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Source: Current Treatment Options in Neurology

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Total 69 results found since Jan 2013.

Imaging Selection for Reperfusion Therapy in Acute Ischemic Stroke
Opinion statement Neuroimaging is essential in the evaluation of the acute stroke patient. Computed tomography (CT) or magnetic resonance imaging (MRI) should be used to confirm the diagnosis of acute stroke, exclude stroke mimics, and triage patients for intravenous tissue plasminogen activator and endovascular revascularization therapies. Advanced neuroimaging techniques, including CT-angiography, MR-angiography, CT-perfusion, and MR-perfusion should be used to further inform acute stroke treatment decisions. Patients considered for endovascular stroke therapy should have (1) a vascular occlusion that can be re...
Source: Current Treatment Options in Neurology - January 27, 2015 Category: Neurology Source Type: research

Understanding Atrial Cardiopathy: an Under-Recognized Contributor to Cardioembolic Stroke
AbstractPurpose of reviewIschemic stroke is the fifth leading cause of death in the world with cardioembolic stroke (CES) causing a disproportional amount of the morbidity and mortality associated with stroke. Atrial fibrillation (AF) is the leading cause of CES, and as the population ages, the incidence of CES is anticipated to rise. The importance of proper diagnosis and treatment of patients with embolic-appearing stroke is significant due to the burden of disease and the severity of the illness.Recent findingsThe past decade has seen an explosion of treatment options for patients with CES related to AF as well as bette...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Mobile Stroke Units: Bringing Treatment to the Patient
AbstractPurpose of reviewMobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.Recent findingsMultiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30  min faster than conventional care. The 90-day modified Rankin Scores ...
Source: Current Treatment Options in Neurology - February 5, 2020 Category: Neurology Source Type: research

Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults
AbstractPurpose of ReviewTo identify the current state of science on stroke in transgender adults and highlight gaps in need of further research. We will review current research on cerebrovascular risk and disease, hormone therapy, and stroke in transgender individuals. Finally, we will provide a framework for healthcare providers to prevent and reduce disparities through inclusive care practices.Recent FindingsTransgender people experience unique stroke risk factors, secondary to both psychosocial stress and health-related behaviors. These include higher rates of HIV, tobacco use, stimulant use, and hepatitis C. The use o...
Source: Current Treatment Options in Neurology - July 11, 2022 Category: Neurology Source Type: research

Acute Blood Pressure Management in Acute Ischemic Stroke and Spontaneous Cerebral Hemorrhage
AbstractPurpose of reviewWe discuss the evidence and guidelines for acute blood pressure (BP) management for patients presenting with acute ischemic stroke or spontaneous cerebral hemorrhage.Recent findingsObservational data suggest that the extremes of BP should be avoided in patients presenting with acute ischemic stroke. There is no convincing evidence that active BP reduction results in improved outcomes for ischemic stroke patients. Current guidelines recommend that BP be maintained ≤ 185/110 mmHg in patients who are candidates for intravenous tissue plasminogen activator (IV tPA) or mechanical thrombectomy and t...
Source: Current Treatment Options in Neurology - August 18, 2018 Category: Neurology Source Type: research

Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - May 7, 2019 Category: Neurology Source Type: research

COVID-19 Era Stroke Service: Virtually Normal
ConclusionsZoom conferences are a promising technology for stroke services. Further studies are needed to further elucidate their benefits and drawbacks.
Source: Current Treatment Options in Neurology - October 8, 2020 Category: Neurology Source Type: research

Emergency Management of Ischemic Stroke in Children
Opinion statement Children who present with acute neurological symptoms suggestive of a stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large infarcts at risk of developing malignant ...
Source: Current Treatment Options in Neurology - April 9, 2015 Category: Neurology Source Type: research

Intra-Arterial Therapy for Acute Ischemic Stroke: a Golden Age
Opinion statement With the recent publication of multiple trials demonstrating the superiority of the endovascular treatment of patients presenting with stroke from large vessel occlusion (LVO) over medical management, the emergent care of these patients is entering a new era. This realization justifies an aggressive treatment approach with these stroke patients, given the poor natural history of the disease. In general, treatment should occur as quickly as is reasonably possible. Patients with NIHSS >8 should be considered, and if <6 h from onset imaging selection achieved with CT and CTA. Those with ASPE...
Source: Current Treatment Options in Neurology - May 18, 2015 Category: Neurology Source Type: research

Treatment of Post-Stroke Depression
We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke.Recent findingsNeuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent met...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Advanced Imaging in the Era of Tissue-Based Treatment for Acute Ischemic Stroke —a Practical Review
AbstractPurpose of the reviewAdvanced imaging is now used to identify acute ischemic stroke (AIS) patients for treatment with tissue plasminogen activator or mechanical thrombectomy, who are either out of the traditional treatment window or have an unknown last known well time. Current guidelines recommend adapting the complex inclusion criteria used in the clinical trials to provide optimal individual patient decisions in clinical practice. This review aims to facilitate such integration by organizing the available data in a practical clinical context.Recent findingsWe review two clinical vignettes of advanced imaging for...
Source: Current Treatment Options in Neurology - September 20, 2021 Category: Neurology Source Type: research

Acute Stroke Treatment in an Anticoagulated Patient: When Is Thrombolysis an Option?
AbstractPurpose of ReviewDirect oral anticoagulants (DOACs: the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban and the direct thrombin inhibitor dabigatran) are the mainstay of stroke prevention in patients with non-valvular atrial fibrillation (AF). Nevertheless, there is a residual stroke risk of 1 –2% per year despite DOAC therapy. Intravenous thrombolysis (IVT) reduces morbidity in patients with ischemic stroke and improves functional outcome. Prior DOAC therapy is a (relative) contraindication for IVT but emerging evidence supports its use in selected patients.Recent FindingsRecent observational studies hi...
Source: Current Treatment Options in Neurology - November 16, 2021 Category: Neurology Source Type: research

Management of the Interventional Stroke Patient
Opinion statement The acute treatment of major ischemic stroke has been revolutionized by strong and consistent evidence from multiple randomized trials. Endovascular treatment by mechanical thrombectomy will be increasingly chosen as an adjunctive or alternative to intravenous thrombolysis. To apply this form of stroke treatment is associated with the challenge of optimal periinterventional treatment. The patient has to be identified, counselled, prepared, monitored, cardiovascularly stabilized, possibly sedated and ventilated, and postprocedurally treated in the optimal way. However, most aspects of periinterve...
Source: Current Treatment Options in Neurology - September 21, 2015 Category: Neurology Source Type: research

Clinical Features of Thalamic Stroke
Opinion statementThe thalamus plays an important role in different brain functions including memory, emotions, sleep-wake cycle, executive functions, mediating general cortical alerting responses, processing of sensory (including taste, somatosensory, visual, and auditory) information and relaying it to the cortex, and sensorimotor control. Thalamic stroke, both in isolation and in combination with infarcts involving other structures, are not rare. The functional complexity of the thalami nuclei and the not uncommon normal variations of arteries supply the thalamus induce wide variations in presentation of thalami infarcts...
Source: Current Treatment Options in Neurology - February 28, 2017 Category: Neurology Source Type: research