear stress and turbulence, which are known risk factors for atherosclerosis and stroke. This study presents the comparative benefit of increasing the number of receiver beams above three for improved estimation of low 3D velocities. The 3D-crossbeam vector Doppler ultrasound configurations were studied in terms of the number of receiver beams, inter-beam angle, and beamselection method (criterion for discriminating between tissue and blood Doppler signals) for a range of velocity orientations, which may prove useful in the design of a future 2D array for vascular imaging...
August 24, 2016: IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control
https://www.readbyqxmd.com/read/28097225/centrally-involved-x-linked-charcot-marie-tooth-disease-presenting-as-a-stroke-mimic
#12
Patrick D Nicholson, Stefan M Pulst
No abstract text is available yet for this article.
February 2017: Neurology. Genetics
https://www.readbyqxmd.com/read/28094088/usefulness-of-multiparametric-computerized-tomography-findings-in-the-differential-diagnosis-of-stroke-mimics-of-epileptic-origin-a-preliminary-study
#13
R López Ruiz, S Quintas, P Largo, M de Toledo, M T Carreras, A Gago-Veiga, R Manzanares, J Vivancos
OBJECTIVE: Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events. MATERIAL AND METHODS: We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy...
January 13, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28094079/a-stroke-mimic-methotrexate-induced-neurotoxicity-in-the-emergency-department
#14
Patrick Rogers, Wilbur J Pan, Richard A Drachtman, Christopher Haines
BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. The treatment of ALL involves multimodality therapy, and methotrexate (MTX) remains a mainstay of treatment. A complication of MTX therapy includes acute, subacute, and chronic neurotoxocity. Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms. CASE REPORT: An 18-year-old woman with a history of ALL presented to the emergency department with acute onset of right-sided facial paralysis, right upper extremity flaccid paralysis, and right lower extremity weakness after receiving MTX therapy 3 days earlier...
January 13, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#15
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28088349/stroke-biomarkers-in-clinical-practice-a-critical-appraisal
#16
REVIEW
Geelyn J L Ng, Amy M L Quek, Christine Cheung, Thiruma V Arumugam, Raymond C S Seet
Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described...
January 11, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28077713/reversible-disruption-of-neuronal-mitochondria-by-ischemic-and-traumatic-injury-revealed-by-quantitative-two-photon-imaging-in-the-neocortex-of-anesthetized-mice
#17
Mikhail Kislin, Jeremy Sword, Ioulia V Fomitcheva, Deborah Croom, Evgeny Pryazhnikov, Eero Lihavainen, Dmytro Toptunov, Heikki Rauvala, Andre S Ribeiro, Leonard Khiroug, Sergei A Kirov
: Mitochondria play a variety of functional roles in cortical neurons, from metabolic support and neuroprotection to the release of cytokines that trigger apoptosis. In dendrites, mitochondrial structure is closely linked to their function, and fragmentation (fission) of the normally elongated mitochondria indicates loss of their function under pathological conditions, such as stroke and brain trauma. Using in vivo two-photon microscopy in mouse brain, we quantified mitochondrial fragmentation in a full spectrum of cortical injuries, ranging from severe to mild...
January 11, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28074981/-thrombolysis-in-stroke-mimics-experience-in-10-cases
#18
Alejandro M Brunser, Arnold Hoppe, Paula Muñoz, Pablo M Lavados, Sergio Illanes, Violeta Díaz, Verónica V Olavarría
BACKGROUND: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM. AIM: To describe the frequency and prognosis of SM treated with IVT. MATERIAL AND METHODS: Prospective analysis of all patients evaluated in a Chilean private clinic between December 2004 and July 2015 with a suspected acute ischemic stroke (AIS)...
October 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/28070749/an-automated-microemboli-detection-and-classification-system-using-backscatter-rf-signals-and-differential-evolution
#19
Karim Ferroudji, Nabil Benoudjit, Ayache Bouakaz
Embolic phenomena, whether air or particulate emboli, can induce immediate damages like heart attack or ischemic stroke. Embolus composition (gaseous or particulate matter) is vital in predicting clinically significant complications. Embolus detection using Doppler methods have shown their limits to differentiate solid and gaseous embolus. Radio-frequency (RF) ultrasound signals backscattered by the emboli contain additional information on the embolus in comparison to the traditionally used Doppler signals...
January 9, 2017: Australasian Physical & Engineering Sciences in Medicine
https://www.readbyqxmd.com/read/28068417/preserved-collateral-blood-flow-in-the-endovascular-m2cao-model-allows-for-clinically-relevant-profiling-of-injury-progression-in-acute-ischemic-stroke
#20
Philip Little, Ola Kvist, Rikard Grankvist, Stefan Jonsson, Peter Damberg, Michael Söderman, Fabian Arnberg, Staffan Holmin
Interventional treatment regimens have increased the demand for accurate understanding of the progression of injury in acute ischemic stroke. However, conventional animal models severely inhibit collateral blood flow and mimic the malignant infarction profile not suitable for treatment. The aim of this study was to provide a clinically relevant profile of the emergence and course of ischemic injury in cases suitable for acute intervention, and was achieved by employing a M2 occlusion model (M2CAO) that more accurately simulates middle cerebral artery (MCA) occlusion in humans...
2017: PloS One
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