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Extensive Workup for Embolic Sources in Lacunar Strokes: Prevalence in an Academic Setting (P1.043)
CONCLUSIONS: Lacunar strokes represent a substantial fraction of the ischemic strokes admitted in this urban hospital setting. These patients typically receive extensive work-up for thromboembolic sources similar to that applied to large artery strokes. Examination of clinical features and outcomes of lacunar stroke, and of the clinical utility of the extensive imaging, is warranted to guide best clinical practices.Disclosure: Dr. Wang has nothing to disclose. Dr. Choi has nothing to disclose. Dr. Gallardo has nothing to disclose. Dr. Nwaneri has nothing to disclose. Dr. Brorson has received personal compensation for activ...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Wang, Y., Choi, Y., Gallardo, J., Nwaneri, I., Brorson, J. Tags: Cerebrovascular Disease and Interventional Neurology: The Spectrum of Small Vessel Cerebrovascular Disease Source Type: research

Balancing Autonomy and Beneficence in Acute Stroke Therapy: Neurologist Attitudes Toward Delaying Thrombolysis in Order to Obtain Informed Consent (P7.332)
CONCLUSIONS: Vascular neurologists indicate they emphasize beneficence over autonomy in deciding when to forego further attempts to reach consent providers to proceed with thrombolytic therapy under the doctrine of presumed consent. Their preference for rapid intervention is magnified when decisions are framed in person failure to benefit and neuron loss, compared with simple chronologic time.Disclosure: Dr. Kaplan has nothing to disclose. Dr. Cranston has nothing to disclose. Dr. Saver has received personal compensation for activities with the University of California, BrainsGate, CoAxia, eV3, Talecris Biotherapeutics Inc...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Kaplan, B., Cranston, J., Saver, J. Tags: Practice, Policy, and Ethics Source Type: research

Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis
Conclusion: We demonstrate a relatively high prevalence of pelvic DVT among select CS patients emphasizing the importance of considering the pelvic veins as a potential source for emboli particularly in the presence of risk factors known to predispose DVT. Because patients were included at the treating physician's discretion, our results reflect ‘real-life' practice. Our results may be of clinical importance as inclusion of pelvic vein imaging in CS patients with PFO had impactful therapeutic and nosologic implications. Further study is needed to define patients most likely to benefit from pelvic vein imaging.Cerebrovasc Dis 2015;39:216-223
Source: Cerebrovascular Diseases - March 13, 2015 Category: Neurology Source Type: research

Reducing Time to Treatment - The Role of Stroke Neurologist as First Responder (S5.006)
CONCLUSIONS: The use of a stroke-trained attending neurologist as a first responder and stroke team leader resulted in rapid patient evaluation and faster decision regarding thrombolytic therapy, improving time to treatment and time to CT.Disclosure: Dr. Ozark has nothing to disclose. Dr. Sabatino has nothing to disclose. Dr. Holmstedt has nothing to disclose. Dr. Turan has received personal compensation for activities with Gore Laboratories Inc., and Boehringer Ingelheim Pharmaceuticals Inc. Dr. Turan has received research support from Stryker Co., the National Institutes of Health, and AstraZeneca.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Ozark, S., Sabatino, P., Holmstedt, C., Turan, T. Tags: Cerebrovascular Disease and Interventional Neurology: Pre-hospital, Telemedicine, and Related Topics Source Type: research

Utility of Workup for Thrombophilias in a Single Center - A Qualitative Perspective (P1.125)
ConclusionStroke is considered cryptogenic in about 30-40 percent cases. Hypercoagulable testing is often ordered in this clinical setting. So far our results are consistent with other reports in the literature that such testing has limited clinical utility. Our results highlight the need to develop stringent clinical guidelines for HT in the setting of ischemic strokes.Disclosure: Dr. Shah has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Drake has received personal compensation for activities with UCB Pharma as a speaker. Dr. Proytcheva has nothing to disclose. Dr. Coull has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Shah, A., Anderson, N., Drake, K., Proytcheva, M., Coull, B. Tags: Cerebrovascular Disease and Interventional Neurology: Ischemic Stroke Subtype Source Type: research

Utility of Pelvic MRV in Evaluation of Patients with Cryptogenic Stroke and PFO (P4.228)
CONCLUSIONS: Our data expands on prior study showing that pelvic MRV has the potential to identify a stroke source in patients with cryptogenic stroke, absent identifiable hypercoagulability state, and PFO.Disclosure: Dr. Osgood has nothing to disclose. Dr. Budman has nothing to disclose. Dr. Henninger has received personal compensation for activities with Brainsgate as a consultant.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Osgood, M., Budman, E., Henninger, N. Tags: Cerebrovascular Disease and Interventional Neurology: Cardiac Source Type: research

Posterior circulation stroke is associated with prolonged door‐to‐needle time
ConclusionsPosterior circulation stroke patients had a delay in neurology evaluation after initial emergency department evaluation and a delay in intravenous tissue plasminogen activator administration compared with anterior circulation stroke patients. There may be difficulties in rapidly recognizing the symptoms of posterior circulation stroke, in contrast to anterior circulation stroke, in the emergency department.
Source: International Journal of Stroke - April 1, 2013 Category: Neurology Authors: Amrou Sarraj, Sarah Medrek, Karen Albright, Sheryl Martin‐Schild, Wafi Bibars, Farhaan Vahidy, James C. Grotta, Sean I. Savitz Tags: Research Source Type: research

Impact of Telemedicine Implementation in Thrombolytic Use for Acute Ischemic Stroke: The University of Pittsburgh Medical Center Telestroke Network Experience
Background: Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care.Methods: All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 pa...
Source: Journal of Stroke and Cerebrovascular Diseases - March 13, 2013 Category: Neurology Authors: Edilberto Amorim, Min-Mei Shih, Steven A. Koehler, Lori L. Massaro, Syed F. Zaidi, Mouhammad A. Jumaa, Vivek K. Reddy, Maxim D. Hammer, Tudor G. Jovin, Lawrence R. Wechsler Tags: Original Articles Source Type: research

Decompressive Hemicraniectomy for Malignant Hemispheric Stroke in the Elderly: Comparison of Outcomes between Individuals 61-70 and >70 Years of Age
Conclusions: We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.
Source: Journal of Stroke and Cerebrovascular Diseases - March 13, 2013 Category: Neurology Authors: Joji Inamasu, Takafumi Kaito, Takeya Watabe, Tsukasa Ganaha, Yasuhiro Yamada, Teppei Tanaka, Shuei Imizu, Takuro Hayashi, Motoharu Hayakawa, Yoko Kato, Yuichi Hirose Tags: Original Articles Source Type: research

Early Access to a Neurologist Reduces the Rate of Missed Diagnosis in Young Strokes
Conclusions: Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.
Source: Journal of Stroke and Cerebrovascular Diseases - February 18, 2013 Category: Neurology Authors: Wazim Mohamed, Pratik Bhattacharya, Seemant Chaturvedi Tags: Original Articles Source Type: research

Transthoracic Echocardiography for Lacunar Strokes: Do We Need It in All Patients? (P01.234)
CONCLUSIONS: Left ventricular hypertrophy is considered sine qua non of hypertensive control, which is one of the major risk factors for lacunar stroke. In our series we did not find any intracardiac abnormality except for LVH which was almost exclusively in patients with hypertension. TTE adds to the stroke workup cost and should be used only in selected cases.Disclosure: Dr. Suchdev has nothing to disclose. Dr. Damani has nothing to disclose. Dr. Varade has nothing to disclose. Dr. Abhishek has nothing to disclose. Dr. Norris has nothing to disclose.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Suchdev, K., Damani, R., Varade, P., Abhishek, F., Norris, G. Tags: P01 Cerebrovascular Disease I Source Type: research

Venous Thromboembolism in the Get With The Guidelines-Stroke Acute Ischemic Stroke Population: Incidence and Patterns of Prophylaxis
Conclusions: Despite a high overall rate of VTE prophylaxis, VTE was found to occur in approximately 3% of GWTG-S patients. Reported rates of VTE prophylaxis differed among hospitals by region and hospital type, and among patients by age, race, and medical comorbidities.
Source: Journal of Stroke and Cerebrovascular Diseases - December 17, 2012 Category: Neurology Authors: G. Logan Douds, Anne S. Hellkamp, DaiWai M. Olson, Gregg C. Fonarow, Eric E. Smith, Lee H. Schwamm, Kevin M. Cockroft Tags: Original Articles Source Type: research

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