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Boosted Tree Model Reforms Multimodal Magnetic Resonance Imaging Infarct Prediction in Acute Stroke Clinical Sciences
Background and Purpose—Stroke imaging is pivotal for diagnosis and stratification of patients with acute ischemic stroke to treatment. The potential of combining multimodal information into reliable estimates of outcome learning calls for robust machine learning techniques with high flexibility and accuracy. We applied the novel extreme gradient boosting algorithm for multimodal magnetic resonance imaging–based infarct prediction.Methods—In a retrospective analysis of 195 patients with acute ischemic stroke, fluid-attenuated inversion recovery, diffusion-weighted imaging, and 10 perfusion parameters were derived from...
Source: Stroke - March 26, 2018 Category: Neurology Authors: Michelle Livne, Jens K. Boldsen, Irene K. Mikkelsen, Jochen B. Fiebach, Jan Sobesky, Kim Mouridsen Tags: Magnetic Resonance Imaging (MRI), Ischemic Stroke Original Contributions Source Type: research

Gradual Lesion Expansion and Brain Shrinkage Years After Stroke Brief Reports
Conclusions— We show gradual lesion expansion many years after stroke, beyond that expected by normal aging and after controlling for other variables. Future studies need to understand how structural reorganization enables long-term recovery even when the brain is shrinking.
Source: Stroke - February 24, 2014 Category: Neurology Authors: Seghier, M. L., Ramsden, S., Lim, L., Leff, A. P., Price, C. J. Tags: Behavioral Changes and Stroke, Computerized tomography and Magnetic Resonance Imaging Brief Reports Source Type: research

The Capillary Index Score as a Marker of Viable Cerebral Tissue: Proof of Concept--The Capillary Index Score in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Trial Clinical Sciences
Conclusions— The absence of capillary blush on pretreatment digital subtraction angiogram seems to correspond to nonviable cerebral tissue. Successful revascularization reduces the chance of tissue hypodensity (infarction), when capillary blush is present. Clinical Trial Registration— URL: http://www.trialregister.nl. Unique identifier: NTR number 1804. URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Al-Ali, F., Berkhemer, O. A., Yousman, W. P., Elias, J. J., Bender, E. N., Lingsma, H. F., van der Lugt, A., Dippel, D. W. J., Roos, Y. B. W. E. M., van Oostenbrugge, R. J., van Zwam, W. H., Dillon, W. P., Majoie, C. B. L. M. Tags: Computerized Tomography (CT), Revascularization, Ischemic Stroke Clinical Sciences Source Type: research

Multiparametric Model for Penumbral Flow Prediction in Acute Stroke Clinical Sciences
In this study, we established a multiparametric perfusion imaging model and cross-validated it using positron emission tomography perfusion for detection of penumbral flow.Methods—In a retrospective analysis of 17 subacute stroke patients with consecutive magnetic resonance imaging and H2O15 positron emission tomography scans, perfusion maps of cerebral blood flow, cerebral blood volume, mean transit time, time-to-maximum, and time-to-peak were constructed and combined using a generalized linear model (GLM). Both the GLM maps and the single perfusion maps alone were cross-validated with positron emission tomography-cereb...
Source: Stroke - June 26, 2017 Category: Neurology Authors: Michelle Livne, Tabea Kossen, Vince I. Madai, Olivier Zaro-Weber, Walter Moeller-Hartmann, Kim Mouridsen, Wolf-Dieter Heiss, Jan Sobesky Tags: Imaging, Magnetic Resonance Imaging (MRI), Ischemic Stroke Original Contributions Source Type: research

Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Stroke Thrombolysis Clinical Sciences
Background and Purpose—We assessed whether the presence, number, and distribution of cerebral microbleeds (CMBs) on pre-intravenous thrombolysis MRI scans of acute ischemic stroke patients are associated with an increased risk of intracerebral hemorrhage (ICH) or poor functional outcome.Methods—We performed an individual patient data meta-analysis, including prospective and retrospective studies of acute ischemic stroke treated with intravenous tissue-type plasminogen activator. Using multilevel mixed-effects logistic regression, we investigated associations of pre-treatment CMB presence, burden (1, 2–4, ≥5, and>10...
Source: Stroke - July 24, 2017 Category: Neurology Authors: Andreas Charidimou, Guillaume Turc, Catherine Oppenheim, Shenqiang Yan, Jan F. Scheitz, Hebun Erdur, Pascal P. Klinger–Gratz, Marwan El–Koussy, Wakoh Takahashi, Yusuke Moriya, Duncan Wilson, Chelsea S. Kidwell, Jeffrey L. Saver, Asma Sallem, S Tags: Magnetic Resonance Imaging (MRI), Prognosis, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates Brief Report
Conclusions—Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0–5 versus 0–6 or 0–6 versus 7–10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.
Source: Stroke - December 22, 2017 Category: Neurology Authors: Robert Fahed, Augustin Lecler, Candice Sabben, Naim Khoury, Celina Ducroux, Vanessa Chalumeau, Daniele Botta, Erwah Kalsoum, William Boisseau, Loic Duron, Dominique Cabral, Patricia Koskas, Azzedine Benaissa, Hasmik Koulakian, Michael Obadia, Benȷa Tags: Magnetic Resonance Imaging (MRI), Ischemic Stroke Brief Reports Source Type: research

Time From Imaging to Endovascular Reperfusion Predicts Outcome in Acute Stroke Clinical Sciences
Conclusions—Compared with target mismatch patients, those with the malignant profile experience faster infarct growth and a steeper decline in the odds of functional independence, with longer delays between baseline imaging and reperfusion. However, this does not exclude the possibility of treatment benefit in patients with a malignant profile.
Source: Stroke - March 26, 2018 Category: Neurology Authors: Jenny P. Tsai, Michael Mlynash, Soren Christensen, Stephanie Kemp, Sun Kim, Nishant K. Mishra, Christian Federau, Raul G. Nogueira, Tudor G. Jovin, Thomas G. Devlin, Naveed Akhtar, Dileep R. Yavagal, Roland Bammer, Matus Straka, Gregory Zaharchuk, Michael Tags: Revascularization, Cerebrovascular Procedures, Ischemic Stroke Original Contributions Source Type: research

Identification of Reversible Disruption of the Human Blood-Brain Barrier Following Acute Ischemia Brief Reports
Conclusions— This study demonstrates that diffuse, mild BBB disruption in the acutely ischemic human brain is reversible with reperfusion. This study also confirms prior findings that focal severe BBB disruption confers an increased risk of hemorrhagic transformation in patients treated with intravenous tissue-type plasminogen activator.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Simpkins, A. N., Dias, C., Leigh, R., on behalf of the National Institutes of Health Natural History of Stroke Investigators, Benson, Hsia, Latour, Luby, Lynch, Merino, Nadareishvili, Warach Tags: Magnetic Resonance Imaging (MRI), Blood-Brain Barrier, Intracranial Hemorrhage, Ischemic Stroke Brief Reports Source Type: research

Optimal Computed Tomographic Perfusion Scan Duration for Assessment of Acute Stroke Lesion Volumes Clinical Sciences
Background and Purpose—The minimal scan duration needed to obtain reliable lesion volumes with computed tomographic perfusion (CTP) has not been well established in the literature.Methods—We retrospectively assessed the impact of gradual truncation of the scan duration on acute ischemic lesion volume measurements. For each scan, we identified its optimal scan time, defined as the shortest scan duration that yields measurements of the ischemic lesion volumes similar to those obtained with longer scanning, and the relative height of the fitted venous output function at its optimal scan time.Results—We analyzed 70 compu...
Source: Stroke - November 27, 2016 Category: Neurology Authors: Aimen S. Kasasbeh, Soren Christensen, Matus Straka, Nishant Mishra, Michael Mlynash, Roland Bammer, Gregory W. Albers, Maarten G. Lansberg Tags: Computerized Tomography (CT), Ischemic Stroke Original Contributions Source Type: research

Magnetic Resonance Imaging Selection for Endovascular Stroke Therapy Clinical Sciences
Conclusions—Workflow in GOLIATH demonstrates that magnetic resonance imaging selection for endovascular therapy can be accomplished rapidly and within a similar time frame as computed tomography-based selection.Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT02317237.
Source: Stroke - May 25, 2018 Category: Neurology Authors: Claus Z. Simonsen, Albert J. Yoo, Mads Rasmussen, Kristina E. Sorensen, Thabele Leslie–Mazwi, Grethe Andersen, Leif H. Sorensen Tags: Magnetic Resonance Imaging (MRI), Revascularization, Ischemic Stroke Original Contributions Source Type: research

Body Mass Index and Stroke: Overweight and Obesity Less Often Associated with Stroke Recurrence
Background: Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke).Methods: A registry designed to collect data on all hospitalized stroke patients in Denmark 2000-2010 includes 61,872 acute stroke patients with information on BMI in 38,506. Data include age, se...
Source: Journal of Stroke and Cerebrovascular Diseases - July 22, 2013 Category: Neurology Authors: Klaus Kaae Andersen, Tom Skyhøj Olsen Tags: Original Articles Source Type: research

World Stroke Organization Global Stroke Services Guidelines and Action Plan
Every two seconds, someone across the globe suffers a symptomatic stroke. ‘Silent’ cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence‐based approaches to stroke prevention, acute stroke management, and stroke recovery. The current challenge lies in implementing these interventions, particularly in regions ...
Source: International Journal of Stroke - September 23, 2014 Category: Neurology Authors: Patrice Lindsay, Karen L. Furie, Stephen M. Davis, Geoffrey A. Donnan, Bo Norrving Tags: Guidelines Source Type: research

Wants Talk Psychotherapy but Cannot Talk: EMDR for Post-stroke Depression with Expressive Aphasia
CONCLUSION This is the first reported case demonstrating that EMDR can be effective for depression, even in those with severe expressive aphasia. In our case, there was no reluctance to disclose information, simply a neurological inability to do so. Through preparation, patience, perseverance, and plasticity (clinician flexibility, though perhaps also neuroplasticity), the patient’s PSD gradually improved, and she was able to reinvent her life within her limitations. ACKNOWLEDGMENTS The authors gratefully acknowledge Eugene Schwartz, E.C. Hurley, and Mark Hubner for providing consultation during patient care. REFERENCES ...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Case Report Current Issue Neurologic Systems and Symptoms Neurology Psychotherapy Stroke aphasia depression EMDR Source Type: research

Trimming the fat in acute ischemic stroke: an assessment of 24‐h CT scans in tPA patients
ConclusionsOur results demonstrate that routine 24‐h computed tomography scan in patients without 24‐h National Institute of Health Stroke Scale worsening (especially those with baseline National Institute of Health Stroke Scale ≤10) is less likely to yield information that results in a deviation from standard acute stroke care. No patient without worsening and baseline National Institute of Health Stroke Scale ≤10 had parenchymal hematoma on 24‐h computed tomography. Application of the National Institute of Health Stroke Scale to distinguish patients who should have 24‐h follow‐up imaging from those who will...
Source: International Journal of Stroke - June 3, 2014 Category: Neurology Authors: Alexander J. George, Amelia K. Boehme, Casey R. Dunn, T. Beasley, James E. Siegler, Karen C. Albright, Ramy El Khoury, Sheryl Martin‐Schild Tags: Research Source Type: research

Cause-specific Mortality after Stroke: Relation to Age, Sex, Stroke Severity, and Risk Factors in a 10-Year Follow-up Study
We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were performed by cause-specific Co...
Source: Journal of Stroke and Cerebrovascular Diseases - May 14, 2012 Category: Neurology Authors: Ulla Brasch Mogensen, Tom Skyhøj Olsen, Klaus Kaae Andersen, Thomas Alexander Gerds Tags: Original Articles Source Type: research