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Acute Ischemic Stroke.
Authors: Rossi UG, Ierardi AM, Cariati M Abstract A 77-year-old woman with a history of hypertension developed acute onset of aphasia and right hemiplegia and hemisensory loss. She was urgently referred to emergency department. Cerebral multidetector computed tomographic angiography (MD-CTA) revealed an acute ischemic stroke due to the occlusion of the left middle cerebral artery (Figure 1). Since the symptoms started three hours previously, the patient was candidate for mechanical thrombectomy. The patient then performed a selective digital subtraction angiography (DSA) of the left internal carotid artery that con...
Source: Acta Neurologica Taiwanica - February 1, 2020 Category: Neurology Tags: Acta Neurol Taiwan Source Type: research
Atrial premature activity detected after an ischaemic stroke unveils atrial myopathy.
CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke. PMID: 32007362 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - January 29, 2020 Category: Cardiology Authors: Py A, Schaaf M, Duhamel S, Si-Mohamed S, Daher J, Altman M, de Breyne B, Mechtouff L, Placide J, Chauveau S, Chevalier P, Nighoghossian N, Bergerot C, Thibault H Tags: Arch Cardiovasc Dis Source Type: research
Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis.
Abstract Stroke represents a serious illness and is extremely relevant from the public health point of view, implying important social and economic burdens. Introducing new procedures or therapies that reduce the costs both in the acute phase of the disease and in the long term becomes a priority for health systems worldwide. The present study quantifies and compares the direct costs for ischemic stroke in patients with thrombolysis treatment versus conservative treatment over a 24-month period from the initial diagnosis, in one of the 7 national pilot centres for the implementation of thrombolytic treatment. The ...
Source: Medicina (Kaunas) - January 28, 2020 Category: Universities & Medical Training Authors: Uivarosan D, Bungau S, Tit DM, Moisa C, Fratila O, Rus M, Bratu OG, Diaconu CC, Pantis C Tags: Medicina (Kaunas) Source Type: research
Paediatric stroke - a review of current guidelines for diagnosis and treatment.
Abstract Stroke, increasingly recognised in children in recent years, is an important cause of long-term morbidity and disability. It can be classified by the stroke type as either arterial ischaemic stroke (AIS), haemorrhagic stroke (HS), or cerebral sinovenous thrombosis (CSVT). Furthermore, perinatal and childhood stroke can be distinguished. A wide range of conditions associated with paediatric stroke has been identified, which differ significantly from those in adults. A paediatric stroke can also present with a variety of symptoms and signs, both specific and non-specific. Because of the diversity of the und...
Source: Neurologia i Neurochirurgia Polska - January 27, 2020 Category: Neurology Authors: Oborska Z, Urban P, Wychowaniec K, Jóźwiak S Tags: Neurol Neurochir Pol Source Type: research
Eicosapentaenoic-to-Arachidonic Acid Ratio Predicts Mortality and Recurrent Vascular Events in Ischemic Stroke Patients.
CONCLUSIONS: Low EPA/AA ratio at baseline and treatment without statins could predict mortality, recurrent ischemic stroke, cardiovascular and peripheral artery diseases, and hemorrhagic stroke among patients with acute ischemic stroke. The combination of baseline EPA/AA ratio and statin therapy could be critical in predicting the long-term prognosis of ischemic stroke patients. PMID: 31969533 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - January 25, 2020 Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
Beneficial actions of prothymosin alpha-mimetic hexapeptide on central post-stroke pain, reduced social activity, learning-deficit and depression following cerebral ischemia in mice
Publication date: Available online 23 January 2020Source: PeptidesAuthor(s): Keita Sasaki, Sebok Kumar Halder, Hayato Matsunaga, Hiroshi UedaAbstractProthymosin alpha (ProTα)-mimetic hexapeptide (amino acid: NEVDQE, P6Q) inhibits cerebral or retinal ischemia-induced behavioral, electrophysiological and histological damage. P6Q also abolishes cerebral hemorrhage induced by ischemia with tissue plasminogen activator (tPA). In the present study we examined the beneficial effects of P6Q on other post-stroke prognostic psychology-related symptoms, which obstruct the motivation toward physical therapy. Intravenous (i.v.) admini...
Source: Peptides - January 24, 2020 Category: Biochemistry Source Type: research
Clinical Risk Factors of Thromboembolic and Major Bleeding Events for Patients with Atrial Fibrillation Treated with Rivaroxaban in Japan
Background: It is important to understand the risk of thromboembolism and bleeding in patients with nonvalvular atrial fibrillation (NVAF) receiving direct oral anticoagulants; however, data on risk factors in Japanese patients are limited. Methods: XAPASS (Xarelto Post-Authorization Safety and Effectiveness Study in Japanese Patients with Atrial Fibrillation) is a prospective observational study examining the safety and effectiveness of rivaroxaban in Japanese real-world clinical practice. We investigated risk factors for stroke/noncentral nervous system systemic embolism (non-CNS SE)/myocardial infarction (MI) and major ...
Source: Journal of Stroke and Cerebrovascular Diseases - January 23, 2020 Category: Neurology Authors: Susumu Miyamoto, Takanori Ikeda, Satoshi Ogawa, Takanari Kitazono, Jyoji Nakagawara, Kazuo Minematsu, Yuji Murakawa, Sanghun Iwashiro, Makiko Takeichi, Yoko Kidani, Yutaka Okayama, Toshiyuki Sunaya, Shoichiro Sato, Satoshi Yamanaka Source Type: research
Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke
ConclusionIn 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases.In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.
Source: Neurological Sciences - January 23, 2020 Category: Neurology Source Type: research
Stroke risk and atrial mechanical dysfunction in cardiac amyloidosis
We present a 42 ‐year‐old male patient with familial transthyretin amyloidosis who suffered an embolic stroke that originated from a left atrial appendage thrombus in the absence of any documented atrial fibrillation. This case highlights atrial mechanical dysfunction in patients with cardiac amyloidosis and th e need to better stratify thrombotic risk in this population with integration of echocardiographic parameters and transesophageal echocardiography.
Source: ESC Heart Failure - January 21, 2020 Category: Cardiology Authors: Brennan Ballantyne, Usha Manian, Olusegun Sheyin, Ryan Davey, Sabe De Tags: Case Report Source Type: research
Monocyte-to-High-Density Lipoprotein Ratio Predicts the Outcome of Acute Ischemic Stroke.
CONCLUSIONS: MHR may be a significant and independent predictor of poor functional outcome in patients with AIS. PMID: 31941849 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - January 18, 2020 Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
IJERPH, Vol. 17, Pages 618: Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke
eng Tsong-Hai Lee Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagn...
Source: International Journal of Environmental Research and Public Health - January 18, 2020 Category: Environmental Health Authors: Yi-Ju Tseng Ru-Fang Hu Shin-Tyng Lee Yu-Li Lin Chien-Lung Hsu Shih-Wei Lin Chia-Wei Liou Jiann-Der Lee Tsung-I Peng Tsong-Hai Lee Tags: Article Source Type: research
RNA expression studies in stroke: what can they tell us about stroke mechanism?
Purpose of review Diagnosis of stroke and understanding the mechanism of stroke is critical to implement optimal treatment. RNA expressed in peripheral blood cells is emerging as a precision biomarker to aid in stroke diagnosis and prediction of stroke cause. In this review, we summarize available data regarding the role of RNA to predict stroke, the rationale for these changes, and a discussion of novel mechanistic insight and clinical applications. Recent findings Differences in RNA gene expression in blood have been identified in patients with stroke, including differences to distinguish ischemic from hemorrhagic s...
Source: Current Opinion in Neurology - January 17, 2020 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research
Stroke after spontaneous intracranial hypotension: Not a single mechanism. Case report and review of literature
We report a case of SIH followed with brain infarction, with a distinct presentation from previous literature, suggesting a different mechanism. A 35 year-old had severe orthostatic headache, responsible for prolonged bed rest. One month later, he had acute left hemiparesis secondary to stroke and right posterior cerebral artery occlusion. Stroke MRI showed arguments for intracranial hypotension (thickened meninges). He was successfully treated with intravenous rtPA thrombolysis. Headache were resolved after an epidural blood patch. A patent foramen ovale was detected. Clinical features of this description were compared w...
Source: Journal of Clinical Neuroscience - January 16, 2020 Category: Neuroscience Source Type: research
Homocysteine Level Predicts Response to Dual Antiplatelet in Women With Minor Stroke or Transient Ischemic Attack: Subanalysis of the CHANCE Trial.
CONCLUSIONS: Homocysteine could be a potential biomarker to discriminate the effects of dual and single antiplatelet therapy in female patients with minor ischemic stroke or high-risk transient ischemic attack. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589. PMID: 31941381 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - January 16, 2020 Category: Cardiology Authors: Li J, Wang Y, Li H, Zuo Z, Lin J, Wang A, Zhao X, Liu L, Wang Y, CHANCE Investigators* Tags: Arterioscler Thromb Vasc Biol Source Type: research
Expression of Cytokines and Chemokines as Predictors of Stroke Outcomes in Acute Ischemic Stroke
Conclusions: Machine learning algorithms can be employed to develop prognostic predictive biomarkers for stroke outcomes in ischemic stroke patients, particularly in regard to identifying acute gene expression changes that occur during stroke.
Source: Frontiers in Neurology - January 15, 2020 Category: Neurology Source Type: research
Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents
Conclusion: ML modeling is feasible. However, large well-designed prospective multicenter studies are needed for accurate ML so that clinicians can balance the risks of recurrence with the risk of TEEs, especially for high-risk anticoagulated patients.
Source: Frontiers in Neurology - January 15, 2020 Category: Neurology Source Type: research
The role of diabetes mellitus on the thrombus composition in patients with acute ischemic stroke.
CONCLUSION: Clots in diabetic patients had more fibrin and fewer erythrocyte components compared with patients without diabetes mellitus, while hyperglycemia on admission did not show association with clot composition. Further studies are needed to confirm these results. PMID: 31924102 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - January 13, 2020 Category: Radiology Tags: Interv Neuroradiol Source Type: research
Ischemic Stroke with Protein S Deficiency Treated by Apixaban
A 57-year-old man with atherosclerosis obliterans was admitted with sudden-onset sensory aphasia and right hemiparesis. Brain MRI revealed acute cerebral infarctions in the left temporal lobe and magnetic resonance angiography showed occlusion of the posterior branch of the left middle cerebral artery. Transesophageal echocardiography and ultrasonography respectively confirmed a patent foramen ovale and deep vein thrombosis in the bilateral femoral veins. Blood findings showed low protein S antigen, low protein S activity, and a missense mutation of the PROS 1 gene.
Source: Journal of Stroke and Cerebrovascular Diseases - January 13, 2020 Category: Neurology Authors: Ikkei Ohashi, Shinichi Wada, Fumitaka Yoshino, Takahiro Kuwashiro, Shinya Matsumoto, Taeko Hotta, Dongchong Kang, Yasushi Okada, Shun Shimohama, Masahiro Yasaka Tags: Case Report Source Type: research
Association of DIAPH1 gene polymorphisms with ischemic stroke.
Abstract DIAPH1 is a formin protein involved in actin polymerization with important roles in vascular remodeling and thrombosis. To investigate potential associations of DIAPH1 single-nucleotide polymorphisms (SNPs) with hypertension and stroke, 2,012 patients with hypertension and 2,210 controls, 2,966 stroke cases [2,212 ischemic stroke (IS), 754 hemorrhagic stroke (HS)] and 2,590 controls were enrolled respectively in the case-control study. A total of 4,098 individual were included in the cohort study. DIAPH1 mRNA expression was compared between 66 IS [43 small artery occlusion (SAO) and 23 large-artery athero...
Source: Aging - January 3, 2020 Category: Biomedical Science Authors: Ren Z, Chen X, Tang W, Li J, Yang S, Chen Y, Zhao X, Zong H, Liu C, Shen C Tags: Aging (Albany NY) Source Type: research
Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low: A retrospective study
The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA2DS2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA2DS2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA2DS2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF....
Source: Medicine - January 1, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
Biomarkers in the risk assessment for stroke and dementia in atrial fibrillation
Purpose of review Atrial fibrillation is one of the most common clinically encountered arrhythmias exhibiting a strong association with a spectrum of cerebral injuries from the occurrence of clinical stroke, subclinical stroke, dementia, and cognitive decline. Dynamic noninvasive specific and sensitive diagnostic tests may allow a personalized approach to the atrial fibrillation patient's treatment based upon quantitative parameters, aiming to prevent or delay stroke, dementia, progressive cognitive decline, or to assess responses to these therapies. This review will explore molecular markers that have been shown to have...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
d-dimer and diffusion-weighted imaging pattern as two diagnostic indicators for cancer-related stroke: A case–control study based on the STROBE guidelines
The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The d-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal ca...
Source: Medicine - January 1, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
HFpEF Is the Substrate for Stroke in Obesity and Diabetes Independent of Atrial Fibrillation
Publication date: January 2020Source: JACC: Heart Failure, Volume 8, Issue 1Author(s): Milton PackerAbstractBoth obesity and type 2 diabetes are important risk factors for the development of heart failure with a preserved ejection fraction (HFpEF), and both disorders increase the risk of systemic thromboembolic events. Traditionally, the risk of stroke has been explained by the strong association of these disorders with atrial fibrillation (AF). However, adiposity and diabetes are risk factors for systemic thromboembolism, even in the absence of AF, because both can lead to the development of an inflammatory and fibrotic a...
Source: JACC: Heart Failure - December 31, 2019 Category: Cardiology Source Type: research
Successful thrombolytic therapy with recombinant tissue plasminogen activator in ischemic stroke after idarucizumab administration for reversal of dabigatran: a case report
ConclusionsIntravenous thrombolytic therapy with recombinant tissue plasminogen activator after reversal of dabigatran with idarucizumab may be safe and feasible in patients with acute ischemic stroke with lacunar infarct. Furthermore, intravenous thrombolytic therapy with recombinant tissue plasminogen activator could be used in patients in emergency settings until just before the end of the recommended time limit within which it needs to be administered because of the immediate effect of idarucizumab.
Source: Journal of Medical Case Reports - December 26, 2019 Category: General Medicine Source Type: research
Increased platelet procoagulant potential predicts recurrent stroke and TIA after lacunar infarction.
CONCLUSIONS: Identification of increased platelet procoagulant potential may improve our ability to identify patients at higher risk of recurrent stroke/TIA following a lacunar stroke. Further study of mechanisms involved is warranted and may yield novel targets for prevention and treatment. PMID: 31858724 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - December 19, 2019 Category: Hematology Authors: Kirkpatrick AC, Vincent AS, Dale GL, Prodan CI Tags: J Thromb Haemost Source Type: research
von Willebrand Factor and Platelet Glycoprotein Ib: A Thromboinflammatory Axis in Stroke
von Willebrand factor (VWF) and platelets are key mediators of normal hemostasis. At sites of vascular injury, VWF recruits platelets via binding to the platelet receptor glycoprotein Ibα (GPIbα). Over the past decades, it has become clear that many hemostatic factors, including VWF and platelets, are also involved in inflammatory processes, forming intriguing links between hemostasis, thrombosis, and inflammation. The so-called “thrombo-inflammatory” nature of the VWF-platelet axis becomes increasingly recognized in different cardiovascular pathologies, making it a potential therapeutic target to interfere with both...
Source: Frontiers in Immunology - December 17, 2019 Category: Allergy & Immunology Source Type: research
Applications of Nanotechnology in the Diagnosis and Therapy of Stroke
Semin Thromb Hemost DOI: 10.1055/s-0039-3399568Stroke is a leading cause of death and disability worldwide. The classification of stroke subtypes is difficult but critical for the prediction of clinical course and patient management, and limited treatment options are available. There is an urgent need for improvements in both diagnosis and therapy. Strokes have rapidly evolving phases of damage involving unique compartments of the brain, which imposes severe limitations for current diagnostic and treatment procedures. The rapid development of nanotechnology in other areas of modern medicine has ignited a widespread interes...
Source: Seminars in Thrombosis and Hemostasis - December 13, 2019 Category: Hematology Authors: Landowski, Lila M. Niego, Be'eri Sutherland, Brad A. Hagemeyer, Christoph E. Howells, David W. Tags: Review Article Source Type: research
mtDNA Copy Number Contributes to All-Cause Mortality of Lacunar Infarct in a Chinese Prospective Stroke Population
AbstractThe study aimed to investigate the relationship between mtDNA copy number and the risk of all-cause mortality in stroke. One thousand four hundred eighty-four stroke patients were documented including 273 deaths (127 thrombosis, 52 lacunar, 94 hemorrhage). Patients in the third quartile had the lowest mortality rates in overall stroke and the three subtypes. The lowest quartile of mtDNA copy number (Q1< 85.85) indicated an increased risk of all-cause mortality in stroke patients (adjusted HR, 1.52; 95% CI, 1.08–2.14;p = 0.017). In the subtype analysis, the risk of all-cause mortality appeared only in la...
Source: Journal of Cardiovascular Translational Research - December 11, 2019 Category: Cardiology Source Type: research
Endovascular Treatment of Acute Ischemic Stroke
AbstractPurpose of reviewEndovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke.Recent findingsThe indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6 –24 h after last-known-well, and improved device and operator proficiency allowing treat...
Source: Current Treatment Options in Cardiovascular Medicine - December 11, 2019 Category: Cardiology Source Type: research
Direct tumor embolism presenting as an acute ischemic stroke
Direct tumor embolism is a rare cause of AIS. Histopathologic analysis of the thrombus is required to confirm the diagnosis. Mechanical thrombectomy is a potentially safe and efficacious treatment.
Source: Neurology Clinical Practice - December 9, 2019 Category: Neurology Authors: Lemus, H. N., Lu, C., Shoirah, H., Shigematsu, T., Liang, J., Van Denakker, T., Boniece, I., Skliut, M. Tags: All Cerebrovascular disease/Stroke, Embolism, Infarction Case Source Type: research
Bilateral anterior cerebral artery infarction presenting with acute paraparesis and parkinsonism
In patients with acute-onset paraparesis inferior, the concurrent presence of new onset cortical signs (abulia or mutism), and more rarely extrapyramidal signs, should alert clinicians to consider acute anterior bihemispheric ischemia. Prompt recognition of this rare form of acute cerebral stroke can enable timely delivering of acute thrombolytic or endovascular treatment.
Source: Neurology Clinical Practice - December 9, 2019 Category: Neurology Authors: Forsberg, J., Blaabjerg, M., Diaz, A., Gaist, T. A., Christensen, A., Gaist, D. Tags: All Imaging, All Clinical Neurology, Clinical neurology examination, Parkinson's disease/Parkinsonism, All Cerebrovascular disease/Stroke Case Source Type: research
Left Atrial Appendage Occlusion in the Management of Stroke in Patients With Atrial Fibrillation
Atrial fibrillation (AF) is associated with a substantially higher risk of thromboembolism, particularly stroke events, resulting in significant morbidity and mortality. Oral anticoagulation (OAC), while effective in reducing embolic events in AF patients, is associated with an increased bleeding risk. Thus, not all patients with AF are candidates for OAC and some are only candidates for OAC in the short term. Of the available nonpharmacologic strategies for the management of AF, left atrial appendage occlusion (LAAO) has emerged as a potential approach for reducing the risk of systemic thromboembolism in AF patients eligi...
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Causal Associations Between Serum Bilirubin Levels and Decreased Stroke Risk: A Two-Sample Mendelian Randomization Study.
CONCLUSIONS: Our findings provide evidence of significant causal relationship between high levels of bilirubin and decreased stroke risk in Korean population in agreement with observational approaches. This highlights the potential for bilirubin to serve as a therapeutic target for oxidative stress-related diseases such as stroke and suggests that previous findings were not a consequence of unmeasured confounding. PMID: 31801373 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - December 5, 2019 Category: Cardiology Authors: Choi Y, Lee SJ, Spiller W, Jung KJ, Lee JY, Kimm H, Back JH, Lee S, Jee SH Tags: Arterioscler Thromb Vasc Biol Source Type: research
Cryptogenic Stroke: Diagnostic Workup and Management
AbstractPurpose of reviewCryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic – and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes – the concept of embolic stroke of undetermined source (ESUS) (Hart et al. Lancet ...
Source: Current Treatment Options in Cardiovascular Medicine - December 3, 2019 Category: Cardiology Source Type: research
Subtype-Dependent Reporting of Stroke With SGLT2 Inhibitors: Implications From a Japanese Pharmacovigilance Study.
Abstract Volume depletion as an adverse events (AE) caused by sodium-glucose cotransporter-2 inhibitors (SGLT2i) because of their diuretic effect may raise the concern about the risk of lacunar stroke; however, an earlier meta-analysis reported no significant increase in the incidence of stroke without clearly distinguishing stroke subtypes. Here, aiming to investigate subtype-wise reporting of stroke potentially related to SGLT2i treatment, we conducted a disproportionality analysis using the Japanese Adverse Drug Event Report database, which contains approximately 500 000 cases recorded between April 2004 and M...
Source: The Journal of Clinical Pharmacology - December 2, 2019 Category: Drugs & Pharmacology Authors: Sato K, Mano T, Iwata A, Toda T Tags: J Clin Pharmacol Source Type: research
Multiple Administrations of Intravenous Thrombolytic Therapy to a Stroke Mimic
Patients who present emergently with focal neurological deficits concerning for acute ischemic stroke can be extremely challenging to diagnose and treat. Unnecessary administration of thrombolytics to potential stroke patients whose symptoms are not caused by an acute ischemic stroke —stroke mimics—may result in patient harm, although the overall risk of hemorrhagic complications among stroke mimics is low.
Source: The Journal of Emergency Medicine - December 2, 2019 Category: Emergency Medicine Authors: Ava L. Liberman, Daniel Antoniello, Steven Tversky, Michael G. Fara, Cen Zhang, Lindsey Gurin, Sara K. Rostanski Tags: Clinical Communications: Adult Source Type: research
An unusual cause of acute ischemic stroke: Adult Onset Still ’s Disease
We present a case where acute ischemic stroke secondary to a floating internal carotid artery thrombus was an early manifestation of AOSD. The patient also had prolonged high spiking fevers, sign ificant leucocytosis, arthralgias and transaminitis. He responded well to a high dose of oral corticosteroids and was eventually started on anticoagulation for secondary stroke prevention. To our knowledge, this is the first described case of arterial thrombosis associated with AOSD. We postulate th at thrombocytosis, vasculitis and hypercoagulability from the underlying inflammatory state may have contributed to the ischemic stroke.
Source: Journal of Thrombosis and Thrombolysis - December 2, 2019 Category: Hematology Source Type: research
Genetic Polymorphisms Associated with Thrombotic Disease Comparison of Two Territories: Myocardial Infarction and Ischemic Stroke.
Conclusions: The Thr325Ile polymorphism, but no Ala147Thr polymorphism, represents an independent risk factor for STEMI in the young Mexican population. PMID: 31781299 [PubMed - in process]
Source: Disease Markers - November 30, 2019 Category: Laboratory Medicine Tags: Dis Markers Source Type: research
ST-elevation myocardial infarction, pulmonary embolism, and cerebral ischemic stroke in a patient with critically low levels of natural anticoagulants
Publication date: Available online 22 November 2019Source: Journal of Cardiology CasesAuthor(s): Elena Vladimirovna Reznik, Ekaterina Sergeevna Shcherbakova, Svetlana Vasilievna Borisovskaya, Yurij Valerevich Gavrilov, Tatyana Mikhailovna Pajeva, Sergey Vladislavovich Lepkov, Aleksej Borisovich Mironkov, Eliso Murmanovna Dzhobava, Igor Gennadievich NikitinAbstractThis clinical case report describes the simultaneous development of an acute myocardial infarction, stroke, and a massive pulmonary thromboembolism in a 44-year-old patient — a carrier of the thrombophilia gene polymorphisms: MTHFR C677T, А1298C, PAI-1 4G/5G, I...
Source: Journal of Cardiology Cases - November 23, 2019 Category: Cardiology Source Type: research
Rosiglitazone ameliorates tissue plasminogen activator-induced brain hemorrhage after stroke.
CONCLUSIONS: RSG treatment protects against BBB damage and ameliorates HT in delayed tPA-treated stroke mice by activating PPAR-γ and favoring microglial polarization toward anti-inflammatory phenotype. PMID: 31756041 [PubMed - as supplied by publisher]
Source: CNS Neuroscience and Therapeutics - November 22, 2019 Category: Neuroscience Authors: Li Y, Zhu ZY, Lu BW, Huang TT, Zhang YM, Zhou NY, Xuan W, Chen ZA, Wen DX, Yu WF, Li PY Tags: CNS Neurosci Ther Source Type: research
Real-world Comparisons of Direct Oral Anticoagulants for Stroke Prevention in Asian Patients with Non-valvular Atrial Fibrillation: a Systematic Review and Meta-analysis
ConclusionsThe meta-analysis shows that the DOACs had greater effectiveness and safety compared to warfarin in real-world practice for stroke prevention, among Asian patients with NVAF.
Source: Cardiovascular Drugs and Therapy - November 19, 2019 Category: Cardiology Source Type: research
Modified diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score including deep white matter lesions predicts symptomatic intracerebral hemorrhage following intravenous thrombolysis
AbstractThe Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used for the assessment of early ischemic changes (EICs) before thrombolysis. However, for symptomatic intracerebral hemorrhage (sICH) following intravenous recombinant tissue plasminogen activator (rt-PA), the prediction abilities of CT-ASPECTS, diffusion-weighted imaging (DWI)-ASPECTS, and DWI-ASPECTS including EICs in deep white matter (DWI-ASPECTS + W) are unclear. We investigated associations between each score and sICH following intravenous rt-PA. Data from consecutive patients who received intravenous rt-PA for acute ischemic...
Source: Journal of Thrombosis and Thrombolysis - November 19, 2019 Category: Hematology Source Type: research
Older age and duration of exposure to type 2 diabetes in selective screening of asymptomatic carotid artery stenosis for primary stroke prevention —A single institution experience
Carotid artery disease is a well-known cause of stroke. In Malaysia, stroke is the third most common cause of death . To our knowledge, there is still limited information regarding stroke and its associated risk factors. Strokes from ischemic infarction of the brain is due to narrowing or occlusion from local thrombosis or embolization of a proximal thrombus. The incidence of ischemic stroke from carotid artery stenosis in an asymptomatic western population is approximately 2.7% according to a report from Netherlands by Hartog et al.
Source: Primary Care Diabetes - November 17, 2019 Category: Primary Care Authors: Lenny Suryani Safri, Henry Tan Chor Lip, M. Iqbal Saripan, Tan Jih Huei, K. Krishna, Mohamad Azim Md Idris, Hanafiah Harunarashid Tags: Original research Source Type: research
Cost-effectiveness of warfarin care bundles and novel oral anticoagulants for stroke prevention in patients with atrial fibrillation in Thailand
Novel oral anticoagulants (NOACs) and warfarin care bundles (e.g. genotyping, patient self-testing or self-management) are alternatives to usual warfarin care for stroke prevention in patients with atrial fibrillation (AF). We aim to evaluate the cost-effectiveness of NOACs and warfarin care bundles in patients with AF in a middle-income country, Thailand.
Source: Thrombosis Research - November 15, 2019 Category: Hematology Authors: Siok Shen Ng, Surakit Nathisuwan, Arintaya Phrommintikul, Nathorn Chaiyakunapruk Tags: Full Length Article Source Type: research
Identification of genetic risk factors associated with ischaemic stroke in young Mexican patients
ConclusionThe polymorphisms Glu298Asp and C677T, affecting the eNOS and 5,10-MTHFR enzymes, respectively, and smoking, hypertension, and family history of stroke were associated with ischaemic stroke in young Mexican patients; this was not the case for the Thr325Ile, Ala147Thr, 4 G/5 G, and PLA1/A2 polymorphisms of the genes coding for fibrinolytic proteins and platelet receptors.ResumenIntroducciónDiversos polimorfismos en genes candidatos que codifican proteínas del sistema hemostático se han propuesto como factores de riesgo para el desarrollo de trombosis.MétodosCasos y controles, sobrevivientes de enferm...
Source: Neurologia - November 11, 2019 Category: Neurology Source Type: research
A Case of Wallenberg's Syndrome Presenting with Spontaneous Thrombosis of a Vertebral Artery Aneurysm
Complete spontaneous thrombosis of intracranial aneurysms is uncommon. Although this type of thrombosis is largely asymptomatic, in rare cases it can be accompanied by parent artery occlusion and ischemic stroke. There are limited reports of complete thrombosis of an unruptured aneurysm of the internal carotid artery and middle cerebral artery. Furthermore, there are no reports of occlusion of the vertebral artery caused by thrombosis of an aneurysm. The mechanisms of spontaneous thrombosis are not established.
Source: Journal of Stroke and Cerebrovascular Diseases - November 11, 2019 Category: Neurology Authors: Misaki Kamogawa, Takashi Koide, Ryogo Kikuchi, Akiyoshi Nakamura, Asako Tagawa, Hiromichi Miyazaki Tags: Case Report Source Type: research
Dual energy CT in the management of antiplatelet therapy in patients with acute ischemic stroke for carotid obstruction.
CONCLUSIONS: DE-CT may contribute to select antiplatelet regimen after acute carotid stenting in tandem occlusions. PMID: 31684785 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - November 9, 2019 Category: Radiology Tags: Interv Neuroradiol Source Type: research
HFpEF Is the Substrate for Stroke in Obesity and Diabetes Independent of Atrial Fibrillation
Publication date: Available online 6 November 2019Source: JACC: Heart FailureAuthor(s): Milton PackerAbstractBoth obesity and type 2 diabetes are important risk factors for the development of heart failure with a preserved ejection fraction (HFpEF), and both disorders increase the risk of systemic thromboembolic events. Traditionally, the risk of stroke has been explained by the strong association of these disorders with atrial fibrillation (AF). However, adiposity and diabetes are risk factors for systemic thromboembolism, even in the absence of AF, because both can lead to the development of an inflammatory and fibrotic ...
Source: JACC: Heart Failure - November 8, 2019 Category: Cardiology Source Type: research
Timing of Initiation of Oral Anticoagulation after Acute Ischemic Stroke in Patients with Atrial Fibrillation
AbstractPatients with atrial fibrillation (AF) who suffer an acute ischemic stroke are at risk for both hemorrhagic transformation and recurrent ischemic stroke in the acute post ‐stroke period. Oral anticoagulants are recommended for secondary stroke prevention in patients with AF. The optimal time to initiate anticoagulant therapy after acute ischemic stroke in patients with AF is uncertain. There is concern that early initiation increases the risk of hemorrhagic transfo rmation, whereas delayed initiation leaves the patient at risk for recurrent ischemic stroke. In this article, we provide a review of the risk of hemo...
Source: Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy - November 7, 2019 Category: Drugs & Pharmacology Authors: Maureen A. Smythe, Dennis Parker, Candice L. Garwood, Adam Cuker, Steve R. Mess é Tags: REVIEW OF THERAPEUTICS Source Type: research