Wake-up Stroke: New Opportunities for Acute Stroke Treatment

AbstractPurposeThis review summarizes the current science underpinning the treatment of patients with ischemic stroke who awaken with stroke symptoms. This large subset of stroke patients has historically been precluded from treatment with disability-limiting reperfusion therapies such as intravenous thrombolysis. Recent advances in neuroimaging have shifted the paradigm of treatment based upon rigid time-based criteria to treatment guided by evidence of salvageable ischemic penumbra on advanced imaging.Recent FindingsSeveral recent randomized controlled trials provide evidence that imaging-guided treatment of wake-up and uncertain onset stroke patients is feasible and effective. Thrombectomy trials have demonstrated dramatic clinical benefit for this treatment modality as many as 24  h from the time patients were last known to be well. Furthermore, appropriately selected wake-up stroke patients beyond 4.5 h from last known well may also benefit from intravenous thrombolysis.SummaryThe evaluation and optimal treatment of patients with ischemic stroke is rapidly evolving, creating a moving target for stroke systems of care. Incorporating this new evidence into practice requires re-examination of how patients with stroke symptoms are evaluated and will challenge regional systems to design mechanisms to ensure rapid access to advanced imaging and treatment options.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research

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Publication date: March 2020Source: The Lancet Neurology, Volume 19, Issue 3Author(s): Hugues Chabriat, Claudio L Bassetti, Ute Marx, Marie-Laure Audoli-Inthavong, Aurore Sors, Estelle Lambert, Marine Wattez, Dirk M Hermann, Katharina ALTHAUS, Sergi AMARO, Hee-Joon BAE, Zbigniew BAK, Leonardo BARBARINI, Pietro BASSI, Rodrigo BAZAN, Daniel BERECZKI, Tomasz BERKOWICZ, Joerg BERROUSCHOT, Dylan BLACQUIERE, Waldemar BROLASummaryBackgroundS44819, a selective GABAA α5 receptor antagonist, reduces tonic post-ischaemic inhibition of the peri-infarct cortex. S44819 improved stroke recovery in rodents and increased cortical exc...
Source: The Lancet Neurology - Category: Neurology Source Type: research
Conclusions: With adequate logistics and strict selection criteria, MT can be implemented in our population with results like those reported in large clinical trials.Resumen El accidente cerebrovascular isqu émico (ACVi) es una importante causa de morbi-mortalidad a nivel mundial. La reperfusión con trombólisis endovenosa es utilizada desde 1996. Más recientemente, la reperfusión con trombectomía mecánica (TM) ha demostrado un beneficio consistente extendiendo la ventana terapéutica. En nuestro país existen dificultades para que su implementación sea una...
Source: Arquivos de Neuro-Psiquiatria - Category: Neurology Source Type: research
CONCLUSIONS: mCIMT could be a more effective therapy than conventional therapy to improve the symptoms of hemineglect in the acute stroke. However, it may be clinically more recommended in patients with a certain motor function after stroke. PMID: 32043533 [PubMed - in process]
Source: Revista de Neurologia - Category: Neurology Authors: Tags: Rev Neurol Source Type: research
CONCLUSIONS: The DWI-based hierarchic algorithm we developed is highly predictive of disability at 3 months after thrombectomy and is easy to use in routine practice.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: INTERVENTIONAL Source Type: research
Background: Ischemia stroke is the leading cause of death and long-term disability. Sanhua Decoction (SHD), a classic Chinese herbal prescription, has been used for ischemic stroke for about thousands of years. Here, we aim to investigate the neuroprotective effects of SHD on cerebral ischemia/reperfusion (CIR) injury rat models.Methods: The male Sprague-Dawley rats (body weight, 250–280 g; age, 7–8 weeks) were randomly divided into sham group, CIR group, and SHD group and were further divided into subgroups according to different time points at 6 h, 1, 3, 7, 14, 21, and 28 d, respectively. The SHD group receiv...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
In this study, we aimed to demonstrate early neutrophil-to-lymphocyte ratio is a prognostic marker in acute minor stroke or transient ischemic at tack. 196 patients diagnosed with acute minor stroke or transient ischemic attack within 24 h of symptom onset were enrolled. Patients were divided into three groups according to the neutrophil-to-lymphocyte ratio value (  3). Clinical, neuroradiological, laboratory and follow-up data were collected from electronic database. Functional outcome was assessed by modified Rankin Scale. Neutrophil-to-lymphocyte ratio associated with functional outcome of 90 days was e...
Source: Acta Neurologica Belgica - Category: Neurology Source Type: research
This study aimed to assess the 3-month outcome of patients who underwent thrombolytic therapy following ischemic stroke. Methods: In the present prospective cohort study, the 3-month outcome of patients (mortality, disability) with acute ischemic stroke admitted to neurology department an educational hospital, Kermanshah, Iran, from 2016 to 2019, who had received thrombolytic therapy was assessed. National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Score (MRS) were used for measuring the degree of disability (on admission, at the time of discharge and 3 months after thrombolytic therapy). Result...
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
AbstractPurpose of reviewMobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.Recent findingsMultiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30  min faster than conventional care. The 90-day modified Rankin Sco...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research
ConclusionsThe SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation.Trial registration: NCT03335995.
Source: Neurocritical Care - Category: Neurology Source Type: research
This study lays the preliminary work for potential use of mitoNEET as a target and NL-1 as a therapeutic for the treatment of cerebral ischemia and reperfusion injury.Graphical abstract
Source: International Journal of Pharmaceutics - Category: Drugs & Pharmacology Source Type: research
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