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Conjugate Eye Deviation as Predictor of Acute Cortical and Subcortical Ischemic Brain Lesions
Emergency imaging of the brain is recommended for symptoms of acute stroke in order to identify contraindications for intravenous administration of recombinant tissue plasminogen activator (rtPA) or to exclude nonvascular etiology of the neurological manifestations [1]. Computed tomography (CT) scan of the brain without administration of intravenous contrast (non-enhanced CT-NECT) is the most common imaging examination performed within the first 3hours after the onset of neurological manifestations, but parenchymal injury due to acute ischemic stroke is not apparent in most cases [2,3].
Source: Clinical Neurology and Neurosurgery - February 9, 2016 Category: Neurosurgery Authors: Dimitrios G. Kaditis, Elias Zintzaras, Dimitra Sali, Grigorios Kotoulas, Alexandros Papadimitriou, Georgios M. Hadjigeorgiou Source Type: research

Risk rtPA: An iOS Mobile Application based on TURN for Predicting 90-day Outcome after IV Thrombolysis
IV thrombolysis using recombinant tissue plasminogen activator (rt-PA) has been shown to improve 90-day outcomes in select ischemic stroke patients [1–3]. However, several barriers still exist to its routine use, the most prominent being a prolonged delay between symptom onset and treatment [4]. Public awareness programs such as the American Stroke Association’s “I am a stroke”, the National Institute of Neurological Disorders and Stroke (NINDS) “Know Stroke” and the American Stroke Association’s “Operation Stroke” were designed to improve awareness [5] and have contributed to improvement in stroke outcomes.
Source: Clinical Neurology and Neurosurgery - February 5, 2016 Category: Neurosurgery Authors: David Asuzu, Karin Nystrӧm, Joseph Schindler, Charles Wira, David Greer, Janet Halliday, Kevin N. Sheth Source Type: research

Stroke and cardiac cell death: two peas in a pod
Ischemic heart and cerebrovascular disease make up the two leading causes of death in the world. Overall, the United States spends a total of $260.7 billion for both cardiac disease and ischemic stroke combined [1,2]. Predisposing factors of these two diseases include high blood pressure, high blood cholesterol levels, diabetes, obesity, and a history of cardiovascular diseases in the immediate family [3–6]. Interestingly, 2-6% of the deaths caused by cardiac origins occurred approximately 3 months after an ischemic stroke [7,8].
Source: Clinical Neurology and Neurosurgery - January 21, 2016 Category: Neurosurgery Authors: Chiara Gonzales-Portillo, Hiroto Ishikawa, Kazutaka Shinozuka, Naoki Tajiri, Yuji Kaneko, Cesar V. Borlongan Source Type: research

Short- and long-term effects of smoking on pain and health-related quality of life after non-instrumented lumbar spine surgery
Smoking is commonly known to exert negative effects on bodily health such as a 25-fold increased risk for lung cancer, a 2- to 4-fold increased risk for coronary heart disease or stroke [1], as well as to represent a cause of premature death [2]. In Germany for example, more than 114.000 premature deaths, 1.6 million years of potential life lost and 21 billion Euros are the socio-economic burden of smoking [3]. Despite these well-known risks, the smoking prevalence is still high and varies greatly across different European countries from as low as 19.7% in Portugal to as high as 45.7% in Bulgaria [4].
Source: Clinical Neurology and Neurosurgery - January 20, 2016 Category: Neurosurgery Authors: Martin N. Stienen, Holger Joswig, Nicolas R. Smoll, Enrico Tessitore, Karl Schaller, Gerhard Hildebrandt, Oliver P. Gautschi Source Type: research

Predicting discharge destination after stroke: a systematic review
In Belgium 52 patients suffer a stroke every day [1]. The annual incidence of stroke in Belgium is 185/100 000 inhabitants. In Europe stroke is responsible for 10% of all causes of death in men and for 15% in women. The amount of Disability Adjusted Life Years (DALY) lost in Europe because of stroke is 10.793.000 years, which is 7% of DALY's lost by disease [2]. Moreover approximately 30% of patients will remain disabled after stroke and will be largely dependent upon family and health professionals for support.
Source: Clinical Neurology and Neurosurgery - January 6, 2016 Category: Neurosurgery Authors: Margot Mees, Jelle Klein, Laetitia Yperzeele, Peter Vanacker, Patrick Cras Source Type: research

Cost-Effectiveness Analysis of CTA and LP for Evaluation of Suspected SAH after Negative Non-Contrast CT
The diagnosis of nontraumatic SAH presenting acutely with thunderclap headache is challenging but critical. Misdiagnosis is associated with a greater risk of death, which increases with time [1]. The reported sensitivity of non-contrast CT for diagnosis of acute SAH has been 94–100% [2–5]. The dilemma arises when the initial CT is negative for acute blood, as even a low false negative rate may be unacceptable. LP has generally been accepted as the next step for evaluation of acute SAH by the American Heart Association, the American Stroke Association and the American College of Radiology [6,7].
Source: Clinical Neurology and Neurosurgery - January 4, 2016 Category: Neurosurgery Authors: Xiao Wu, Vivek B. Kalra, Howard P. Forman, Ajay Malhotra Source Type: research

Resource utilization and costs for treatment of stroke patients in an acute stroke unit in Greece
Cerebrovascular diseases account for 22.9% in women and 14.7% in men, of all deaths in Greece [1], comprising the leading cause of death in the country. The incidence of these diseases, and stroke in specific, is relatively low compared to other European countries [2,3]. However, the 28-days case fatality and one year crude mortality have been estimated at 26.6% and 36.8%, respectively, according to the Arcadia Stroke Registry [3,4], a population based study performed in the Southern part of Greece.
Source: Clinical Neurology and Neurosurgery - December 24, 2015 Category: Neurosurgery Authors: Persefoni Kritikou, Konstantinos Spengos, Nikolaos Zakopoulos, Yannis Tountas, John Yfantopoulos, Konstantinos Vemmos Source Type: research

Microparticle derived proteins as potential biomarkers for cerebral vasospasm post subarachnoid hemorrhage. A preliminary study
Cerebral aneurysmal rupture leading to subarachnoid hemorrhage (SAH) represents about 5% of all strokes and affects as many as 30,000 Americans each year. It has been associated with initial mortality of 10-15%. Of patients who are able to reach medical care, 25% die within the first 2 weeks, and 20-30% of the survivors are severely and permanently disabled. Overall, the mortality rate associated with aneurysmal SAH (aSAH) is 32-67%, which makes it the most lethal type of hemorrhagic stroke [1].
Source: Clinical Neurology and Neurosurgery - December 21, 2015 Category: Neurosurgery Authors: Magdalena M. Przybycien-Szymanska, Yuchen Yang, William W. Ashley Source Type: research

Long-term medication persistence in stroke patients treated with intravenous thrombolysis
Recurrent strokes constitute a notable proportion of all preventable strokes (up to 30%) and are more disabling, fatal and costly than the first stroke [1]. Strategies to reduce the increasing global burden of stroke include not only mass population high-risk approaches to prevent first-ever stroke but also the treatment of acute stroke patients and the secondary prevention of recurrent stroke. Preventive treatments such as medications and a healthy lifestyle have shown efficacy on stroke recurrence [2].
Source: Clinical Neurology and Neurosurgery - December 14, 2015 Category: Neurosurgery Authors: Maja Stefanovic Budimkic, Tatjana Pekmezovic, Ljiljana Beslac-Bumbasirevic, Marko Ercegovac, Ivana Berisavac, Predrag Stanarcevic, Visnja Padjen, Dejana R. Jovanovic Source Type: research

Is acute stress and plasminogen activator inhibitor polymorphism associated with acute ischemic stroke?
Identifying the cause of ischemic stroke (IS) in young adults is of major importance in preventing stroke recurrence. In most cases, IS is a multifactorial disease with genetic predisposition, whereas the inherited risk is likely to be multigenic. Alterations in thrombosis and fibrinolysis comprise important parts of stroke pathophysiology. Plasminogen activator inhibitor type-1 (PAI-1) is an important component of the coagulation system that is a strong inhibitor of fibrinolysis in the circulation.
Source: Clinical Neurology and Neurosurgery - November 28, 2015 Category: Neurosurgery Authors: Hasan Hüseyin Kozak, Ali Ulvi Uca, Mustafa Altaş Source Type: research

Use of Anti-platelet Agents after Traumatic Intracranial Hemorrhage
Anti-platelet therapies (APTs) are frequently utilized medications, and are commonly indicated in patients with traumatic intracranial hemorrhage (tICH). Although venous thromboembolism prophylaxis after tICH has been studied, no data exist to guide clinicians on when it is safe to initiate APTs [1]. Indications for APTs include ischemic stroke prevention after blunt cerebrovascular injury (BCVI), acute myocardial infarction treatment, and secondary prevention of heart attack and stroke [2–6].
Source: Clinical Neurology and Neurosurgery - November 28, 2015 Category: Neurosurgery Authors: Keith Kerr, Christopher Wilkerson, Scott Shepard, Alex Choi, Ryan Kitagawa Source Type: research

Pennsylvania Comprehensive Stroke Center Collaborative: Statement on the Recently Updated IV rt-PA Prescriber Information for Acute Ischemic Stroke
Recently, the FDA guidelines regarding the eligibility of patients with acute ischemic stroke to receive IV rt-PA have been modified and are not in complete accord with the latest AHA/ASA guidelines. The resultant differences may result in discrepancies in patient selection for intravenous thrombolysis.
Source: Clinical Neurology and Neurosurgery - October 21, 2015 Category: Neurosurgery Authors: Badih Daou, Maureen Deprince, Robin D’Ambrosio, Stavropoula Tjoumakaris, Robert H. Rosenwasser, Daniel J. Ackerman, Rodney Bell, Diana L. Tzeng, Michelle Ghobrial, Andres Fernandez, Qaisar Shah, Dan J. Gzesh, Deborah Murphy, John E. Castaldo, Claranne M Source Type: research

Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke
Autonomic function is frequently altered in patients with ischemic stroke during acute and chronic stages. Cardiac arrhythmias and sudden death during acute stroke are related to autonomic function imbalance.[1–3] Non-invasive tests have suggested sympathetic hyperactivity and cardiovagal dysfunction in acute stroke [1,2,4–7] with diverse results when considering the influence of lateralization, site and sub-type of ischemic stroke [1–3,8]. Autonomic cardiovascular dysfunction is associated with stroke severity [8].
Source: Clinical Neurology and Neurosurgery - October 8, 2015 Category: Neurosurgery Authors: Juan Idiaquez, Hector Farias, Francisco Torres, Jorge Vega, David A. Low Source Type: research

Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis: A case-control study
Aneurysmal subarachnoid hemorrhage (aSAH) is a unique form of hemorrhagic stroke caused by rupture of an intracranial aneurysm with an estimated incidence of 10 per 100,000 person-years. [1] Aneurysm re-rupture prior to treatment represents a major source of early morbidity and carries a mortality rate of up to 51%. [2] Efforts to reduce the likelihood of early re-rupture have focused on early intervention for treatment of the aneurysm and administration of antifibrinolytics. Early intervention, either through surgical clipping or endovascular embolization, has proven effective in reducing rates of re-rupture and represent...
Source: Clinical Neurology and Neurosurgery - September 10, 2015 Category: Neurosurgery Authors: Paul M. Foreman, Michelle Chua, Mark R. Harrigan, Winfield S. Fisher, R. Shane Tubbs, Mohammadali M. Shoja, Christoph J. Griessenauer Source Type: research

United States Trends in Thrombolysis for Older Adults with Acute Ischemic Stroke
Appropriate use of tissue plasminogen activator (tPA), or thrombolysis, reduces long-term disability and death for ischemic stroke patients, despite the immediate risks of dying and intracranial hemorrhage.[1–3] Prior to 2005, rates of thrombolysis in the U.S. were low,[4] although recent studies have described an increasing trend in the use of thrombolysis among ischemic stroke patients.[5] This rise in utilization may be attributed to good outcomes associated with thrombolysis and its use within primary stroke centers as well as financial incentives from diagnosis-related group (DRG) 559.
Source: Clinical Neurology and Neurosurgery - August 28, 2015 Category: Neurosurgery Authors: Benjamin P. George, Anthony O. Asemota, E. Ray Dorsey, Adil H. Haider, Blair J. Smart, Victor C. Urrutia, Eric B. Schneider Source Type: research

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