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Intravenous Thrombolysis in Posterior Circulation Stroke
Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset. Introduction History of Intravenous Thrombolysis—The Most Relevant Studies Intravenous...
Source: Frontiers in Neurology - April 25, 2019 Category: Neurology Source Type: research

Hemodynamic Characteristics Associated With Paraclinoid Aneurysm Recurrence in Patients After Embolization
Conclusions: High peak systolic WSS, OSI and velocity around aneurysm neck areas after embolization of paraclinoidal aneurysms may be important factors leading to recurrence. Introduction Paraclinoid aneurysms are defined as aneurysms arising from the segment of the internal carotid artery (ICA) between the distal dural ring and the origin of the posterior communicating artery. They account for approximately 1.3–5% of all intracranial aneurysms and they comprise the majority of such aneurysms in females (1–3). Hemodynamic characteristics are thought to be the most important risk factors for occurrence...
Source: Frontiers in Neurology - April 24, 2019 Category: Neurology Source Type: research

Associations of Anemia With Outcomes in Patients With Spontaneous Intracerebral Hemorrhage: A Meta-Analysis
Conclusions: Anemia on admission was associated with higher mortality and an increased risk of poor outcome in patients with ICH. However, the results were limited by the high heterogeneity of included studies. Prospective, multi-center or population-based, large sample cohort studies are needed in the future. Introduction Intracerebral hemorrhage (ICH) is the second most common cause of stroke and a highly lethal disease (1), which still lacks effective therapeutic interventions (2, 3). Although age, baseline ICH volume and neurological status on admission are well-known predictors of outcome of ICH (4), none of t...
Source: Frontiers in Neurology - April 24, 2019 Category: Neurology Source Type: research

A Novel Homozygous Non-sense Mutation in the Catalytic Domain of MTHFR Causes Severe 5,10-Methylenetetrahydrofolate Reductase Deficiency
Conclusion: We identified a novel non-sense mutation in MTHFR gene in a single Egyptian family with severe MTHFR deficiency. The present investigation is clinically important, as it adds to the growing list of MTHFR mutations, which might help in genetic counseling of families of affected children and proper genotype-phenotype correlation. Background Severe 5,10-Methylenetetrahydrofolate reductase (MTHFR; OMIM 236250) deficiency is a rare inborn error of metabolism and inherited in an autosomal recessive fashion. It is a very common disorder of folate metabolism and is clinically characterized with low plasma methion...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis
Conclusion Our data suggest that women who suffer from IS present with a poorer functional outcome than men at 3-months, regardless of other preclinical and clinical factors during the acute phase. These relationships seem to be mediated by atrial dysfunction and inflammation. The inflammatory response is slightly higher in women; however, there are no sex differences in their functional behavior. There is a probable relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, and the connection seems to be more important in cardioembolic stroke patients. In patients wi...
Source: Frontiers in Neurology - April 16, 2019 Category: Neurology Source Type: research

Frequency of Hemorrhage on Follow Up Imaging in Stroke Patients Treated With rt-PA Depending on Clinical Course
Conclusions: Frequency of hemorrhagic transformation in Routine follow-up brain imaging and consecutive changes in therapeutic management were different depending on clinical course measured by NHISS score. Introduction Brain imaging 24–36 h after systemic thrombolysis for acute ischemic stroke is recommended in American Stroke Association and European Stroke Organization guidelines (1, 2). Brain imaging is performed to detect secondary bleeding or hemorrhagic transformation in order to adapt medical stroke prevention if necessary. Guideline recommendations are based on the results of the first study on rt-PA...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Long-term Risk of Complications after Percutaneous Transcatheter Closure of Patent Foramen Ovale (S51.003)
Conclusions:Approximately 1 in 6 patients who undergo percutaneous transcatheter closure of PFO after stroke or transient ischemic attack experience a serious complication or death within 5 years.Study Supported by:Dr. Gialdini is supported by the Feil Family Foundation.Dr. Navi is supported by NIH grant K23NS091395 and the Florence Gould Endowment for Discovery in Stroke.Dr. Iadecola is supported by NIH grants R37NS089323-02, R01NS034179-21, R01NS037853-19, and R01 NS073666-04.Dr. Kamel is supported by NIH grants K23NS082367 and R01NS097443 as well as the Michael Goldberg Research Fund.Disclosure: Dr. Merkler has nothing ...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Merkler, A., Gialdini, G., Yaghi, S., Okin, P., Iadecola, C., Navi, B., Kamel, H. Tags: Cerebrovascular Disease and Interventional Neurology: Stroke Prevention and Translation Source Type: research

Beating the Clock: Time Delays to Thrombolytic Therapy with Advanced Imaging and Impact of Optimized Workflow
This study is to assess the time delay while using this scanner compared with our 64-slice scanner.
Source: Journal of Stroke and Cerebrovascular Diseases - April 20, 2015 Category: Neurology Authors: Santanu Chakraborty, James Ross, Mathew J. Hogan, Dar Dowlatshahi, Grant Stotts Source Type: research

Alpha 1-Antitrypsin Therapy Mitigated Ischemic Stroke Damage in Rats
Our objective is to develop a new therapy for the treatment of stroke. Currently, the only effective therapy for acute ischemic stroke is the thrombolytic agent recombinant tissue plasminogen activator. α1-Antitrypsin (AAT), a serine proteinase inhibitor with potent anti-inflammatory, anti-apoptotic, antimicrobial, and cytoprotective activities, could be beneficial in stroke. The goal of this study is to test whether AAT can improve ischemic stroke outcome in an established rat model. Middle cerebral artery occlusion was induced in male rats via intracranial (i.c.) microinjection of endothelin-1. Five to 10 minutes after...
Source: Journal of Stroke and Cerebrovascular Diseases - March 3, 2014 Category: Neurology Authors: Huong L. Moldthan, Aaron C. Hirko, Jeffrey S. Thinschmidt, Maria B. Grant, Zhimin Li, Joanna Peris, Yuanqing Lu, Ahmed S. Elshikha, Michael A. King, Jeffrey A. Hughes, Sihong Song Tags: Original Articles Source Type: research

Thrombolytic Utilization in Ischemic Stroke Is Significantly Higher in US Hospitals with Neurology Residency Program (S02.006)
CONCLUSIONS: Stroke care at NR hospitals is associated with an increased thrombolytic utilization rate. The increased tPA utilization at NR between 2002-2006 may be related to the rapid increase in Primary Stroke Centers across the country.Disclosure: Dr. Moradiya has nothing to disclose. Dr. Grant has nothing to disclose. Dr. Valsamis has nothing to disclose. Dr. Levine has received personal compensation in an editorical capacity for MEDLINK.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Moradiya, Y., Grant, J., Valsamis, H., Levine, S. Tags: S02 Acute Stroke Therapy Source Type: research

Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement in Middle Cerebral Artery Acute Ischemic Stroke and Stroke Laterality (P02.018)
CONCLUSIONS: Our study indicates that high NIHSS on admission, aspiration pneumonia and inability to undergo first swallow evaluation are independent predictors of PEG placement in patients with acute MCA strokes. This knowledge can be used for early identification of patients that require PEG tube placement to provide prompt nutritional support.Supported by: Hartford Hospital Research Center grant.Disclosure: Dr. San Luis has nothing to disclose. Dr. McCullough has received personal compensation for activities with Genentech, Inc. Dr. Ollenschleger has nothing to disclose. Dr. Staff has nothing to disclose. Dr. Fortunato ...
Source: Neurology - February 14, 2013 Category: Neurology Authors: San Luis, C., McCullough, L., Ollenschleger, M., Staff, I., Fortunato, G. Tags: P02 Cerebrovascular Disease II Source Type: research