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Acute Secondary Prevention of Ischemic Stroke: Overlooked No Longer
Recent studies of interventions initiated acutely following onset of minor ischemic stroke or transient ischemic attack (TIA) have disclosed early stroke recurrence rates that are substantially higher than long-term recurrence rates and that can be reduced by acute antiplatelet treatment interventions. These observations, bolstered by analysis based on kinetic modeling of the time course of recurrence following initial events, suggest that acute stroke patients experience an underlying vulnerable state that quickly transitions to a more stable state. Some evidence also supports the benefits of early treatment with direct-a...
Source: Frontiers in Neurology - September 10, 2021 Category: Neurology Source Type: research

Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study
Conclusion: A high technical success rate of IVBS stenting could be achieved, and the safety was acceptable, whereas Mori C lesions were more vulnerable to endovascular procedure and showed a higher rate of complications than A and B types.
Source: Frontiers in Neurology - February 16, 2021 Category: Neurology Source Type: research

Prestroke statin use enhances collateralization in acute ischemic stroke patients.
CONCLUSIONS: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim. PMID: 32925118 [PubMed - as supplied by publisher]
Source: Restorative Neurology and Neuroscience - September 16, 2020 Category: Neurology Tags: Restor Neurol Neurosci Source Type: research

Acute ischemic stroke management in Lebanon: obstacles and solutions.
This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The pati...
Source: Functional Neurology - May 27, 2020 Category: Neurology Tags: Funct Neurol Source Type: research

Temporal Trends and Predictors of Drug Utilization and Outcomes in First-Ever Stroke Patients: A Population-Based Study Using the Singapore Stroke Registry
ConclusionsPrescription of secondary stroke preventive medications (particularly in ischemic stroke) was associated with more favorable outcomes, highlighting the importance of physician adherence to evidence-based pharmacotherapy.
Source: CNS Drugs - July 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

Ultra-early Institution of Statin Treatment is Associated with Improved Outcomes Among Acute Ischemic Stroke Patients Receiving Thrombolytic Treatment (P5.150)
Conclusions:Ultra-early institution of statin treatment in acute ischemic stroke patients treated with IV rt-PA with or without endovascular treatment was associated with improved outcome at both 3 and 12 monthsDisclosure: Dr. Saleem has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Saleem, M., Qureshi, A. Tags: Clinical Neuro-rehabilitation Source Type: research

Ischemic stroke in a patient with Parry-Romberg syndrome (P4.064)
Conclusions:The only other reported patient with PRS and stroke was also found to have a PFO. It is possible that the elevated ANA seen in this patient correlates with propensity towards small venous clots not seen on ultrasound. This may lead to paradoxical emboli and ischemic strokes. It is important to note this potential association between PRS and ischemic stroke in young patients without other known risk factors. It would be worthwhile to treat this subset of patients with medications for secondary stroke prevention.Disclosure: Dr. Ebiana has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Khosa has nothi...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Ebiana, V., Singh, S., Khosa, S., Moheb, N., Trikamji, B., Rao, N., Mishra, S. Tags: General Neurology: Vascular Neurology Source Type: research

The effect of statin use in acute ischemic stroke patients treated with thrombolytic therapy
This study investigated the effects of statins for the acute ischemic stroke patients after thrombolysis on the stroke outcome considering statin intensity and time window.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Jong-Moo Park, Tae Kyoung Kim, Eui Sung Jung, Kyusik Kang, Woung-Woo Lee, Jungju Lee, Ohyun Kwon, Byung-Kun Kim Source Type: research

Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation
We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cereb...
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Zacharia, G., Shani, D., Ortiz, R. A. Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research

Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study Clinical Sciences
Conclusions— AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Hayden, D. T., Hannon, N., Callaly, E., Ni Chroinin, D., Horgan, G., Kyne, L., Duggan, J., Dolan, E., O'Rourke, K., Williams, D., Murphy, S., Kelly, P. J. Tags: Cerebrovascular Disease/Stroke Clinical Sciences Source Type: research

Does hospitalist directed care reduce the length of stay for acute ischemic stroke patients and improve adherence to the "Get with the Guidelines" inpatient quality measures? (P5.153)
CONCLUSIONS: There is a significant improvement in adherence to the GWTG-ISPM when an AIS patient is admitted under the care of a hospitalist. Prospective databases are recommended to evaluate if this leads to better long-term outcomes.Disclosure: Dr. Tekle has nothing to disclose. Dr. Hassan has nothing to disclose. Dr. Sanchez has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Abantao has nothing to disclose. Dr. Sanchez has nothing to disclose. Dr. Jones-Fillingum has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Tekle, W., Hassan, A., Sanchez, C., Malik, A., Abantao, E., Sanchez, O., Jones-Fillingum, L., Qureshi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Quality Research and Initiatives Source Type: research

Statin Use and Brain Hemorrhage Real Risk or Unfounded Fear?
The relationship between statin use and intracerebral hemorrhage (ICH) has not been definitively established. Studies show both benefit and detriment. Statins may decrease the level of platelet aggregation and thrombogenesis and thus worsen an ICH, but they also modulate the immune system, inhibit the inflammatory process, and improve cerebral blood flow, promoting neuroprotection and tissue recovery. Despite physiological and clinical evidence on both sides of the argument, the idea that statins should be avoided whenever brain hemorrhage is involved has permeated stroke practice. Indeed, early and more recent epidemiolog...
Source: JAMA Neurology - November 1, 2014 Category: Neurology Source Type: research

Demographic and Clinical Predictors of Leptomeningeal Collaterals in Stroke Patients
Background: Leptomeningeal collaterals improve outcome after stroke, including reduction of hemorrhagic complications after thrombolytic or endovascular therapy, smaller infarct size, and reduction in symptoms at follow-up evaluation. The purpose of this study was to determine the demographic and clinical variables that are associated with a greater degree of cerebral collaterals.Methods: Clinical data of patients presenting with M1 occlusions of the middle cerebral artery (MCA) and associated computed tomography angiography studies after admission from 3 separate institutions were retrospectively compiled (n = 82). Occl...
Source: Journal of Stroke and Cerebrovascular Diseases - August 4, 2014 Category: Neurology Authors: Nitin Malik, Qinghua Hou, Achala Vagal, James Patrie, Wenjun Xin, Patrik Michel, Ashraf Eskandari, Tudor Jovin, Max Wintermark Tags: Original Articles Source Type: research

Stroke in Patients With Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study Clinical Sciences
Conclusions— In patients with aortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA2DS2-VASc score were the major predictors of stroke. Incident stroke was strongly associated with mortality. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
Source: Stroke - June 23, 2014 Category: Neurology Authors: Greve, A. M., Dalsgaard, M., Bang, C. N., Egstrup, K., Ray, S., Boman, K., Rossebo, A. B., Gohlke-Baerwolf, C., Devereux, R. B., Kober, L., Wachtell, K. Tags: Thrombosis risk factors, CV surgery: valvular disease, Acute Cerebral Infarction Clinical Sciences Source Type: research

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