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Stroke—Must read

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20 papers 0 to 25 followers Pertinent stroke, stroke neuroimaging and endovascular papers
By Daniel Vela-Duarte Neurology / Vascular Neurology
Mark R Etherton, Andrew D Barreto, Lee H Schwamm, Ona Wu
Despite the proven efficacy of intravenous alteplase or endovascular thrombectomy for the treatment of patients with acute ischemic stroke, only a minority receive these treatments. This low treatment rate is due in large part to delay in hospital arrival or uncertainty as to the exact time of onset of ischemic stroke, which renders patients outside the current guideline-recommended window of eligibility for receiving these therapeutics. However, recent pivotal clinical trials of late-window thrombectomy now force us to rethink the value of a simplistic chronological formulation that "time is brain...
2018: Frontiers in Neurology
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
Volker Maus, Alev Kalkan, Christoph Kabbasch, Nuran Abdullayev, Henning Stetefeld, Utako Birgit Barnikol, Thomas Liebig, Christian Dohmen, Gereon Rudolf Fink, Jan Borggrefe, Anastasios Mpotsaris
BACKGROUND: Mechanical thrombectomy (MT) of basilar artery occlusions (BAO) is a subject of debate. We investigated the clinical outcome of MT in BAO and predictors of a favorable outcome. MATERIAL AND METHODS: A total of 104 MTs of BAO (carried out between 2010 and 2016) were analyzed. Favorable outcome as a modified Rankin scale (mRS) ≤ 2 at 90 days was the primary endpoint. The influence of the following variables on outcome was investigated: number of detectable posterior communicating arteries (PcoAs), patency of basilar tip, completeness of BAO and posterior circulation Alberta Stroke Program early computed tomography score (PC-ASPECTS)...
December 19, 2017: Clinical Neuroradiology
D Renard
Cerebral microbleeds (CMBs) are small foci of (acute, subacute or chronic) blood products, best seen using magnetic resonance imaging (MRI) techniques sensitive to iron deposits (i.e. gradient-echo T2*-weighted and susceptibility-weighted imaging), frequently encountered in small vessel disease (SVD) (with hypertensive vasculopathy and cerebral amyloid angiopathy as the most frequent conditions) and also in other disorders. In this review, the MRI characteristics of CMBs and the associated MRI abnormalities encountered in common and less common SVD and non-SVD conditions are the main focus...
March 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Werner Hacke
New England Journal of Medicine, Volume 378, Issue 1, Page 81-83, January 2018.
January 4, 2018: New England Journal of Medicine
Jan C Purrucker, Thorsten Steiner
PURPOSE OF REVIEW: An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs...
February 2017: Current Opinion in Neurology
Götz Thomalla, Florent Boutitie, Jochen B Fiebach, Claus Z Simonsen, Norbert Nighoghossian, Salvador Pedraza, Robin Lemmens, 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 AND PURPOSE: We describe clinical and magnetic resonance imaging (MRI) characteristics of stroke patients with unknown time of symptom onset potentially eligible for thrombolysis from a large prospective cohort. METHODS: We analyzed baseline data from WAKE-UP (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke: A Randomized, Doubleblind, Placebo-Controlled Trial), an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset...
March 2017: Stroke; a Journal of Cerebral Circulation
Eduard Shantsila, Gregory Yh Lip
BACKGROUND: Morbidity in patients with chronic heart failure is high, and this predisposes them to thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principle oral antithrombotic agents. Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulants have become a standard in the management of heart failure with atrial fibrillation...
September 15, 2016: Cochrane Database of Systematic Reviews
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...
October 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...
October 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...
November 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
2015-12-22 08:23:13
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