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Value of routine echocardiography in the management of stroke.
Abstract BACKGROUND: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. METHODS: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondar...
Source: cmaj - August 5, 2019 Category: General Medicine Authors: Fralick M, Goldberg N, Rohailla S, Guo Y, Burke MJ, Lapointe-Shaw L, Kwan JL, Weinerman AS, Rawal S, Tang T, Razak F, Verma AA Tags: CMAJ Source Type: research

Propensity Score-Matched Analysis of Lesion Patterns in Stroke Patients With Patent Foramen Ovale and Patients With Spontaneous Intracranial Artery Dissection
Conclusion: The present study suggests that lesion patterns observed from DWI of patients with PFO and SIAD might provide clues to the etiology of infarcts. Single lesions (cortical or subcortical) might be a typical feature of PFO associated strokes, while multiple lesions in one vascular territory might be a specific feature of SIAD associated strokes. Introduction Both patent foramen ovale (PFO) and spontaneous intracranial artery dissection (SIAD) are important stroke risk factors, especially in young and middle-aged adults (1–3). About 25% of patients with ischemic stroke are cryptogenic (4), and PFO is ...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

Transcranial Doppler to detect right ‐to‐left shunt in cryptogenic acute ischemic stroke
ConclusionsTranscranial Doppler with “bubble test” appears as the best screening test for the detection of RLS in young and middle‐aged adults with cryptogenic acute cerebral ischemic events to select patients potentially suitable for closure procedure after TEE confirmation.
Source: Brain and Behavior - December 1, 2018 Category: Neurology Authors: Paola Palazzo, Pierre Ingrand, Pierre Agius, Rafik Belhadj Chaidi, Jean ‐Philippe Neau Tags: ORIGINAL RESEARCH Source Type: research

Non ‐obstructive carotid atherosclerosis and patent foramen ovale in young adults with cryptogenic stroke
ConclusionsThis study demonstrates that NOCA is common in young adults with CS. NOCA is negatively associated with PFO. Detecting NOCA is an important component of stroke investigation in young adults.
Source: European Journal of Neurology - February 28, 2017 Category: Neurology Authors: A. Jaffre, B. Guidolin, J. ‐B. Ruidavets, N. Nasr, V. Larrue Tags: Original Article Source Type: research

Cryptogenic Stroke: Making the Management Less Cryptic
Cryptogenic stroke (CS) accounts for 20% to 40% of ischemic strokes. CS is defined as a cortical infarct suggestive of an embolic stroke with no identifiable cardiac etiology, large vessel occlusive disease, or small vessel lacunar stroke. The likely etiologies for CS are patent foramen ovale (PFO) and paroxysmal atrial fibrillation, which can be detected by transesophageal echocardiography and long-term cardiac rhythm monitoring. In a busy academic hospital, the stroke service is frequently asked to provide a rational approach to patients with such a presentation. The 2011 American Heart Association/American Stroke Associ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Analysis of Inpatient Thrombophilia Testing for Adults with an Ischemic Stroke or Transient Ischemic Attack and its Impact on Clinical Management (P1.123)
Conclusions: Inpatient thrombophilia testing did not affect management in the vast majority of patients with an ischemic stroke or TIA despite a positive test result. Therefore, by avoiding inpatient testing, healthcare costs may be reduced without affecting patient care.Disclosure: Dr. Gavva has nothing to disclose. Dr. Alberts has received personal compensation for activities with AGA medical, AstraZeneca, Bayer, Pfizer, Bistol-Myers-Squibb, Boehringer Ingelheim, diaDexus, Genentech, KOS, Medicine Company, PDL biopharma, Pfizer, Photothera, Sanofi. Dr. Johnson has nothing to disclose. Dr. Sarode has received personal com...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Gavva, C., Alberts, M., Johnson, M., Sarode, R. Tags: Cerebrovascular Disease: Epidemiology Source Type: research

Autism in the Son of a Woman with Mitochondrial Myopathy and Dysautonomia: A Case Report
Conclusion Given emerging evidence that mitochondrial dysfunction, particularly in the electron transport chain needed for cellular energy production, is an underlying pathophysiological mechanism for some varieties of ASD, clinicians should have a high index of suspicion for mitochondrial disease, especially when they encounter a patient with unusual neurological or constitutional symptoms. The prevalence of mitochondrial disease in ASD patients may be as high as five percent, which means that it is not the “zebra”[27] diagnosis that it might be in a non-ASD patient, where prevalence is about 0.01 percent.10 Reference...
Source: Innovations in Clinical Neuroscience - October 9, 2015 Category: Neuroscience Authors: ICN Online Editor Tags: Anxiety Disorders Asperger's syndrome Autism Behavioral and Cognitive Neurology Case Report Current Issue Intellectual Disability Neurologic Systems and Symptoms Pervasive Developmental Disorders ASD autism spectrum disorder dysauton Source Type: research

Routine troponin measurements are unnecessary in acute ischemic stroke evaluations (P4.285)
CONCLUSIONS: Troponin elevation in patients with ischemic stroke is not caused by acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponins should be measured based on clinical context rather than routinely in all acute ischemic stroke patients.Disclosure: Dr. Ali has nothing to disclose. Dr. Young has nothing to disclose. Dr. Rabinstein has received royalty payments from Elsevier and Oxford University Press. Dr. Rabinstein has received research support from DJO Global. Dr. Flemming has nothing to disclose. Dr. Fugate has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Ali, F., Young, J., Rabinstein, A., Flemming, K., Fugate, J. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Ischemic Stroke Care Source Type: research

Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis
Conclusion: We demonstrate a relatively high prevalence of pelvic DVT among select CS patients emphasizing the importance of considering the pelvic veins as a potential source for emboli particularly in the presence of risk factors known to predispose DVT. Because patients were included at the treating physician's discretion, our results reflect ‘real-life' practice. Our results may be of clinical importance as inclusion of pelvic vein imaging in CS patients with PFO had impactful therapeutic and nosologic implications. Further study is needed to define patients most likely to benefit from pelvic vein imaging.Cerebrovasc Dis 2015;39:216-223
Source: Cerebrovascular Diseases - March 13, 2015 Category: Neurology Source Type: research

Utility of Pelvic MRV in Evaluation of Patients with Cryptogenic Stroke and PFO (P4.228)
CONCLUSIONS: Our data expands on prior study showing that pelvic MRV has the potential to identify a stroke source in patients with cryptogenic stroke, absent identifiable hypercoagulability state, and PFO.Disclosure: Dr. Osgood has nothing to disclose. Dr. Budman has nothing to disclose. Dr. Henninger has received personal compensation for activities with Brainsgate as a consultant.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Osgood, M., Budman, E., Henninger, N. Tags: Cerebrovascular Disease and Interventional Neurology: Cardiac Source Type: research