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Stroke—Must read

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12 papers 0 to 25 followers Pertinent stroke, stroke neuroimaging and endovascular papers
By Daniel Vela-Duarte Neurology / Vascular Neurology
Andrew Wassef, Ken Butcher
BACKGROUND: Four nonvitamin K antagonist oral anticoagulants (NOACs) are approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). AIMS: In this review, we assemble available evidence for the best management of ischemic and hemorrhagic stroke patients in the context of NOAC use. SUMMARY OF REVIEW: NOACs provide predictable anticoagulation with fixed dosages. The direct thrombin inhibitor dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban are all noninferior to warfarin for the prevention of ischemic stroke and systemic embolism and are associated with reduced incidence of intracranial hemorrhage...
October 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Gregoire Boulouis, Andreas Charidimou, Steven M Greenberg
Sporadic cerebral amyloid angiopathy is a small vessel disorder defined pathologically by progressive amyloid deposition in the walls of cortical and leptomeningeal vessels resulting from disruption of a complex balance between production, circulation, and clearance of amyloid-β peptide (Aβ) in the brain. Cerebral amyloid angiopathy is a major cause of lobar symptomatic intracerebral hemorrhage, transient focal neurologic episodes, and a key contributor to vascular cognitive impairment. The mechanisms and consequences of amyloid-β deposition at the pathological level and its neuroimaging manifestations, clinical consequences, and implications for patient care are addressed in this review...
June 2016: Seminars in Neurology
Joshua VanDerWerf, Monisha A Kumar
Coagulopathy, defined as impaired clot formation, is common in intensive care units (ICUs). Many physiological derangements lead to dysfunctional hemostasis in the ICU; most of these are acquired rather than congenital. Coagulopathies in the ICU are often related to systemic diseases, autoimmune dysfunction, acute infection, organ dysfunction, therapeutic medications, and/or other medical treatments. A significant complication of coagulopathy in the critically ill is major bleeding, defined as fatal hemorrhage, hemodynamic instability, transfusion requirement, or intracranial hematomas...
June 2016: Seminars in Neurology
Shamik Bhattacharyya, Aaron L Berkowitz
Primary angiitis of the central nervous system (PACNS) is an extremely rare condition, defined as a vasculitis limited to the CNS with no identifiable cause. Its presentation is non-specific and includes headache, cognitive dysfunction and focal neurological signs. Laboratory studies, neuroimaging and angiography are neither sufficiently sensitive nor specific for diagnosis; a definitive diagnosis requires brain biopsy. As a result, PACNS is commonly misdiagnosed. Here, we review its clinical, laboratory and radiological features, and focus on avoiding common diagnostic pitfalls...
June 2016: Practical Neurology
Carlos García-Esperón, Elena López-Cancio, Lorena Martín-Aguilar, Mónica Millán, Carlos Castaño, Josep Munuera, Antoni Dávalos
The "pontine warning syndrome" is characterized by recurrent episodes of motor hemiparesis, dysarthria and horizontal gaze palsy associated with basilar artery branch infarction. We report a case of a patient who presented with recurrent, self-limited episodes of locked-in syndrome, related to a bilateral pontine infarction. As far as we know, this clinical presentation as a subtype of pontine warning syndrome has never been described. We discuss the case, the differential diagnosis of the neuroimaging and the possible underlying mechanism...
October 2016: Neuroradiology Journal
Tom van Seeters, Geert Jan Biessels, L Jaap Kappelle, Yolanda van der Graaf, Birgitta K Velthuis
INTRODUCTION: Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. METHODS: We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion...
July 20, 2016: Neuroradiology
Johannes Hensler, Ulf Jensen-Kondering, Stephan Ulmer, Olav Jansen
INTRODUCTION: Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought. METHODS: This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature...
August 11, 2016: Neuroradiology
Duncan Wilson, Andreas Charidimou, Gareth Ambler, Zoe V Fox, Simone Gregoire, Phillip Rayson, Toshio Imaizumi, Felix Fluri, Hiromitsu Naka, Solveig Horstmann, Roland Veltkamp, Peter M Rothwell, Vincent I H Kwa, Vincent Thijs, Yong-Seok Lee, Young Dae Kim, Yining Huang, Ka Sing Wong, Hans Rolf Jäger, David J Werring
OBJECTIVE: To determine associations between cerebral microbleed (CMB) burden with recurrent ischemic stroke (IS) and intracerebral hemorrhage (ICH) risk after IS or TIA. METHODS: We identified prospective studies of patients with IS or TIA that investigated CMBs and stroke (ICH and IS) risk during ≥3 months follow-up. Authors provided aggregate summary-level data on stroke outcomes, with CMBs categorized according to burden (single, 2-4, and ≥5 CMBs) and distribution...
October 4, 2016: Neurology
J P Klaas
No abstract text is available yet for this article.
June 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
K D Kurz, G Ringstad, A Odland, R Advani, E Farbu, M W Kurz
Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used...
January 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
J Venhovens, J Meulstee, W I M Verhagen
Almost 20 % of cerebral ischaemic strokes occur in the posterior circulation. Estimates are that 20 % of these patients present with isolated vertigo. In approximately one-sixth to one-third of these patients, this symptom is wrongly diagnosed to be peripheral vestibular in origin. As a result, these missed stroke patients are withheld from therapeutic and secondary prophylactic treatment, which may result in unnecessary morbidity and mortality. We therefore propose a diagnostic algorithm concerning the clinical differentiation of acute vestibular syndrome (AVS) patients based on a critical review of the available literature...
March 16, 2016: Journal of Neurology
Christian Weimar
PURPOSE OF REVIEW: The purpose of this review is to update the reader on current concepts of workup and secondary prevention in patients with stroke of undetermined cause. RECENT FINDINGS: Clinical research in patients with cryptogenic stroke has been hampered by the lack of standardized, widely accepted diagnostic criteria. The new definition of 'Embolic stroke of undetermined etiology' postulates an embolic mechanism of ischemic stroke. It is based on the exclusion of lacunar infarction by brain imaging, arterial stenosis more than 50% or dissection of the respective brain-supplying artery by computed tomography/magnetic resonance-angiography or ultrasound, atrial fibrillation by at least 24 h EKG monitoring, as well as some rare etiologies such as vasculitis, drug abuse, or coagulopathies...
February 2016: Current Opinion in Neurology
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