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Managing uncertainty: Physicians' decision-making for stroke prevention for patients with atrial fibrillation and intracerebral haemorrhage
Conclusion Physicians described the process of deciding on stroke prevention in patients with AF post-ICH as 'challenging' due to considerable 'clinical equipoise'. Key factors that affected decision-making was patient comorbidities, functional status, and patient willingness to engage with oral anticoagulation therapy. Shared decision-making was believed to be beneficial, but physicians believed that the ultimate responsibility to decide on stroke prevention lay with the clinician.PMID:35253141 | DOI:10.1055/a-1789-4824
Source: Thrombosis and Haemostasis - March 7, 2022 Category: Hematology Authors: Elena Ivany Robyn Lotto Gregory Yh Lip Deirdre Lane Source Type: research

Imaging assessment of acute ischaemic stroke - a review of radiological methods.
Abstract Acute ischaemic stroke is the second largest cause of death worldwide and a cause of major physical and psychological morbidity. Current evidence based treatment includes intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), both requiring careful patient selection and to be administered as quickly as possible within a limited time window from symptom onset. Imaging plays a crucial role identifying patients who may benefit from MT or IVT whilst excluding those that maybe harmed. For IVT, imaging must as a minimum exclude haemorrhage, stroke mimics and provide an estimate of non-viable brain. Fo...
Source: The British Journal of Radiology - November 16, 2017 Category: Radiology Authors: Smith A, Rowland Hill C Tags: Br J Radiol Source Type: research

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study
This study is registered with ClinicalTrials.gov, number NCT02513316. Findings Between Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0�...
Source: The Lancet Neurology - May 16, 2018 Category: Neurology Source Type: research

Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice.
CONCLUSION: Automated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake. PMID: 30397015 [PubMed - as supplied by publisher]
Source: The British Journal of General Practice - November 5, 2018 Category: Primary Care Authors: Holt TA, Dalton AR, Kirkpatrick S, Hislop J, Marshall T, Fay M, Qureshi N, Lasserson DS, Kearley K, Mollison J, Yu LM, Fitzmaurice D, Hobbs FR Tags: Br J Gen Pract Source Type: research

Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs.
CONCLUSION: At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged. PMID: 32162310 [PubMed - as supplied by publisher]
Source: The British Journal of Surgery - March 11, 2020 Category: Surgery Authors: Poorthuis MHF, Bulbulia R, Morris DR, Pan H, Rothwell PM, Algra A, Becquemin JP, Bonati LH, Brott TG, Brown MM, Calvet D, Eckstein HH, Fraedrich G, Gregson J, Greving JP, Hendrikse J, Howard G, Jansen O, Mas JL, Lewis SC, de Borst GJ, Halliday A, Carotid Tags: Br J Surg Source Type: research

Study Documents Neurological, Psychiatric Complications From COVID-19
While previous studies and case reports have found that COVID-19 patients have experienced vascular and neurological problems, a newstudy inthe Lancet Psychiatry reports that patients are also showing symptoms of psychiatric disorders, including psychosis and depression.The study was the result of a collaborative effort of specialists in the United Kingdom to document COVID-19 complications.“To our knowledge, this is the first systematic, nationwide U.K. surveillance study of the breadth of acute complications of COVID-19 in the nervous system,” wrote Aravinthan Varatharaj, M.R.C.P., of University Hospital Southampton ...
Source: Psychiatr News - June 29, 2020 Category: Psychiatry Tags: Aravinthan Varatharaj brain hemorrhage brain inflammation cognition COVID-19 depression Lancet Psychiatry pain psychiatric disorders psychosis stroke United Kingdom weakness Source Type: research

What is the Price of the Potential for a Meaningful Recovery following Intracerebral Hemorrhage?
In this issue of the Journal of Stroke and Cerebrovascular Diseases, Vardanyan and colleagues report on the cost-utility of minimally invasive surgery (MIS) with thrombolysis for spontaneous intracerebral hemorrhage (ICH) from the perspective of the United Kingdom (UK) National Health Service (NHS)1 using data from the Minimally Invasive Surgery Plus Alteplase in Intracerebral Hemorrhage Evacuation (MISTIE III) trial2 and the UK Sentinel Stroke National Audit Programme (SSNAP).3 The economic evaluation revealed that the incremental cost-effectiveness ratio for MIS with thrombolysis fell significantly above the UK's Nationa...
Source: Journal of Stroke and Cerebrovascular Diseases - July 27, 2021 Category: Neurology Authors: Lourdes R. Carhuapoma, Avni Kapadia, Henry A. Glick, Daniel F. Hanley Source Type: research

ASPECT Score and Its Application to Vasospasm in Aneurysmal Subarachnoid Haemorrhage: a Case –Control Study
AbstractDelayed cerebral ischaemia (DCI) is a significant complication of aneurysmal subarachnoid haemorrhage (aSAH) and is strongly associated with poorer outcome. The Alberta Stroke Program Early Computer Tomography (ASPECT) score is an established scoring tool, used in acute ischaemic stroke, to quantify early ischaemic changes on CT head scans. We aim to identify if ASPECT scoring correlates with functional outcome in DCI following aSAH. Retrospective case –control study. Inclusion criteria: admission to the Department of Neurosurgery at Leeds Teaching Hospitals NHS Trust (a tertiary neurosurgical centre in the Unite...
Source: Translational Stroke Research - August 9, 2022 Category: Neurology Source Type: research

Predictors of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Clinical Sciences
Background and Purpose—The mortality and morbidity after aneurysmal subarachnoid hemorrhage has improved because of better diagnosis, early treatment to secure the aneurysm, and better management of disease-specific complications. With these improvements in care, it is not clear if the previously identified independent predictors of a negative outcome have changed. The aim of this study was to identify the independent predictors of an unfavorable outcome (Glasgow Outcome Score 1, 2, and 3) in aneurysmal subarachnoid hemorrhage patients.Methods—Univariate and multivariate analysis of prospectively collected data on pati...
Source: Stroke - October 23, 2017 Category: Neurology Authors: James P. Galea, Louise Dulhanty, Hiren C. Patel Tags: Cerebral Aneurysm, Cerebrovascular Disease/Stroke Original Contributions Source Type: research

Acupuncture inhibits mammalian target of rapamycin, promotes autophagy and attenuates neurological deficits in a rat model of hemorrhagic stroke
CONCLUSION: Acupuncture improved neurological deficits in a rat model of ICH, possibly by inhibiting the mTOR pathway and activating autophagy.PMID:34284645 | DOI:10.1177/09645284211028873
Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society - July 21, 2021 Category: Complementary Medicine Authors: Hao Liu Beng Zhang Xin-Wei Li Jia Du Pei-Pei Feng Chen Cheng Zhong-Hua Zhu Ke-Lang Lou Chen Ruan Chi Zhou Xiao-Wei Sun Source Type: research

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