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Latest & greatest articles for stroke
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, the incidence of new strokes is 795,000 per year, of which 87% are ischemic (2). Endo- vascularthrombectomy(EVT)is provento providebetterclinicaloutcomes in patients with ischemicstrokes caused by large-vessel occlusion compared with best medical therapy alone (3–12). Furthermore, endovas- cular thrombectomy has proven to be cost-effective (13). The American Heart Association (AHA) and multiple international stroke organizations recommendEVTasstandardofcareforselectedpatients(14–18).Basedon 2015 AHA (...) ;PISTEInvestigators. Endovascular therapy for acute ischaemicstroke: the Pragmatic IschaemicStroke Thrombectomy Evaluation (PISTE) randomised, controlled trial. J Neurol Neurosurg Psychiatry 2017; 88:38–44. 11. Nogueira RG, Jadhav AP, Haussen DC, et al; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between de?cit and infarct. N Engl J Med 2018; 378:11–21. 12. Saver JL, Goyal M, Bonafe A, et al; SWIFT PRIME Investigators. Stent- retriever thrombectomy after intravenous t-PA vs
of 543 acute stroke patients including patients with ischemia in the posterior circulation, hemorrhagic stroke, transientischemicattack, and stroke mimics to best represent the prehospital setting. Results- Cortical symptoms alone showed to be a reliable indicator for LVO (sensitivity: 0.91; specificity: 0.70) and MT (sensitivity: 0.90; specificity: 0.60) in acute stroke patients, whereas motor deficits showed a sensitivity of 0.85 for LVO (specificity: 0.53) and 0.87 for MT (specificity: 0.48 (...) Large Vessel Occlusion in Acute Stroke Background and Purpose- To date, no clinical score has become widely accepted as an eligible prehospital marker for large vessel occlusion (LVO) and the need of mechanical thrombectomy (MT) in ischemicstroke. On the basis of pathophysiological considerations, we propose that cortical symptoms such as aphasia and neglect are more sensitive indicators for LVO and MT than motor deficits. Methods- We, thus, retrospectively evaluated a consecutive cohort
Emergent Large Vessel Occlusion Screen Is an Ideal Prehospital Scale to Avoid Missing Endovascular Therapy in Acute Stroke Background and Purpose- The strong evidence of endovascular therapy in acute ischemicstroke patients with large vessel occlusion (LVO) is revealed. Such patients are required to direct transport to the hospital capable of endovascular therapy. There are several prehospital scales available for paramedics to predict LVO. However, they are time consuming, and several of them (...) include factors caused by other types than LVO. Therefore, we need a fast, simple, and reliable prehospital scale for LVO. Methods- We developed a new prehospital stroke scale, emergent large vessel occlusion (ELVO) screen, for paramedics to predict LVO. The study was prospectively performed by multistroke centers. When paramedics referred to stroke center to accept suspected stroke patients, we obtain the following information over the telephone. ELVO screen was designed focusing on cortical symptoms
Immediate and Delayed Procedural Stroke or Death in Stenting Versus Endarterectomy for Symptomatic Carotid Stenosis Background and Purpose- Stenting for symptomatic carotid stenosis (carotid artery stenting [CAS]) carries a higher risk of procedural stroke or death than carotid endarterectomy (CEA). It is unclear whether this extra risk is present both on the day of procedure and within 1 to 30 days thereafter and whether clinical risk factors differ between these periods. Methods- We analyzed (...) the risk of stroke or death occurring on the day of procedure (immediate procedural events) and within 1 to 30 days thereafter (delayed procedural events) in 4597 individual patients with symptomatic carotid stenosis who underwent CAS (n=2326) or CEA (n=2271) in 4 randomized trials. Results- Compared with CEA, patients treated with CAS were at greater risk for immediate procedural events (110 versus 42; 4.7% versus 1.9%; odds ratio, 2.6; 95% CI, 1.9-3.8) but not for delayed procedural events (59 versus
= 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case-crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood (...) stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.Use of carbamazepine and valproic acid, but not lithium and lamotrigine
care pathway No standard methods for early differentiation of type of stroke are recommended or used in the NHS. NICE's guideline on stroke and transientischaemicattack in over 16s recommends that people suspected of having a stroke, and who need brain imaging, have a CT scan. This is currently used to identify large artery occlusion, where mechanical thrombectomy treatment may be suitable. Around 40% of ischaemicstrokes are caused by large artery occlusions (NHS England). If imaging confirms (...) outcomes for people with large artery occlusions. As well as pharmacological therapy or mechanical thrombectomy, people with acute ischaemicstroke will also have therapy to minimise brain damage, such as oxygen therapy, blood pressure control and blood sugar control. The following NICE publications have been identified as relevant to this care pathway: Stroke and transientischaemicattack in over 16s: diagnosis and initial management Stroke rehabilitation in adults Mechanical clot retrieval
Overview of stroke Overview of stroke - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of stroke Last reviewed: February 2019 Last updated: November 2018 Introduction Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is subdivided into ischaemicstroke (caused by vascularocclusion or stenosis) and haemorrhagic stroke (caused by vascular (...) . [Erratum in: Circulation. 2018 Mar 20;137(12):e493.] https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000558 http://www.ncbi.nlm.nih.gov/pubmed/29386200?tool=bestpractice.com Related conditions Condition Description Regardless of the specific aetiology, ischaemicstroke occurs when blood supply in a cerebralvascular territory is critically reduced due to occlusion or critical stenosis of a cerebral artery. A minority of ischaemicstrokes are caused by cerebral sinus or cortical vein
Evolocumab (Repatha) - In adults with established atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease) Published 12 November 2018 Statement of advice SMC2133 evolocumab 140mg solution for injection in pre-filled syringe / 140mg solution for injection in pre-filled pen / 420mg solution of injection in cartridge (Repatha®) Amgen Ltd 5 October 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation evolocumab (...) (Repatha®) is not recommended for use within NHSScotland. Indication under review: In adults with established atherosclerotic cardiovascular disease (myocardial infarction, stroke or peripheral arterial disease) to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors: ? in combination with the maximum tolerated dose of a statin with or without other lipid- lowering therapies or, ? alone or in combination with other lipid-lowering therapies in patients
Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemicstroke Essentials The risk of thrombosis among ischemicstroke patients using glucocorticoids is unknown. We examined the risk of thrombosis in 98 487 ischemicstroke patients, by glucocorticoid use. Myocardial infarction and venous thromboembolism risk was increased in glucocorticoid users. Hemorrhagic stroke risk was lower and recurrent ischemicstroke the same in glucocorticoid users. SUMMARY (...) redemption ≤ 90 days before admission), former use, and non-use. With non-users as reference, we studied the risks of recurrent ischemicstroke, hemorrhagic stroke, myocardial infarction and venous thromboembolism associated with glucocorticoid use. Comorbidity and comedication-adjusted 1-year hazard ratios (aHRs) with 95% confidence intervals (CIs) were computed on the basis of Cox regression analysis. Results We identified 98 487 patients with a first-time (index) ischemicstroke. After the index
Fingolimod enhances the efficacy of delayed alteplase administration in acute ischemicstroke by promoting anterograde reperfusion and retrograde collateral flow The present study was undertaken to determine the efficacy of coadministration of fingolimod with alteplase in acute ischemicstroke patients in a delayed time window.This was a prospective, randomized, open-label, blinded endpoint clinical trial, enrolling patients with internal carotid artery or middle cerebral artery proximal (...) occlusion within 4.5 to 6 hours from symptom onset. Patients were randomly assigned to receive alteplase alone or alteplase with fingolimod. All patients underwent pretreatment and 24-hour noncontrast computed tomography (CT)/perfusion CT/CT angiography. The coprimary endpoints were the decrease of National Institutes of Health Stroke Scale scores over 24 hours and the favorable shift of modified Rankin Scale score (mRS) distribution at day 90. Exploratory outcomes included vessel recanalization
Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke Background and Purpose- We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training. Methods- Twelve outpatient US
neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic (...) Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality.MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive
Effects of robot-(Morning Walk((R))) assisted gait training for patients after stroke: a randomized controlled trial To investigate the effects of Morning Walk®-assisted gait training for patients with stroke.Prospective randomized controlled trial.Three hospital rehabilitation departments (two tertiary and one secondary).We enrolled 58 patients with hemiparesis following a first-time stroke within the preceding year and with Functional Ambulation Category scores ⩾2.The patients were randomly (...) improved more ( p = .047) in the Morning Walk® group (∆mean ± SD; 14.36 ± 9.01) than the control group (∆mean ± SD; 9.65 ± 8.14).Compared with conventional physiotherapy alone, our results suggest that voluntary strength and balance of stroke patients with hemiparesis might be improved with Morning Walk®-assisted gait training combined with conventional physiotherapy.
Return to work after ischemicstroke in young adults: A registry-based follow-up study We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemicstroke (IS) and during follow-up, and clinical factors associated with NRTW.Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were (...) Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.NRTW is a frequent adverse outcome after IS in young adults with mild to moderate
NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemicstroke To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemicstroke (AIS).Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics (...) , sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types.In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients
Assoc. 2016;5:1-14. 1. Fugate JE, Rabinstein AA. Absolute and relative contraindicationstoIVrt-PAfor acute ischemicstroke. Neurohospitalist. 2015;5: 110-121. 2. Brown MD, Burton JH, Nazarian DJ, et al. Clinical policy: use of intravenous tissue plasminogen activator for the management of acute ischemicstroke in the emergency department. Ann Emerg Med. 2015;66: 322-333.e31. 3. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemicstroke in the Safe Implementation (...) of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369:275-282. 4. Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischaemicstroke (SITS-ISTR): an observational study. Lancet. 2008;372: 1303-1309. 5. Luo S, Zhuang M, Zeng W, et al. Intravenous thrombolysis for acute ischemicstroke in patients receiving antiplatelet therapy: a systematic review and meta-analysis of 19 studies. J Am Heart Assoc. 2016;5:1-14. 6. Xian Y, Federspiel
Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? (SRS therapy) Is Antibiotic Therapy Helpful for Preventing Infection After Acute Stroke? TAKE-HOME MESSAGE In patients with acute ischemic or hemorrhagic stroke, prophylactic antibiotics reduce the overall infection rate, but do not reduce the risk of pneumonia, death or dependency. EBEM Commentators Latha Ganti, MD, MBA Department of Clinical Sciences University of Central Florida College of Medicine Orlando, FL Bryan (...) studies and ongoing trials. STUDY SELECTION Randomized trials that compared preventive antibiotictherapyversus control in patients with acute ischemic or hemorrhagic stroke were included. There were no limits on route of antibiotic administration (oral or parenteral) or duration, but therapy had to be started within 24 hours after the onset of stroke in patients without infection at presentation. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data with a standardized data collection