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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

Role of Occlusive Devices to Prevent Thromboembolism Among Persons With a Patent Foramen Ovale and Prior Stroke
Opinion statement Patent foramen ovale (PFO) has been linked to stroke, presumably through the mechanism of paradoxical embolism; however, data is confusing regarding the causal relationship between PFO and embolic stroke. What has come to light in the past decade of research is that PFO closure with devices that achieve a high rate of closure may reduce the risk of recurrent stroke compared with medical therapy, but this benefit has not been shown in the general population with a PFO and cryptogenic stroke. The important question now is which patient will benefit from PFO closure for stroke risk reduction. A val...
Source: Current Treatment Options in Neurology - March 7, 2015 Category: Neurology Source Type: research

Selection of Warfarin or One of the New Oral Antithrombotic Agents for Long-Term Prevention of Stroke among Persons with Atrial Fibrillation
Opinion statement Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, which can potentially increases the risk of stroke by five-fold, thus, resulting in high public healthcare burden. Stroke prevention is vital in the management of AF patients. Vitamin K antagonists (VKA, eg, warfarin) have been the mainstay treatment to prevent ischemic stroke and systemic thromboembolism in AF patients for several decades. Despite the efficacy of warfarin, its limitations have recently driven the advent of some new antithrombotic agents, the non-VKA oral anticoagulant (NOACs, including dabigatran, ri...
Source: Current Treatment Options in Neurology - February 11, 2015 Category: Neurology Source Type: research

Decompressive Craniectomy in Neurocritical Care
Opinion statement Decompressive craniectomy (DC) involves the removal of a portion of the skull in the setting of life threatening brain edema or potentially uncontrollable intracranial pressures. Often performed on an emergent basis, evaluation and arrangement for DC should be swift and decisive. However, the evidence base for DC in the wide range of conditions for which it is currently performed is still developing. The procedure is associated with a number of complications and ethical considerations; thus, its place in contemporary practice remains controversial. While randomized trials conducted in the last d...
Source: Current Treatment Options in Neurology - January 27, 2015 Category: Neurology Source Type: research

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

Treatment of Malignant Brain Edema and Increased Intracranial Pressure After Stroke
Opinion statement The management of patients with large territory ischemic strokes and the subsequent development of malignant brain edema and increased intracranial pressure is a significant challenge in modern neurology and neurocritical care. These patients are at high risk of subsequent neurologic decline and are best cared for in an intensive care unit or a comprehensive stroke center with access to neurosurgical support. Risks include hemorrhagic conversion, herniation, poor functional outcome, and death. This review discusses recent advances in understanding the pathophysiology of edema formation, identify...
Source: Current Treatment Options in Neurology - November 9, 2014 Category: Neurology Source Type: research

In search of a treatment for radiation-induced optic neuropathy
Opinion statement Radiation-induced optic neuropathy (RON) is an iatrogenic complication that causes severe, irreversible vision loss in one or both eyes within the months to years following radiation therapy. Posterior RON is a rare but devastating toxicity of radiation applied to the visual pathways to treat paranasal sinus and skull base tumors. Anterior RON is an unavoidable consequence of proton beam irradiation or ophthalmic plaque treatment of orbital, choroidal, or retinal tumors. Various treatments aimed at stabilizing and ideally reversing vision loss have been investigated but only in small cases serie...
Source: Current Treatment Options in Neurology - November 8, 2014 Category: Neurology Source Type: research

Etiology and Treatment of Arterial Ischemic Stroke in Children and Young Adults
Opinion statement Stroke is the second leading cause of death worldwide (Go et al. Circulation 129:e28–292, 2014) and is a major cause of morbidity and mortality. Compared with older adults, arterial ischemic stroke (AIS) is relatively uncommon in children and young adults, comprising 5-10 % of all stroke (Biller Nat Rev Cardiol 6:395–97, 2009), but is associated with significant cost. In contrast to the declining overall incidence of stroke, some early studies suggest that the rate of stroke hospitalizations in children and young adults is rising (George et al. Ann Neurol 70:713–21, 2011; Kissela et al. S...
Source: Current Treatment Options in Neurology - September 18, 2014 Category: Neurology Source Type: research

Anticoagulation for Noncardiac Indications in Neurologic Patients: Comparative Use of Non-Vitamin K Oral Anticoagulants, Low-Molecular-Weight Heparins, and Warfarin
Opinion statement Patients with neurologic disorders may develop a wide variety of thromboembolic events, both as a primary manifestation and as a consequence of their underlying neurologic condition. There are many available options for anticoagulation, ranging from warfarin to the parenteral subcutaneously administered anticoagulants to the non-vitamin K oral anticoagulants (NOACs). Warfarin is orally available, well-studied, and easily reversible in the setting of bleeding, but has a prolonged onset of action, measured in days, and equally slow offset; requires frequent monitoring for dose titration; and has m...
Source: Current Treatment Options in Neurology - July 19, 2014 Category: Neurology Source Type: research

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