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Protocol for Cerebral Microbleeds During the Non–Vitamin K Antagonist Oral Anticoagulants or Warfarin Therapy in Stroke Patients With Nonvalvular Atrial Fibrillation (CMB-NOW) Study: Multisite Pilot Trial
Anticoagulants are widely used to prevent recurrence of ischemic stroke in patients with nonvalvular atrial fibrillation, but in some patients, they also cause bleeding, particularly intracranial hemorrhage. One of the independent predictors of intracerebral hemorrhage is the presence of cerebral microbleeds (CMBs); a high incidence of intracerebral hemorrhage is reported in warfarin-treated patients with multiple CMBs. Longitudinal study suggested that the presence of CMBs at baseline is a predictor of new CMBs in warfarin-treated patients.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2015 Category: Neurology Authors: Shunya Takizawa, Fumiaki Tanaka, Kazutoshi Nishiyama, Yasuhiro Hasegawa, Eiichiro Nagata, Atsushi Mizuma, Sachiko Yutani, Taira Nakayama, Hiroyuki Kobayashi, Noriharu Yanagimachi, Takashi Okazaki, Kazuo Kitagawa, CMB-NOW Study Investigators Source Type: research

Ruptured Cerebral Microaneurysm Diagnosed by 3-Dimensional Fast Spin-Echo T1 Imaging with Variable Flip Angles
Cerebral microaneurysms, which are 2 mm or small in size, are a rare cause of subarachnoid hemorrhage (SAH). The authors present 2 cases with ruptured microaneurysms, in which 3-dimensional (3D) fast spin-echo T1 imaging with variable flip angles (CUBE T1) using gadolinium-diethylenetriaminepentaacetic acid (Gd) enhancement was useful in diagnosing the microaneurysms as the source of bleeding. Case 1 was a 61-year-old woman who had an SAH localized to the left Sylvian fissure. A small bulge (1.4 mm) at the bifurcation of left middle cerebral artery (MCA), which was detected by 3D angiography, was well enhanced by CUBE T1...
Source: Journal of Stroke and Cerebrovascular Diseases - May 23, 2015 Category: Neurology Authors: Hidenori Endo, Kuniyasu Niizuma, Miki Fujimura, Kenichi Sato, Takashi Inoue, Shin-ichiro Osawa, Teiji Tominaga Tags: Case Report Source Type: research

Fatal Intraperitoneal Bleeding after Intravenous Administration of Tissue Plasminogen Activator
We report a case of acute ischemic stroke, which developed fatal intraperitoneal bleeding after intravenous administration of alteplase. An 86-year-old woman developed acute infarction of the right middle cerebral artery during admission for chronic heart failure. Two days before the stroke, liver biopsy was performed; the result was benign. Although rivaroxaban was prescribed for atrial fibrillation, the rivaroxaban had been discontinued for liver biopsy until the time when she developed the stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - April 18, 2015 Category: Neurology Authors: Chise Anan, Masahiro Oomura, Tomoaki Saeki, Toshimasa Ikeda, Chikako Sato, Kentaro Yamada Tags: Case Report Source Type: research

Rupture of an Aneurysm of the Superior Cerebellar Artery Feeding a Dural Arteriovenous Fistula
We experienced a very rare case of bleeding from an aneurysm of a branch of the superior cerebellar artery, which feeds a dural arteriovenous fistula (DAVF) of the posterior fossa. The aneurysm was not detected on initial angiography and 2 episodes of rebleeding resulted in deterioration of the patient's condition. Although rare, aneurysms of the pial feeding arteries should be considered as a cause of bleeding in cases of DAVF.
Source: Journal of Stroke and Cerebrovascular Diseases - March 24, 2015 Category: Neurology Authors: Shinya Kohyama, Fumitaka Yamane, Hideaki Ishihara, Nahoko Uemiya, Shoichiro Ishihara Tags: Case Report Source Type: research

Cerebral Amyloid Angiopathy Causing Large Contralateral Hemorrhage During Surgery for Lobar Hemorrhage: A Case Report
We report a rare case of cerebral amyloid angiopathy (CAA) causing large contralateral hemorrhage during surgery for lobar hemorrhage. A 62-year-old woman presented with lobar hemorrhage in the left frontal and parietal lobes recurring over the previous 1 month. Because we could not detect the origin of the lobar hemorrhage, we performed a biopsy around the lobar hemorrhage site with the removal of a hematoma. During the surgery, we identified acute brain swelling without bleeding from the operative field.
Source: Journal of Stroke and Cerebrovascular Diseases - January 16, 2015 Category: Neurology Authors: Hidetaka Arishima, Hiroyuki Neishi, Toshiaki Kodera, Ryuhei Kitai, Ken-ichiro Kikuta Tags: Case Report Source Type: research

Acquired Hemophilia A Associated with Internal Border-zone Infarction Triggered by Major Hemorrhage of Thigh and Leg: A Case Report
We describe a first case of internal border-zone infarction (I-BZI) complicated with acquired hemophilia A. A 79-year-old man was introduced from other hospital by cerebral infarction and severe anemia. His left thigh and leg were swollen with subcutaneous bleeding. Activated partial thromboplastin time was 99.4 seconds. Factor VIII activity was less than 1% and Factor VIII inhibitor concentration was 85 BU, respectively.
Source: Journal of Stroke and Cerebrovascular Diseases - October 10, 2014 Category: Neurology Authors: Masayuki Miyazaki, Shuuhei Nagami, Hisao Shimizu, Nobuyuki Takahashi Tags: Case Report Source Type: research

Subdural and Intracerebral Hemorrhage Caused by Spontaneous Bleeding in the Middle Meningeal Artery after Coil Embolization of a Cerebral Aneurysm
Nontraumatic acute subdural hemorrhage (SDH) with intracerebral hemorrhage (ICH) is rare and is usually caused by severe bleeding from aneurysms or arteriovenous fistulas. We encountered a very rare case of spontaneous bleeding from the middle meningeal artery (MMA), which caused hemorrhage in the temporal lobe and subdural space 2 weeks after coil embolization of an ipsilateral, unruptured internal cerebral artery aneurysm in the cavernous portion. At onset, the distribution of hematoma on a computed tomography scan led us to believe that the treated intracavernous aneurysm could bleed into the intradural space. Emergenc...
Source: Journal of Stroke and Cerebrovascular Diseases - August 18, 2014 Category: Neurology Authors: Shinya Kohyama, Yoshiaki Kakehi, Fumitaka Yamane, Hidetoshi Ooigawa, Hiroki Kurita, Shoichiro Ishihara Tags: Case Reports Source Type: research

Aortic Transgraft Hemorrhage after Intravenous Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke
Conclusions: Our analysis provides reassurance regarding the risk of IV tPA therapy in patients undergoing aortic graft replacement.
Source: Journal of Stroke and Cerebrovascular Diseases - August 4, 2014 Category: Neurology Authors: Tomohiro Kawano, Katsufumi Kajimoto, Masahiro Higashi, Kenji Minatoya, Kazunori Toyoda, Kazuyuki Nagatsuka Tags: Original Articles Source Type: research

Elevated International Normalized Ratio as a Manifestation of Post-thrombolytic Coagulopathy in Acute Ischemic Stroke
Conclusions: We report an under-recognized early transient coagulopathy associated with elevated INR in stroke patients after treatment with tPA.
Source: Journal of Stroke and Cerebrovascular Diseases - July 30, 2014 Category: Neurology Authors: Vivien H. Lee, James J. Conners, Shawna Cutting, Sarah Y. Song, Richard A. Bernstein, Shyam Prabhakaran Tags: Original Articles Source Type: research

Safety of Standard-dose (.9-mg/kg) Alteplase Intravenous Thrombolysis for Acute Ischemic Stroke in Afro–Caribbeans, French West Indies
Conclusions: The excess hemorrhagic risk after standard-dose alteplase infusion into older Afro–Caribbean patients warrants further study to determine the possible role of cerebral microangiopathy and should be evaluated in different black populations.
Source: Journal of Stroke and Cerebrovascular Diseases - June 23, 2014 Category: Neurology Authors: Nicolas Chausson, Stéphane Olindo, Julien Joux, Martine Saint-Vil, Mathieu Aveillan, Didier Smadja Tags: Original Articles Source Type: research

The Roles and Issues of P2Y12 Percent Inhibition Assessed by VerifyNow Assay for Patients Undergoing Neurointervention: A Prospective Study
Conclusions: Optimal threshold, measured using the VerifyNow P2Y12 assay, can be identified using specific thresholds (26% 
Source: Journal of Stroke and Cerebrovascular Diseases - June 23, 2014 Category: Neurology Authors: Daina Kashiwazaki, Naoya Kuwayama, Naoki Akioka, Yumiko Hayakawa, Satoshi Kuroda Tags: Original Articles Source Type: research

The Effects of Citicoline on Acute Ischemic Stroke: A Review
Early reopening of the occluded artery is, thus, important in ischemic stroke, and it has been calculated that 2 million neurons die every minute in an ischemic stroke if no effective therapy is given; therefore, “Time is Brain.” In massive hemispheric infarction and edema, surgical decompression lowers the risk of death or severe disability defined as a modified Rankin Scale score greater than 4 in selected patients. The majority, around 80%-85% of all ischemic stroke victims, does not fulfill the criteria for revascularization therapy, and also for these patients, there is no effective acute therapy. Also there is no...
Source: Journal of Stroke and Cerebrovascular Diseases - April 15, 2014 Category: Neurology Authors: Karsten Overgaard Tags: Review Articles Source Type: research

Tranexamic Acid for Spontaneous Intracerebral Hemorrhage: A Randomized Controlled Pilot Trial (ISRCTN50867461)
Background: Spontaneous intracerebral hemorrhage (ICH) can be devastating, particularly if hematoma expansion (HE) occurs. Tranexamic acid (TA), an antifibrinolytic drug, significantly reduced mortality in bleeding patients after trauma in the large CRASH-2 trial. The CRASH-2 ICH substudy found that TA nonsignificantly reduced mortality and dependency in traumatic ICH. The aim of this study was to assess the feasibility of performing a randomized controlled trial of tranexamic acid in spontaneous ICH, ahead of a definitive study.Methods: We performed a single-center, prospective, randomized (2:1), double-blind, placebo-co...
Source: Journal of Stroke and Cerebrovascular Diseases - March 31, 2014 Category: Neurology Authors: Nikola Sprigg, Cheryl J. Renton, Robert A. Dineen, Yune Kwong, Philip M.W. Bath Tags: Original Articles Source Type: research

Safety Evaluation of Substituting Clopidogrel for Ticlopidine in Japanese Patients with Ischemic Stroke—Hiroshima Ticlopidine, Clopidogrel Safe Exchange Trial
Conclusions: The adverse event rates after the substitution of ticlopidine for clopidogrel is similar to the adverse event rates of patients who were initially treated with clopidogrel. The substitution of clopidogrel for ticlopidine should be considered for patients who develop hematologic abnormalities from ticlopidine treatment.
Source: Journal of Stroke and Cerebrovascular Diseases - February 21, 2014 Category: Neurology Authors: Tatsuo Kohriyama, Chie Mihara, Takakazu Yokoyama, Tsuyoshi Torii, Atsuo Yamada, Kazuhiro Takamatsu, Taisei Ota, Kouichi Noda, Satoshi Kataoka, Hijiri Ito, Eiichi Nomura, Toshiho Ohtsuki, Shiro Aoki, Tomohisa Nezu, Ikuko Takeda, Tomoya Mukai, Naohisa Hosom Tags: Original Articles Source Type: research

Spatial Relationship between Cerebral Microbleeds, Moyamoya Vessels, and Hematoma in Moyamoya Disease
Conclusions: Spatial relationship was demonstrated between the moyamoya vessels and perivascular hemosiderin deposition particularly around the subependymal–leptomeningeal anastomosis, suggesting the mechanism for the development of cMBs in MMD. Present study further supports previous findings that cMBs potentially serve as a marker for the bleeding-prone microangiopathy in MMD. The significance of the present study lies in selecting optimal surgical candidate for preventing future hemorrhage by the presence of the cMBs, whereas current surgical indication relying on the degree of ischemia frequently fails to detect pati...
Source: Journal of Stroke and Cerebrovascular Diseases - February 19, 2014 Category: Neurology Authors: Ken Kazumata, Daisuke Shinbo, Masaki Ito, Hideo Shichinohe, Satoshi Kuroda, Naoki Nakayama, Kiyohiro Houkin Tags: Original Articles Source Type: research

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