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Carla Bentes, Ana Rita Peralta, Pedro Viana, Hugo Martins, Carlos Morgado, Carlos Casimiro, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho E Melo, Teresa Paiva, José M Ferro
OBJECTIVE: To identify the most accurate quantitative electroencephalographic (qEEG) predictor(s) of unfavorable post-ischemic stroke outcome, and its discriminative capacity compared to already known demographic, clinical and imaging prognostic markers. METHODS: Prospective cohort of 151 consecutive anterior circulation ischemic stroke patients followed for 12 months. EEG was recorded within 72 h and at discharge or 7 days post-stroke. QEEG (global band power, symmetry, affected/unaffected hemisphere and time changes) indices were calculated from mean Fast Fourier Transform and analyzed as predictors of unfavorable outcome (mRS ≥ 3), at discharge and 12 months poststroke, before and after adjustment for age, admission NIHSS and ASPECTS...
June 18, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Anne Laure Castel, Manuel Toledano, Christophe Tribouilloy, François Delelis, Amandine Mailliet, Nathalie Marotte, Raphaëlle A Guerbaai, Franck Levy, Pierre Graux, Pierre-Vladimir Ennezat, Sylvestre Maréchaux
BACKGROUND: Whether echocardiography platform and analysis software impact left ventricular (LV) volumes, ejection fraction (EF), and stroke volume (SV) by transthoracic tridimensional echocardiography (3DE) has not yet been assessed. Hence, our aim was to compare 3DE LV end-diastolic and end-systolic volumes (EDV and ESV), LVEF, and SV obtained with echocardiography platform from 2 different manufacturers. METHODS: 3DE was performed in 84 patients (65% of screened consecutive patients), with equipment from 2 different manufacturers, with subsequent off-line postprocessing to obtain parameters of LV function and size (Philips QLAB 3DQ and General Electric EchoPAC 4D autoLVQ)...
May 27, 2018: American Heart Journal
Waleed Brinjikji, Patrick J Nicholson, Christopher A Hilditch, Anderson Chun On Tsang, Timo Krings
BACKGROUND: Orbital infarction syndrome (OIS) is a rare entity defined as ischemia of all intraorbital and intra-occular structures including the optic nerve, extraocular muscles and orbital fat. This entity is rare due to rich anastomotic orbital vascularization from both the internal carotid artery and external carotid artery. We report a case of a patient who suffered ENT to the ophthalmic artery and external carotid artery which resulted in orbital infarction syndrome and describe techniques to avoid such complications...
June 20, 2018: World Neurosurgery
Qian Wang, Lu Liu, Ling Gao, Qiu Li
AIM: To show long-term cardiovascular safety of the GLP-1 receptor agonists for diabetes patients with cardiovascular risk. METHODS: For cardiovascular outcomes, the association between treatment and outcomes was estimated using the odds ratio and 95% confidence interval. I2 test was adopted to assess the magnitude of heterogeneity between studies, with values more than 25%, 50%, and 75% defined as low, moderate, or high heterogeneity. RESULTS: We combined data from four cardiovascular outcomes trials and prospectively blinded endpoint adjudication...
June 20, 2018: Diabetes Research and Clinical Practice
Bryan T C Chuang, Xiaoguang Liu, Alexander J Lundberg, Tommy J K Toung, John A Ulatowski, Raymond C Koehler
BACKGROUND: Injection of a clot into the internal carotid artery is an experimental model of ischemic stroke that is considered to closely mimic embolic stroke in humans. In this model, the common carotid artery typically remains temporarily occluded to permit time for stabilization of the clot in the middle cerebral artery. However, the associated lengthening of the anesthesia duration could affect arterial blood pressure and stroke outcome. NEW METHOD: We refined the model by examining how increasing isoflurane anesthesia duration from 30 to 60 min after clot embolization affects mortality, infarct volume, edema, blood-brain barrier permeability, and the 8-h post-ischemic time course of blood pressure, which has not been reported previously in this model...
June 20, 2018: Journal of Neuroscience Methods
Shashank Shekhar, Mark W Cunningham, Mallikarjuna R Pabbidi, Shaoxun Wang, George W Booz, Fan Fan
Ischemic stroke is a devastating and debilitating medical condition with limited therapeutic options. However, accumulating evidence indicates a central role of inflammation in all aspects of stroke including its initiation, the progression of injury, and recovery or wound healing. A central target of inflammation is disruption of the blood brain barrier or neurovascular unit. Here we discuss recent developments in identifying potential molecular targets and immunomodulatory approaches to preserve or protect barrier function and limit infarct damage and functional impairment...
June 20, 2018: European Journal of Pharmacology
J Truijen, L S Rasmussen, Y S Kim, J Stam, W J Stok, F C Pott, J J van Lieshout
BACKGROUND AND PURPOSE: Cerebrovascular responses to head-of-bed positioning in patients with acute ischemic stroke are heterogeneous, questioning applicability of general recommendations on head positioning. Cerebral autoregulation is impaired to various extents after acute stroke, while it is unknown whether this affects cerebral perfusion during posture change. We aimed to elucidate whether the cerebrovascular response to head position manipulation depends on autoregulatory performance in ischemic stroke patients...
June 23, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Justin W Andrushko, Dakota T Zirk
No abstract text is available yet for this article.
June 22, 2018: Journal of Physiology
Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, Sahar Ahmed, Ghassan Bachuwa, Mustafa Hassan, Deepak L Bhatt
Dual antiplatelet therapy with aspirin and clopidogrel are recommended as adjuncts to fibrinolytic-treated patients with ST-elevation myocardial infarction (STEMI). However, the role of switching to ticagrelor within 24 h of fibrinolytics compared with clopidogrel continuation in this setting is uncertain. Hence, we conducted a comprehensive search of electronic databases for all randomized clinical trials (RCTs) that evaluated the safety and efficacy of ticagrelor versus clopidogrel after fibrinolytic therapy in patients with STEMI...
June 22, 2018: Journal of Thrombosis and Thrombolysis
Gilles Adam, Marine Ferrier, Sofia Patsoura, Raluca Gramada, Zuzana Meluchova, Vanessa Cazzola, Jean Darcourt, Christophe Cognard, Alain Viguier, Fabrice Bonneville
Acute ischaemic stroke represents the most common cause of new sudden neurological deficit, but other diseases mimicking stroke happen in about one-third of the cases. Magnetic resonance imaging (MRI) is the best technique to identify those 'stroke mimics'. In this article, we propose a diagnostic approach of those stroke mimics on MRI according to an algorithm based on diffusion-weighted imaging (DWI), which can be abnormal or normal, followed by the results of other common additional MRI sequences, such as T2 with gradient recalled echo weighted imaging (T2-GRE) and fluid-attenuated inversion recovery (FLAIR)...
June 22, 2018: Insights Into Imaging
Takashi Kanda, Masaaki Uematsu, Masashi Fujita, Osamu Iida, Masaharu Masuda, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takuya Tsujimura, Yasuhiro Matsuda, Shota Okuno, Toshiaki Mano
Predictors of outcomes in patients with heart failure with preserved left-ventricular ejection fraction (HFpEF) remain unclear. The ratio of early diastolic transmitral flow velocity to early diastolic myocardial velocity (E/e') has been proposed, but the predictive accuracy remains unsatisfactory. We hypothesized that E/e' normalized by the stroke volume (SV), E/e'/SV, could be a good predictor of outcome in HFpEF patients by reflecting the terminal slope of the end-diastolic pressure-volume relation, i.e...
June 22, 2018: Heart and Vessels
Per Wändell, Axel C Carlsson, Jan Sundquist, Kristina Sundquist
Risk of dementia is increased in patients with atrial fibrillation (AF). We aimed to study associations between relevant comorbidities and prevalent as well as incident dementia in AF patients. Study population included all adults (n = 12,283) ≥ 45 years diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for associations between comorbidities and prevalent dementia. In a subsample (n = 12,096), (excluding patients with dementia diagnosed before AF onset), Cox regression was used to estimate hazard ratios (HR) with 95% CIs for association between comorbidities, and incident dementia, after adjustment for age, socioeconomic factors and anticoagulant treatment...
June 22, 2018: GeroScience
Jing Chen, Dalong Sun, Mingli Liu, Shufan Zhang, Chuancheng Ren
This study aimed to examine the effectiveness of defibrinogen therapy on functional recovery and safety among 1332 consecutive ischemic stroke patients who had not received intravenous thrombolysis with recombinant tissue plasminogen activator. Stroke patients undergoing conservative and relatively individualized multiple-day dosing regimens of defibrinogen therapy between January 1, 2008 and May 30, 2016 were enrolled. Data were analyzed according to functional success (Barthel Index of 95 or 100, mRS of 0 or 1) and safety variables (intracranial hemorrhage, mortality and stroke recurrence)...
June 22, 2018: Scientific Reports
Carlos Laredo, Yashu Zhao, Salvatore Rudilosso, Arturo Renú, José Carlos Pariente, Ángel Chamorro, Xabier Urra
The prognostic relevance of strokes in different locations is debated. For example, insular strokes have been associated with increased mortality, but this association could reflect their greater severity. In two independent cohorts of patients with supratentorial ischemic stroke (n = 90 and 105), we studied the prognostic consequences of lesion size and location using voxel-based lesion-symptom mapping before and after volume control, which better accounts for total lesion volume. Strokes affecting the insula were larger than non-insular strokes (28 vs 2cc and 25 vs 3cc, p < 0...
June 22, 2018: Scientific Reports
Cheng Chen, Pengcheng Xun, Cari Tsinovoi, Leslie A McClure, John Brockman, Leslie MacDonald, Mary Cushman, Jianwen Cai, Lisa Kamendulis, Jason Mackey, Ka He
OBJECTIVES: To examine the association between urinary cadmium levels and the incidence of ischemic stroke and to explore possible effect modifications. METHODS: A case-cohort study was designed nested in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including 680 adjudicated incident cases of ischemic stroke and 2,540 participants in a randomly selected subcohort. Urinary creatinine-corrected cadmium concentration was measured at baseline...
June 22, 2018: Neurology
Anouchska S A Autar, Hajo M Hund, Sharad A Ramlal, Daniël Hansen, Geert J Lycklama À Nijeholt, Bart J Emmer, Moniek P M de Maat, Diederik W J Dippel, Aad van der Lugt, Adriaan C G M van Es, Heleen M M van Beusekom
BACKGROUND: Currently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR-CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent-retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices...
June 22, 2018: Journal of the American Heart Association
Salma Ladhani, Brianna Empringham, Kuan-Wen Wang, Carol Portwine, Laura Banfield, Russell J de Souza, Lehana Thabane, M Constantine Samaan
INTRODUCTION: Acute lymphoblastic leukaemia is the most common paediatric cancer. Survivors of childhood acute lymphoblastic leukaemia (SALL) are at risk of obesity and related cardiometabolic diseases including type 2 diabetes, hypertension, stroke and cardiovascular events. Therefore, it is important to address obesity in this population as this may help mitigate future cardiometabolic comorbidities. In this systematic review, we aim to assess current treatment strategies including lifestyle interventions, pharmacotherapy and bariatric surgery to manage overweight and obesity in SALL...
June 22, 2018: BMJ Open
Guohua Zheng, Yuhui Zheng, Zhenyu Xiong, Bingzhao Ye, Jing Tao, Lidian Chen
INTRODUCTION: Poststroke cognitive impairment is one of the most common complications in stroke survivors, and >65% of these patients suffer from cognitive impairment at 12 months following onset, which strongly affects the rehabilitation of their motor function and quality of life. Therefore, it is important to improve the cognitive ability of stroke survivors. As an important component of traditional Chinese Qigong exercises, characterised by the coordination of mind and body with a low exercise intensity, Baduanjin has the potential benefit of improving cognitive ability for patients who had a stroke with cognitive impairment...
June 22, 2018: BMJ Open
Lawrence H Young, Catherine M Viscoli, Gregory G Schwartz, Silvio E Inzucchi, Jeptha P Curtis, Mark J Gorman, Karen L Furie, Robin Conwit, Erica Spatz, Anne Lovejoy, J Dawn Abbott, Daniel L Jacoby, Daniel M Kolansky, Frederick S Ling, Steven E Pfau, Walter N Kernan
Background -The Insulin Resistance Intervention after Stroke (IRIS) trial demonstrated that pioglitazone reduced risk for both cardiovascular events and diabetes in insulin resistant patients. However, concern remains that pioglitazone may increase risk for heart failure (HF) in susceptible individuals. Methods -In IRIS, patients with insulin resistance but without diabetes were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemic stroke or TIA and followed for up to 5 years. To identify patients at higher HF risk with pioglitazone we performed a secondary analysis of IRIS participants without HF history at entry...
June 22, 2018: Circulation
Niklas W Andersson, Henrik Svanström, Marie Lund, Björn Pasternak, Mads Melbye
BACKGROUND: The comparative effectiveness and safety of individual direct oral anticoagulants (DOACs) in clinical practice is largely unknown. The study objectives were to compare effectiveness and safety of DOACs in patients with non-valvular atrial fibrillation (NVAF). METHODS: Based on nationwide registers we established a population-based historical cohort study of 12,638 new users of standard dose DOACs (apixaban 5 mg twice daily, dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily) with NVAF in Denmark, July 2013 to March 2016...
June 19, 2018: International Journal of Cardiology
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