Editorial Comment: Stroke Following Chiropractic Manipulation
I think this is a very interesting case with a very well done discussion of the incidence and mechanisms involved in the ischemic arterial strokes following manipulation of the neck. I have had an interest in this subject, and for that matter, the larger subject of vertebral artery distribution strokes in children since I was a resident some 40 years ago. We had a young woman in her early 20s come to the hospital with a lateral medullary infarction secondary to chiropractic manipulation of her neck when I was the senior resident on the neurology inpatient service. This led to some exploration of the literature and resulted in similar conclusions to those voiced here by Dr Deputy in that we do not know what the incidence of neurologic injury actually is. Although many of us, neurologists and child neurologists alike, have seen occasional patients with vertebral artery distribution infarcts following minor injury, trauma, or manipulation of the neck, there have been few systematic studies of the condition and the incidence is low enough that few have the experience to do such a study. The development of the pediatric stroke registry may provide sufficient numbers of cases to allow some general conclusions to be made, but so far this has not been forthcoming.
Publication date: March 2020Source: Journal of Vascular and Interventional Radiology, Volume 31, Issue 3, SupplementAuthor(s): R. Wang, K. Chang, H. Zhou, J. Wu, G. Cohan, M. Jayaraman, R. Huang, J. Boxerman, L. Yang, F. Hui, J. Woo, H. Bai
Publication date: March 2020Source: Journal of Vascular and Interventional Radiology, Volume 31, Issue 3, SupplementAuthor(s): R. Le, A. Hoefnagel, J. Yao, D. Rao
Publication date: Available online 19 February 2020Source: Journal of Clinical NeuroscienceAuthor(s): Bomi Kim, Yeon Mee Kim, Sung-cheol Jin, Jun-won Lee, Byung In Lee, Sung Eun Kim, Kyong Jin Shin, JinSe Park, Kang Min Park, Si Eun Kim, Seongho Park, Sam Yeol HaAbstractWe analyzed the histopathological findings of the clots obtained from patients with acute ischemic stroke by mechanical thrombectomy. We then developed a clinical scoring system for predicting pathogenic causes in patients with undetermined ischemic stroke using these histopathological and the angiographic findings during endovascular treatment. Only cases ...
A new potential neuroprotectant has been found to be beneficial for patients with ischemic stroke undergoing thrombectomy in the ESCAPE-NA1 trial, but only for those not receiving thrombolysis.Medscape Medical News
New data from a second EXTEND-IA TNK (tenecteplase) trial clarify the optimum dose of the bolus thrombolytic for use in ischemic stroke, for which enthusiasm is growing.Medscape Medical News
Publication date: Available online 20 February 2020Source: Life SciencesAuthor(s): Mahsa Hassanipour, Mohammadreza Zarisfi, Vahid Ehsani, Mohammad AllahtavakoliAbstractLate treatment with tissue plasminogen activator (tPA) leads to reperfusion injury and poor outcome in ischemic stroke. We have recently shown the beneficial effects of local brain hypothermia after late thrombolysis. Herein, we investigated whether transient whole-body hypothermia was neuroprotective and could prevent the side effects of late tPA therapy at 5.5 h after embolic stroke. After induction of stroke, male rats were randomly assigned into four g...
This study aims to evaluate the safety and efficacy of performing mechanical thrombectomies in older adults.
Mechanical thrombectomy has been established as the standard of care for LVO (large-vessel occlusion) acute ischemic stroke following the favorable results of several prominent studies. Current guidelines and a recent meta-analysis endorse both thrombectomy techniques of aspiration and stent retriever as comparably effective treatments. The present study was conducted at a community hospital, which was recently certified as a comprehensive stroke center, to evaluate the efficacy of aspiration vs.
Endovascular treatment of ischemic stroke has shown positive clinical outcomes. Further optimization requires identifying patients who will benefit from reperfusion. We propose using deep learning, specifically 3D convolutional neural networks (CNN), to identify infarcted tissue (core) on CT perfusion (CTP) with diffusion weighted imaging (DWI) MRI as gold standard for irreversible brain infarction and evaluate lesion size impact on the network ’s performance.
Workflow optimization is essential in the setting of mechanical thrombectomy for acute ischemic stroke (AIS). Either conscious sedation or general anesthesia can be used during intervention. The purpose was to study the differences between the type of anesthesia used and its impact on time to recanalization during mechanical thrombectomy.