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Secondary Stroke Prevention in Cryptogenic Stroke and Embolic Stroke of Undetermined Source (ESUS)
AbstractPurpose of the ReviewThe purpose of the study was to review the literature on cryptogenic stroke and embolic stroke of undetermined stroke (ESUS). Cryptogenic stroke according to TOAST criteria is a stroke which is not due to cardiogenic embolism, small vessel disease with lacunes or large vessel disease of brain supplying arteries. In the context of secondary stroke prevention studies, cryptogenic stroke is not operationally defined.Recent FindingsThe new concept of “embolic stroke of undetermined source” (ESUS) provides an operational definition. ESUS is diagnosed as a non-lacunar stroke on cerebral imaging a...
Source: Current Neurology and Neuroscience Reports - July 13, 2017 Category: Neuroscience Source Type: research

Contemporary Antiplatelet and Anticoagulant Therapies for Secondary Stroke Prevention: A Narrative Review of Current Literature and Guidelines
AbstractPurpose of ReviewStroke is a leading cause of death and disability worldwide. The annual incidence of new or recurrent stroke is approximately 795,000 cases per year in the United States, of which 87% are ischemic in nature. In addition to the management of modifiable high-risk factors to reduce the risk of recurrent stroke, antithrombotic agents (antiplatelets and anticoagulants) play an important role in secondary stroke prevention. This review will discuss the published literature on the use of antiplatelets and anticoagulants in secondary prevention of acute ischemic stroke and transient ischemic attack (TIA), ...
Source: Current Neurology and Neuroscience Reports - April 11, 2023 Category: Neuroscience Source Type: research

Navigating Antiplatelet Treatment Options for Stroke: Evidence-Based and Pragmatic Strategies
AbstractPurpose of ReviewThe benefit of using antiplatelet monotherapy in acute ischemic stroke and secondary stroke prevention is well established. In the last few years, several large randomized trials showed that the use of short-term dual antiplatelet therapy in particular stroke subtypes may reduce the risk of recurrent ischemic events. The aim of this article is to provide a critical analysis of the current evidence and recommendations for the use of antiplatelet agents for stroke prevention.Recent FindingsLong-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for se...
Source: Current Neurology and Neuroscience Reports - October 13, 2022 Category: Neuroscience Source Type: research

Stroke Chameleons and Stroke Mimics in the Emergency Department
AbstractPurpose of ReviewWe discuss the frequency of stroke misdiagnosis in the emergency department (ED), identify common diagnostic pitfalls, describe strategies to reduce diagnostic error, and detail ongoing research.Recent FindingsThe National Academy of Medicine has re-defined and highlighted the importance of diagnostic errors for patient safety. Recent rates of stroke under-diagnosis (false-negative cases, “stroke chameleons”) range from 2–26% and 30–43% for stroke over-diagnosis (false-positive cases, “stroke mimics”). Failure to diagnosis stroke can preclude time-sensitive treatments and has been assoc...
Source: Current Neurology and Neuroscience Reports - February 21, 2017 Category: Neuroscience Source Type: research

Aphasia As a Predictor of Stroke Outcome
AbstractPurpose of ReviewAphasia is a common feature of stroke, affecting 21 –38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes.Recent FindingsDuring the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independen...
Source: Current Neurology and Neuroscience Reports - September 19, 2017 Category: Neuroscience Source Type: research

Sleep-Wake Disorders in Stroke —Increased Stroke Risk and Deteriorated Recovery? An Evaluation on the Necessity for Prevention and Treatment
AbstractPurpose of ReviewSleep-wake disorders (SWD) are common not only in the general population but also in stroke patients, in whom SWD may be pre-existent or appear “de novo” as a consequence of brain damage. Despite increasing evidence of a negative impact of SWD on cardiocerebrovascular risk, cognitive functions, and quality of life, SWD are insufficiently considered in the prevention and management of patients with stroke. This narrative review aims at s ummarizing the current data on the bidirectional link between SWD and stroke.Recent FindingsSeveral studies have demonstrated that sleep-disordered breathing (S...
Source: Current Neurology and Neuroscience Reports - September 7, 2018 Category: Neuroscience Source Type: research

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack
This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke.Recent FindingsEchocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary informat...
Source: Current Neurology and Neuroscience Reports - June 29, 2020 Category: Neuroscience Source Type: research

Development of Regional Stroke Programs
Abstract The organization of stroke care has undergone a dramatic evolution in the USA over the last two decades. Beginning with the recommendation for Primary Stroke Centers (PSCs) in 1994, there has been a concerted effort by physicians, the American Heart Association/American Stroke Association (AHA/ASA), National Institutes of Health (NIH), and state legislatures to advance an evidence-based system of care with several tiers of stroke centers. At the apex of this structure are Regional Stroke Centers (RSCs), which do not have official recognition like PSCs and Comprehensive Stroke Centers (CSCs), but their ex...
Source: Current Neurology and Neuroscience Reports - March 13, 2015 Category: Neuroscience Source Type: research

The Impact of Physical Activity Before and After Stroke on Stroke Risk and Recovery: a Narrative Review
AbstractPurpose of the ReviewSummarising the evidence for pre- and post-stroke physical activity (PA) and exercise to reduce stroke risk, and improve recovery and brain health.Recent FindingsPre-stroke PA reduces the risk of stroke, and post-stroke PA and exercise reduce cardiovascular risk factors, which can moderate the risk of recurrent strokes. Pre-clinical evidence indicates that exercise enhances neuroplasticity. The results from clinical studies showed that exercise changes brain activity patterns in stroke survivors, which can be a signal neuroplasticity. The intensity of pre- and post-stroke PA and exercise is a k...
Source: Current Neurology and Neuroscience Reports - April 21, 2019 Category: Neuroscience Source Type: research

Lipid-Modifying Therapies and Stroke Prevention
AbstractPurpose of ReviewWe reviewed lipid-modifying therapies and the risk of stroke and other cerebrovascular outcomes, with a focus on newer therapies.Recent FindingsStatins and ezetimibe reduce ischemic stroke risk without increasing hemorrhagic stroke risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors similarly reduce ischemic stroke risk in statin-treated patients with atherosclerosis without increasing hemorrhagic stroke, even with very low achieved low-density lipoprotein cholesterol levels. Icosapent ethyl reduces the risk of total and first ischemic stroke in patients with established cardiova...
Source: Current Neurology and Neuroscience Reports - May 13, 2022 Category: Neuroscience Source Type: research

Impact of Infection on Stroke Morbidity and Outcomes
AbstractEach year, millions of persons worldwide are disabled by stroke. The burden of stroke is expected to increase as a consequence of growth in our elderly population. Outcome is dependent upon limitation of secondary medical processes in the acute setting that lead to deterioration and increased long-term disability. The prevalence of infection after stroke is greater that seen in other medical conditions with similar acuity and its impact upon morbidity and mortality is substantial. Physical impairment and immune modulation are chief determinants in rate of infection after stroke. Each of these factors has been a tar...
Source: Current Neurology and Neuroscience Reports - August 1, 2016 Category: Neuroscience Source Type: research

Circulating Troponin I Level in Patients with Acute Ischemic Stroke
The objective of this study and systematic review is to determine how high the circulating troponin I level can rise due to ischemic stroke.Recent FindingsAnonymized medical records from Vanderbilt University Medical Center were reviewed identifying 151,972 unique acute ischemic stroke events, of which 1226 met criteria for inclusion in this study. Included patients had at least one measurement of troponin I level documented during the hospital visit when an acute ischemic stroke was diagnosed and were free of known cardiac/coronary disease, renal impairment, sepsis, or other confounders. In this group, 20.6% had a circula...
Source: Current Neurology and Neuroscience Reports - April 20, 2018 Category: Neuroscience Source Type: research

Post-stroke Dysphagia: Recent Insights and Unanswered Questions
AbstractPurpose of ReviewWe explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia?Recent FindingsThere have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae....
Source: Current Neurology and Neuroscience Reports - November 2, 2020 Category: Neuroscience Source Type: research

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