Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease
Semin Neurol DOI: 10.1055/s-0041-1726331Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explo...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Gusdon, Aaron M. Farrokh, Salia Grotta, James C. Tags: Review Article Source Type: research
A Comprehensive Review of Risk Factor, Mechanism, and Management of Left Ventricular Assist Device –Associated Stroke
Semin Neurol DOI: 10.1055/s-0041-1726328The use of left ventricular assist devices (LVADs) has been increasing in the last decade, along with the number of patients with advanced heart failure refractory to medical therapy. Ischemic stroke and intracranial hemorrhage remain the leading causes of morbidity and mortality in LVAD patients. Despite the common occurrence and the significant outcome impact, underlying mechanisms and management strategies of stroke in LVAD patients are controversial. In this article, we review our current knowledge on pathophysiology and risk factors of LVAD-associated stroke, outline the diagnos...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Cho, Sung-Min Tahsili-Fahadan, Pouya Kilic, Ahmet Choi, Chun Woo Starling, Randall C. Uchino, Ken Tags: Review Article Source Type: research
Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach
Semin Neurol DOI: 10.1055/s-0041-1726284Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood–brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury during ...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Chiarini, Giovanni Cho, Sung-Min Whitman, Glenn Rasulo, Frank Lorusso, Roberto Tags: Review Article Source Type: research
Delirium in Cardiac and Cardiovascular Surgical Intensive Care Units
Semin Neurol DOI: 10.1055/s-0041-1726283Delirium is a common occurrence in cardiac and cardiovascular surgical intensive care units. Due to multiple confounding factors, this diagnosis remains challenging for medical professionals. Multiple theories exist regarding the pathophysiology of delirium, which include disruption of neurotransmitters as well as inflammation. Delirium has been associated with prolonged hospitalizations and an increase in mortality. Although there are widely used screening tools for delirium, none have been validated in this particular patient population. Limited treatments exist for delirium, so: b...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Breit, Hannah Bleck, Thomas P. Koffman, Lauren Tags: Review Article Source Type: research
Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management
Semin Neurol DOI: 10.1055/s-0041-1726333Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasmi...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Boyanpally, Anusha Cutting, Shawna Furie, Karen Tags: Review Article Source Type: research
Neurorehabilitation
Semin Neurol 2021; 41: 109-110 DOI: 10.1055/s-0041-1726458 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - April 8, 2021 Category: Neurology Authors: Dwyer, Brigid Katz, Douglas I. Tags: Preface Source Type: research
Brigid Dwyer, MD, and Douglas I. Katz, MD
Semin Neurol 2021; 41: 107-108 DOI: 10.1055/s-0041-1726457 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - April 8, 2021 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research
Brain –Computer Interfaces in Neurorecovery and Neurorehabilitation
Semin Neurol DOI: 10.1055/s-0041-1725137Recent advances in brain–computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain–computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain–computer interfaces for persons with...
Source: Seminars in Neurology - March 19, 2021 Category: Neurology Authors: Young, Michael J. Lin, David J. Hochberg, Leigh R. Tags: Review Article Source Type: research
Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease
Semin Neurol DOI: 10.1055/s-0041-1725133Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of ea...
Source: Seminars in Neurology - March 19, 2021 Category: Neurology Authors: Ellis, Terry D. Col ón-Semenza, Cristina DeAngelis, Tamara R. Thomas, Cathi A. Hilaire, Marie-H élène Saint Earhart, Gammon M. Dibble, Leland E. Tags: Review Article Source Type: research
Retention of Physical Gains in the Community Following Physical Training for Multiple Sclerosis: A Systematic Review and Implications
Semin Neurol DOI: 10.1055/s-0041-1725139Multiple sclerosis (MS) is a progressive neurological illness whose typically young adult onset results in a nearly entire lifetime of worsening disability. But despite being an unrelenting neurodegenerative disease, numerous clinical trials over the past 40 years for MS have vigorously attempted to improve or at least stabilize declining physical function. Although the vast majority of the studies assessed training effects only within controlled laboratory or clinic settings, in recent years a growing interest has emerged to test whether newer therapies can instead benefit real-life...
Source: Seminars in Neurology - March 9, 2021 Category: Neurology Authors: Mark, Victor W. Tags: Review Article Source Type: research
Learning and Stroke Recovery: Parallelism of Biological Substrates
Semin Neurol DOI: 10.1055/s-0041-1725136Stroke is a debilitating disease. Current effective therapies for stroke recovery are limited to neurorehabilitation. Most stroke recovery occurs in a limited and early time window. Many of the mechanisms of spontaneous recovery after stroke parallel mechanisms of normal learning and memory. While various efforts are in place to identify potential drug targets, an emerging approach is to understand biological correlates between learning and stroke recovery. This review assesses parallels between biological changes at the molecular, structural, and functional levels during learning an...
Source: Seminars in Neurology - March 9, 2021 Category: Neurology Authors: Joy, Mary Teena Carmichael, S Thomas Tags: Review Article Source Type: research
Rehabilitation of Concussion and Persistent Postconcussive Symptoms
This article presents a structured method for the diagnosis of concussion and PPCS in the outpatient setting, which includes a history, physical examination, and additional tests as clinically indicated to help identify underlying symptom generators. Treatment for concussion and PPCS should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, ...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Wilber, Charles G. Leddy, John J. Bezherano, Itai Bromley, Lacey Edwards, Amanda E. Willer, Barry S. Haider, Mohammad N. Tags: Review Article Source Type: research
Hereditary Myelopathies
Semin Neurol DOI: 10.1055/s-0041-1725153Hereditary myelopathies are an important and likely underappreciated component of neurogenetic disease. While previously distinctions have been made by age of onset, the growing power and availability of high-quality neuroimaging and next-generation sequencing are increasingly expanding classical phenotypes and diminishing the utility of age-based classifications. Increasingly, cases of “atypical” disease presentations are challenging past assumptions regarding the age of onset and survival in many disorders and identifying allelic syndromes in others. Despite this, there is poor...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Walker, Melissa A. Tags: Review Article Source Type: research
Principles of Neural Repair and Their Application to Stroke Recovery Trials
Semin Neurol DOI: 10.1055/s-0041-1725140Neural repair is the underlying therapeutic strategy for many treatments currently under investigation to improve recovery after stroke. Repair-based therapies are distinct from acute stroke strategies: instead of salvaging threatened brain tissue, the goal is to improve behavioral outcomes on the basis of experience-dependent brain plasticity. Furthermore, timing, concomitant behavioral experiences, modality specific outcome measures, and careful patient selection are fundamental concepts for stroke recovery trials that can be deduced from principles of neural repair. Here we discus...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Lin, David J. Cramer, Steven C. Tags: Review Article Source Type: research
Clinical Neurorehabilitation: Using Principles of Neurological Diagnosis, Prognosis, and Neuroplasticity in Assessment and Treatment Planning
This article discusses a clinical neurological paradigm, using rigorous clinical assessment of neuropathological and clinical diagnosis, along with prognostication of natural history and recovery. In the context of the role of neuroplasticity in recovery, this paradigm can add significant value to rehabilitation team management and planning. It contributes to enhanced understanding of neurological impairments and syndromes as they relate to functional disability, aiding in targeting deficits and setting treatment goals. Rehabilitation strategies and goals should be informed by natural history and prognosis, and viewed in t...
Source: Seminars in Neurology - March 4, 2021 Category: Neurology Authors: Katz, Douglas I. Dwyer, Brigid Tags: Review Article Source Type: research
