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Imaging-based selection of patients for acute stroke treatment: Is it ready for prime time?
Historically, brain imaging in acute stroke has sought to exclude brain hemorrhage in order to allow therapy aiming at recanalization of the occluded intracranial artery. The National Institute of Neurological Disorders and Stroke study, published in 1995, found a clinical benefit of IV thrombolysis in acute stroke after exclusion of brain hemorrhage based on noncontrast CT (NCCT).1 More than 20 years later, the decision at most centers whether to give thrombolysis within the first 4.5 hours remains based on NCCT; often, the bolus of recombinant tissue plasminogen activator (rt-PA) is administered in the CT scanner suite e...
Source: Neurology - June 12, 2017 Category: Neurology Authors: Carrera, E., Wintermark, M. Tags: CT, MRI, Infarction EDITORIALS Source Type: research

Role Of Sulfonylureas In Perihematomal Edema In Spontaneous Intracerebral Hemorrhage (N8.002)
Conclusions:Our study shows a trend towards decreased absolute PHE and better clinical outcomes in ICH patients with diabetes who are taking SUs. However, our findings are limited by the study design, low power, and imbalances in baseline ICH volume. Further studies are required to evaluate the role of SUs in attenuating PHE.Disclosure: Dr. Male has nothing to disclose. Dr. Robertson has nothing to disclose. Dr. Alkuwaiti has nothing to disclose. Dr. Bell has nothing to disclose. Dr. Lindsay has nothing to disclose. Dr. Reshi has nothing to disclose. Dr. Ezzeddine has received personal compensation for activities with Air ...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Male, S., Robertson, J., Alkuwaiti, M., Bell, C., Lindsay, D., Reshi, R., Ezzeddine, M., Streib, C. Tags: Neuroscience in the Clinic: Novel Therapeutic Targets in Critical Care Neurology: Intracerebral and Intraventricular Hemorrhage Source Type: research

Effect Of Insufficient Blood Pressure Control On Intracerebral Hemorrhage Volume In Patients Transferred To A Comprehensive Stroke Center (P2.255)
Conclusions:Poorly controlled BP following ICH transfer to a CSC was associated with increased hematoma volume without worsening overall clinical outcome. Further analysis with a larger sample size may support and expand our observations and lend support to performance improvement initiatives focused on improving BP control at the referring hospital prior to patient transfer.Disclosure: Dr. Tversky has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Tversky, S. Tags: Intracerebral Hemorrhage Source Type: research

To study the impact of chronic vasodilator therapy on perihematomal edema in primary intracerebral hemorrhage(ICH) (P2.259)
Conclusions:Though limited by small sample size, this retro spective study suggests that chronic vasodilator therapy may serve to prevent worsening cerebral edema. This is a tantalizing finding that, if confirmed, could lead to potential pharmacological interventions for patients with ICH. Further prospective studies evaluating the effect of vasodilators in this patient population will be required.Disclosure: Dr. Singh has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Pennington has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Shapshak has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Singh, M., Albright, K., Pennington, A., Gupta, S., Shapshak, A. H. Tags: Intracerebral Hemorrhage Source Type: research

Volume of intracranial blood is associated with occurrence of stress induced hyperglycemia after aneurysmal subarachnoid hemorrhage (P5.065)
Conclusions:Volume of ICH is associated with incidence of SIH in aSAH. These results suggest quantity of ICH after aSAH is responsible for severity of acute hyperglycemia and associated metabolic derangement alluding to neuro-humoral cross-talk.Disclosure: Dr. Ross has nothing to disclose. Dr. Thompson has nothing to disclose. Dr. Aghaei has nothing to disclose. Dr. Cornwell has nothing to disclose. Dr. Wu has nothing to disclose. Dr. Zheng has nothing to disclose. Dr. Ray has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Ross, S., Thompson, D., Aghaei, F., Cornwell, B., Wu, D., Zheng, B., Ray, B. Tags: Neurocritical Care: Subarachnoid Hemorrhage Source Type: research

Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Thrombocytopenia (P4.264)
Conclusions:IV rtPA for AIS might be safe in patients with platelet count <100,000/mm3 and it is reasonable not to delay IV rtPA administration while waiting for the platelet count result, unless there is strong suspicion for abnormal platelet count .Disclosure: Dr. Mowla has nothing to disclose. Dr. Kamal has nothing to disclose. Dr. Lail has nothing to disclose. Dr. Vaughn has nothing to disclose. Dr. Mehla has nothing to disclose. Dr. Deline has nothing to disclose. Dr. Ching has nothing to disclose. Dr. Crumlish has nothing to disclose. Dr. Sawyer has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Mowla, A., Kamal, H., Lail, N., Vaughn, C., Mehla, S., Deline, C., Ching, M., Crumlish, A., Sawyer, R. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Target Stroke Implementation: Best Practice Strategies Cut Thrombolysis Time to < 30 minutes in a 1,550 Bed Academic Urban County Hospital (P4.280)
Conclusions:Individualized hospital gap analysis identifies targeted interventions to shorten treatment times. DTN and DTG time can be reduced with implementation of simple, low-cost interventions, with persistent effect and no increase in symptomatic intracranial hemorrhage or stroke mimic treatment.Disclosure: Dr. Marulanda-Londoño has nothing to disclose. Dr. Bhatt has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Asdaghi has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Akram has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. D’Amour has nothing to disclos...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Marulanda-Londono, E., Bhatt, N., Atchaneeyasakul, K., Asdaghi, N., Malik, A., Akram, N., Zhang, T., DAmour, D., Hesse, K., Sacco, R., Romano, J. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Risk factors of stroke recurrence in a low income country: case of Senegal (P6.289)
Conclusions:Stroke recurrence is relatively frequent in Senegal. Frequently, patients are irregularly followed up sometimes because of the unavailability of neurologists and neurology unit in peripheral regions and the cost of treatment. Effort should be done to improve the management of cardiovascular risk factors.Disclosure: Dr. Gams Massi has nothing to disclose. Dr. Nyassinde has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Massi, D. G., Nyassinde, J. Tags: Prevention of Cerebrovascular Disease Source Type: research

Giant-Cell Arteritis Presenting as Isolated Bilateral CN-VI Palsies: A Rare Case Report of a 65 Year Male. (P2.378)
Conclusions:GCA is the most prevalent systemic vasculitis in the elderly. It can present with a wide variety of symptoms ranging from fatigue, headache, visual loss, and even stroke. However as noted in this case, isolated CN-VI palsy can be a very rare, early manifestation of GCA. As GCA responds well to corticosteroid therapy, prompt diagnosis and treatment is critical to prevent and/or limit neurologic sequelae. As highlighted by this case, in the event of recurrent incidents and absence of other diagnosis; GCA should be considered even if headache is absent.Disclosure: Dr. Lunagariya has nothing to disclose. Dr. Patel ...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Lunagariya, A., Patel, U., Kotadiya, F., Wilson, C. Tags: CNS Inflammatory Diseases and Differential Diagnosis II Source Type: research

Non-Neurologist Self Assessment of Emergency Neurology Proficiency and Interest in a Novel Intensive Stroke and Neurocritical Care Training Program: The X-CHANGE Program (P1.045)
Conclusions:Hospital based non-neurology physicians have significant exposure to critically ill neurological patients. Many are not comfortable with important fundamental skills, such as the neurological exam. There is strong interest in a proposed intensive training program emphasizing bedside teaching. Based upon these results, we are developing a formal intensive training program for practicing non -neurology physicians called the "Cross-disciplinary Cerebrovascular HospitAl NeuroloGy Education" program.Disclosure: Dr. Yee has nothing to disclose. Dr. Ke has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Bar...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Yee, A., Ke, M., Wong, C., Barazangi, N., Tong, D., Chen, C. Tags: Graduate Medical Education Research Source Type: research

Contrast induced encephalopathy mimicking reperfusion injury (P3.285)
Conclusions:Diagnostic or therapeutic angiography is frequently performed for acute ischemic or hemorrhagic stroke. Clinicians should be aware of contrast induced encephalopathy and consider it in cases of neurologic deterioration after angiography in order to initiate appropriate treatment and avoid unnecessary invasive tests.Disclosure: Dr. Bakradze has nothing to disclose. Dr. Pasquale has nothing to disclose. Dr. Kirchoff-Torres has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Bakradze, E., Pasquale, D., Kirchoff-Torres, K. Tags: Cerebrovascular Disease Case Reports II Source Type: research

Association between Leucocyte Count and Perihematomal Edema Growth After Primary Intracerebral Hemorrhage (N8.001)
Conclusions:Higher admission leucocyte count, particularly monocyte count, is associated with PHE growth. This suggests a potential role of inflammation in modulating PHE after ICH.Study Supported by: American Academy of Neurology and American Brain Foundation Clinical Research Training FellowshipDisclosure: Dr. Gusdon has nothing to disclose. Dr. Gialdini has nothing to disclose. Dr. Baradaran has nothing to disclose. Dr. Merkler has nothing to disclose. Dr. Iadecola has received personal compensation in an editorial capacity for the Journal of Neuroscience. Dr. Navi has nothing to disclose. Dr. Gupta has nothing to discl...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Gusdon, A., Gialdini, G., Baradaran, H., Merkler, A., Iadecola, C., Navi, B., Gupta, A., Kamel, H., Murthy, S. Tags: Neuroscience in the Clinic: Novel Therapeutic Targets in Critical Care Neurology: Intracerebral and Intraventricular Hemorrhage Source Type: research

DCE-MRI blood-brain barrier assessment in acute ischemic stroke
Conclusion: BBB in acute stroke patients can be successfully assessed quantitatively. The decrease of BBB permeability in unaffected regions at follow-up may be an indicator of global BBB leakage even in vessel territories remote from the index infarct.
Source: Neurology - January 29, 2017 Category: Neurology Authors: Villringer, K., Sanz Cuesta, B. E., Ostwaldt, A.-C., Grittner, U., Brunecker, P., Khalil, A. A., Schindler, K., Eisenblätter, O., Audebert, H., Fiebach, J. B. Tags: Diagnostic test assessment, MRI, All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Teaching NeuroImages: Intracranial vertebral dissection in a 15-year-old boy with sickle cell disease
A 15-year-old boy with sickle cell disease became unresponsive after sudden-onset headache. There was no antecedent trauma. A head CT scan demonstrated subarachnoid hemorrhage at the medulla (figure). Magnetic resonance angiography of the head and neck identified the patient's known bilateral internal carotid artery stenosis (a moyamoya-like arteriopathy associated with stroke in sickle cell disease) and a new right vertebral artery dissection, which was confirmed on conventional angiography (figure). Prior MRI performed as part of routine cerebral monitoring did not reveal any preexisting abnormality of the vertebral artery.
Source: Neurology - December 11, 2016 Category: Neurology Authors: Siegler, J. E., Banwell, B., Ichord, R. N. Tags: Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Multicompartmental intracranial hemorrhage in a pediatric patient
A previously healthy 9-year-old girl presented with sudden-onset headache followed by confusion. In the emergency department, she was hypertensive, bradycardic, and no longer responsive to any stimuli. An emergent head CT scan demonstrated a left frontal intraparenchymal hematoma with intraventricular and subarachnoid extension as well as subfalcine herniation (figure). She underwent decompressive hemicraniectomy, and digital subtraction angiography confirmed a 7-mm left middle cerebral artery aneurysm (figure).
Source: Neurology - December 4, 2016 Category: Neurology Authors: Siegler, J. E., Ichord, R. N. Tags: Childhood stroke, Intracerebral hemorrhage, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

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