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Timing of Anticoagulant Re-Initiation following Intracerebral Hemorrhage in Mechanical Heart Valves: Survey of Neurosurgeons and Thrombosis Experts
While oral anticoagulation is universally recommended among patients with mechanical heart valves (MHVs) [1], there is limited evidence to guide clinicians in managing patients who suffer intracerebral hemorrhage (ICH), a feared complication of anticoagulant treatment estimated to occur at 2-3% per patient-year [2]. In particular, the timing of oral anticoagulant (OAC) re-initiation following stabilization of hemorrhage is challenged by the intricate need to balance the risks of valve thrombosis and ischemic stroke with those of recurrent bleeding.
Source: Clinical Neurology and Neurosurgery - January 13, 2017 Category: Neurosurgery Authors: Fahad AlKherayf, Yan Xu, Harrison Westwick, Ioana Doina Moldovan, Philip S. Wells Source Type: research

Thrombolytic Treatment to Stroke Mimic Patients via Telestroke
The safety of intravenous thrombolysis (IVT) use among patients presenting with conditions mimicking acute ischemic stroke (AIS) is well established [1]. Rates of patients with stroke mimics (SM) treated with IVT at community hospitals who follow a “drip-and-ship” paradigm is higher than rates found for those presenting to stroke centers [2]. The implementation of telestroke (TS) where neurologists are connected to hospitals in areas without on-site neurological expertise has been proven to be effective in the safe implementation of IVT [3 ].
Source: Clinical Neurology and Neurosurgery - December 13, 2016 Category: Neurosurgery Authors: Ganesh Asaithambi, Amy L. Castle, Michael A. Sperl, Jayashree Ravichandran, Aditi Gupta, Bridget M. Ho, Sandra K. Hanson Source Type: research

Is acute stress and plasminogen activator inhibitor polymorphism associated with acute ischemic stroke?
Identifying the cause of ischemic stroke (IS) in young adults is of major importance in preventing stroke recurrence. In most cases, IS is a multifactorial disease with genetic predisposition, whereas the inherited risk is likely to be multigenic. Alterations in thrombosis and fibrinolysis comprise important parts of stroke pathophysiology. Plasminogen activator inhibitor type-1 (PAI-1) is an important component of the coagulation system that is a strong inhibitor of fibrinolysis in the circulation.
Source: Clinical Neurology and Neurosurgery - November 28, 2015 Category: Neurosurgery Authors: Hasan Hüseyin Kozak, Ali Ulvi Uca, Mustafa Altaş Source Type: research

Use of Anti-platelet Agents after Traumatic Intracranial Hemorrhage
Anti-platelet therapies (APTs) are frequently utilized medications, and are commonly indicated in patients with traumatic intracranial hemorrhage (tICH). Although venous thromboembolism prophylaxis after tICH has been studied, no data exist to guide clinicians on when it is safe to initiate APTs [1]. Indications for APTs include ischemic stroke prevention after blunt cerebrovascular injury (BCVI), acute myocardial infarction treatment, and secondary prevention of heart attack and stroke [2–6].
Source: Clinical Neurology and Neurosurgery - November 28, 2015 Category: Neurosurgery Authors: Keith Kerr, Christopher Wilkerson, Scott Shepard, Alex Choi, Ryan Kitagawa Source Type: research

Antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage increases the risk for deep venous thrombosis: A case-control study
Aneurysmal subarachnoid hemorrhage (aSAH) is a unique form of hemorrhagic stroke caused by rupture of an intracranial aneurysm with an estimated incidence of 10 per 100,000 person-years. [1] Aneurysm re-rupture prior to treatment represents a major source of early morbidity and carries a mortality rate of up to 51%. [2] Efforts to reduce the likelihood of early re-rupture have focused on early intervention for treatment of the aneurysm and administration of antifibrinolytics. Early intervention, either through surgical clipping or endovascular embolization, has proven effective in reducing rates of re-rupture and represent...
Source: Clinical Neurology and Neurosurgery - September 10, 2015 Category: Neurosurgery Authors: Paul M. Foreman, Michelle Chua, Mark R. Harrigan, Winfield S. Fisher, R. Shane Tubbs, Mohammadali M. Shoja, Christoph J. Griessenauer Source Type: research

MRI Diagnosis of Dural Sinus - Cortical Venous Thrombosis: Immediate Post-contrast 3D GRE T1-weighted Imaging versus Unenhanced MR Venography and Conventional MR Sequences
Cerebral dural venous sinus (DVS) thrombosis is a relatively uncommon disorder when compared with other stroke etiologies. It occurs in three to four people per one million and is responsible for nearly 1-2% of strokes in young adults [1,2]. Its incidence is probably underestimated due to lack of noninvasive accurate imaging modalities and challenging interpretation of available MRI sequences [3,4]. Early diagnosis and treatment are crucial for accurate management. In untreated patients, DVS thrombosis can cause impaired consciousness, coma, and death.
Source: Clinical Neurology and Neurosurgery - April 22, 2015 Category: Neurosurgery Authors: Sebahattin Sari, Samet Verim, Salih Hamcan, Bilal Battal, Veysel Akgun, Hakan Akgun, Serhat Celikkanat, Mustafa Tasar Tags: Original Research Source Type: research

MRI diagnosis of dural sinus—Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences
Cerebral dural venous sinus (DVS) thrombosis is a relatively uncommon disorder when compared with other stroke etiologies. It occurs in three to four people per one million and is responsible for nearly 1–2% of strokes in young adults [1,2]. Its incidence is probably underestimated due to lack of noninvasive accurate imaging modalities and challenging interpretation of available MRI sequences [3,4]. Early diagnosis and treatment are crucial for accurate management. In untreated patients, DVS thrombosis can cause impaired consciousness, coma, and death.
Source: Clinical Neurology and Neurosurgery - April 22, 2015 Category: Neurosurgery Authors: Sebahattin Sari, Samet Verim, Salih Hamcan, Bilal Battal, Veysel Akgun, Hakan Akgun, Serhat Celikkanat, Mustafa Tasar Source Type: research

Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke
Thrombolytic therapy generally improves clinical outcome after acute ischemic stroke, but the decision to administer thrombolytics may be challenging because of hemorrhagic complications and poor response in some patients [1–4]. Many models for risk stratification of thrombolytic treatment have been developed to support the clinician in this complex decision-making process.
Source: Clinical Neurology and Neurosurgery - August 14, 2014 Category: Neurosurgery Authors: Robbert-Jan Van Hooff, Koenraad Nieboer, Ann De Smedt, Maarten Moens, Peter Paul De Deyn, Jacques De Keyser, Raf Brouns Source Type: research

Concurrent asymptomatic inflammatory aneurysm and ischemic stroke due to cysticercal arteritis
Neurocysticercosis (NCC) is recognized as an important public health problem in developing countries. Cysticercal arteritis (CA) may cause endothelial disruption, edema, thrombosis, and the formation of fusiform aneurysms due to a weakening of the vessel walls . Here, we report a case with concurrent asymptomatic internal carotid artery (ICA) inflammatory aneurysm and contralateral ischemic stroke due to CA.
Source: Clinical Neurology and Neurosurgery - November 11, 2013 Category: Neurosurgery Authors: Antonio Arauz, Francisco Ruiz-Navarro, Humberto Silos, Juan Camilo Vargas-González, Nayelli Arguelles-Morales, Marisela Reyes, Angélica Ruiz-Franco, Aleyda Rivera, Agnes Fleury Tags: Case reports Source Type: research

Cervical rib resulting in amaurosis fugax and stroke
We report a patient with right cervical rib causing amaurosis fugax which was followed by right middle cerebral artery territory stroke.
Source: Clinical Neurology and Neurosurgery - September 16, 2013 Category: Neurosurgery Authors: Jayantee Kalita, Pankaj Kumar, Usha Kant Misra Tags: Case reports Source Type: research

Thrombolytic therapy in total mismatch with severe stroke after acute MCA-occlusion and negative DWI
Total mismatch is a recently described magnetic resonance imaging (MRI) pattern in acute stroke patients with no signal changes in diffusion weighted images (DWI) and extensive hypoperfusion on perfusion weighted images (PWI). The prognostic value and importance for treatment decision based on this finding in MRI have recently been controversially discussed in patients with minor stroke . Here we report a case of a 98-year-old woman that presented with severe stroke and total mismatch in the left middle cerebral artery (MCA) territory in MRI scan and an occlusion of the proximal MCA (M1) in time-of flight MR angiography (T...
Source: Clinical Neurology and Neurosurgery - August 6, 2012 Category: Neurosurgery Authors: Lars Neeb, Frederik Geisler, Matthias Wendt, Andrea Rocco, Jochen B. Fiebach, Kersten Villringer Tags: Case reports Source Type: research