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Advances in Management of the Stroke Etiology One-Percenters
AbstractPurpose of ReviewUncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from “standard” care.Recent FindingsRandomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in “high-risk” patients with antiphospholipid antibody...
Source: Current Neurology and Neuroscience Reports - May 29, 2023 Category: Neuroscience Source Type: research

Cerebrovascular Complications of Anemia
AbstractPurpose of the ReviewAnemia has been called the fifth cardiovascular risk factor. It is one of the most prevalent pathologies worldwide. In this article, we aimed to perform a narrative review of the main cerebrovascular complications of anemia and its influence on stroke prognosis.Recent FindingsBoth hypoproliferative anemia (thalassemia, iron deficiency anemia, etc.) and hyperproliferative anemia (sickle cell disease, paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis, etc.) are associated to cerebrovascular disease ranging from transient ischemic attack to ischemic stroke and hemorrhagic stroke with b...
Source: Current Neurology and Neuroscience Reports - September 3, 2021 Category: Neuroscience Source Type: research

Neurologic Manifestations of the Antiphospholipid Syndrome — an Update
AbstractPurpose of ReviewIn recent years, the spectrum of neurological manifestations of antiphospholipid syndrome (APS) has been growing. We provide a critical review of the literature with special emphasis on presentation, proposed mechanisms of disease, and treatment of neurological involvement in APS.Recent FindingsAlthough stroke is the most common cause of neurological manifestations in patients with APS, other neurological disorders have been increasingly associated with the disease, including cognitive dysfunction, headache, and epilepsy. Direct oral anticoagulants have failed to show non-inferiority compared to vi...
Source: Current Neurology and Neuroscience Reports - June 14, 2021 Category: Neuroscience Source Type: research

Thrombolysis beyond 4.5  h in Acute Ischemic Stroke
AbstractPurpose of ReviewThe purpose of this article is to review the current approaches using neuroimaging techniques to expand eligibility for intravenous thrombolytic therapy in acute ischemic stroke patients with stroke of unknown symptom onset.Recent FindingsIn recent years, several randomized, placebo-controlled trials have shown neuroimaging-guided approaches to be feasible in determining eligibility for alteplase beyond 4.5  h from last known well, and efficacious for reducing disability. DWI-FLAIR mismatch on MRI is an effective tool to identify stroke lesions less than 4.5 h in onset in patients with stroke of ...
Source: Current Neurology and Neuroscience Reports - June 29, 2020 Category: Neuroscience Source Type: research

Cancer and Cerebrovascular Disease
AbstractPurpose of ReviewTo review the latest information about the interactions between cancer and cerebrovascular disease.Recent FindingsAdditional data support the finding that both ischemic and hemorrhagic stroke are important complications of cancer or its treatment. Reperfusion therapy is being given successfully to patients with stroke complicating cancer.SummaryHemorrhagic stroke may occur with metastatic disease to the brain, coagulopathies from cancer, in particular leukemia, or as complications of chemotherapy. Ischemic stroke also may be a complication of metastatic disease with local invasion of vessels, a pro...
Source: Current Neurology and Neuroscience Reports - August 22, 2019 Category: Neuroscience Source Type: research

Neurologic Complications of Sickle Cell Disease
AbstractPurpose of ReviewSickle cell anemia is a multiorgan disease with acute and chronic complications. Involvement of the central nervous system (CNS) is associated with increased mortality and morbidity. This review highlights the broad spectrum of neurological complications seen in patients with sickle cell disease.Recent FindingsIncreasing recognition of neurological complications has led to improved diagnostic and treatment options throughout the years. Neurologic complications in sickle cell disease include silent cerebral ischemia, ischemic/hemorrhagic stroke, moyamoya syndrome, posterior reversible encephalopathy...
Source: Current Neurology and Neuroscience Reports - February 28, 2019 Category: Neuroscience Source Type: research

DVT Prevention in Stroke
AbstractPurpose of ReviewThe purpose of this review is to discuss the prevention of venous thromboembolism (VTE) in stroke patients. We discuss use of oral anticoagulation and other interventions for the prevention of VTE. A new class of medications, non-vitamin K antagonist oral anticoagulants (NOACs), have been successfully trialed for the prevention of VTE. We review the data and guidance statements for VTE prevention.Recent FindingsWarfarin and vitamin K antagonist drugs have been the mainstay of VTE prevention for decades. More recently, NOACs have become available for both stroke and systemic embolism prevention in n...
Source: Current Neurology and Neuroscience Reports - September 18, 2017 Category: Neuroscience Source Type: research

Non-Vitamin K Oral Anticoagulants (NOACs) and Their Reversal
AbstractPurpose of ReviewAn 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14  h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC?Recent FindingsIdarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs.SummaryIn this article, we review currently available NOACs, t...
Source: Current Neurology and Neuroscience Reports - July 22, 2017 Category: Neuroscience Source Type: research

History, Evolution, and Importance of Emergency Endovascular Treatment of Acute Ischemic Stroke
Abstract More than 800,000 people in North America suffer a stroke each year, with ischemic stroke making up the majority of these cases. The outcomes of ischemic stroke range from complete functional and cognitive recovery to severe disability and death; outcome is strongly associated with timely reperfusion treatment. Historically, ischemic stroke has been treated with intravenous thrombolytic agents with moderate success. However, five recently published positive trials have established the efficacy of endovascular treatment in acute ischemic stroke. In this review, we will discuss the history of stroke treatm...
Source: Current Neurology and Neuroscience Reports - March 27, 2016 Category: Neuroscience Source Type: research

Administration of Uric Acid in the Emergency Treatment of Acute Ischemic Stroke
Abstract Oxidative stress is one of the main mechanisms implicated in the pathophysiology of inflammatory and neurodegenerative diseases of the central nervous system (CNS). Uric acid (UA) is the end product of purine catabolism in humans, and it is the main endogenous antioxidant in blood. Low circulating UA levels have been associated with an increased prevalence and worse clinical course of several neurodegenerative and inflammatory diseases of the CNS, including Parkinson’s disease and multiple sclerosis. Moreover, the exogenous administration of UA exerts robust neuroprotective properties in experimental m...
Source: Current Neurology and Neuroscience Reports - December 28, 2015 Category: Neuroscience Source Type: research

Cerebral Thrombosis and Myeloproliferative Neoplasms
Abstract Myeloproliferative neoplasms (MPN) are acquired clonal disorders characterized by the proliferation of bone marrow myeloid cells. Different somatic mutations have been recently associated with MPN, the most common being JAK-2 V617F. Among MPN, polycythemia vera and essential thrombocythemia are particularly associated with an increased risk to develop thrombotic complications, either arterial or venous. Cerebrovascular events (stroke and transient ischemic attacks) are prevalent, accounting for approximately two-thirds of all events. Also cerebral vein thrombosis can complicate MPN and can be the first m...
Source: Current Neurology and Neuroscience Reports - September 14, 2014 Category: Neuroscience Source Type: research