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Quiz case: a clinical reasoning challenge in the emergency stroke setting
AbstractA right-handed woman in her 80s was admitted to the emergency department 1 h after sudden-onset global aphasia and right-sided hemiparesis. Medical history included arterial hypertension, dyslipidemia, hyperuricemia, aortic stenosis, osteoporosis, and recent pulmonary embolism. Medication consisted of apixaban, bisoprolol, hydrochlorothiazide, allopurinol, fenofibrate, and vitamin D. Vital parameters (blood pressure, heart rate, body temperature, oxygen saturation) and glycemia were all within normal range. Electrocardiogram showed a first-degree atrioventricular block. The patient was promptly transported to the e...
Source: Neurological Sciences - August 5, 2023 Category: Neurology Source Type: research

Dysarthria-Facial Paresis and Rostral Pontine Ischemic Stroke
We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical nuance to its presentation with a particularly clear imaging correlation. A 78-year-old, right-handed man with a past medical history of aortic stenosis presented after a transcatheter aortic valve replacement. Immediately postoperatively, no neurological deficits were noted. That evening, he described his speech as “drunken.” He was later noted to have a right lower facial droop in addition to the speech change. His speech exhibited labial, lingual, and (to...
Source: Case Reports in Neurology - March 10, 2022 Category: Neurology Source Type: research

Stroke Severity in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis
An assessment of the comparative incidence of fatal or disabling stroke may influence choice of intervention for patients with severe aortic stenosis. We explored whether transcatheter aortic valve implantation (TAVI) is associated with a lower incidence of fatal or disabling stroke, compared to surgical aortic valve replacement (SAVR).
Source: Journal of Stroke and Cerebrovascular Diseases - July 9, 2021 Category: Neurology Authors: P ádraig Synnott, Robert P Murphy, Conor Judge, Maria Costello, Catriona Reddin, Karen Dennehy, Elaine Loughlin, Andrew Smyth, Darren Mylotte, Martin J. O'Donnell, Michelle Canavan Source Type: research

Prevalence and Risk Factors of Silent Brain Infarction in Patients with Aortic Stenosis
Conclusion: These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA2DS2-VASc score and eGFR are useful for risk stratification.Cerebrovasc Dis Extra 2020;10:116 –123
Source: Cerebrovascular Diseases Extra - October 8, 2020 Category: Neurology Source Type: research

Cerebral Infarction after Transcatheter Aortic Valve Implantation in Japan: Retrospective Analysis at a Single High-Volume Center
Perioperative cerebral infarction is one of the concerning complications after transcatheter aortic valve implantation in patients with aortic stenosis. Several studies have reported on this complication; however, those included only Caucasians and analyzed a small number of cases. Here, we report on the characteristics and risk factors of symptomatic cerebral infarction after transcatheter aortic valve implantation in a single, high-volume center in Japan.
Source: Journal of Stroke and Cerebrovascular Diseases - October 30, 2019 Category: Neurology Authors: Takashi Iizuka, Koichi Oki, Kentaro Hayashida, Kazushi Minami, Yoshikane Izawa, Shinichi Takahashi, Hideyuki Shimizu, Keiichi Fukuda, Jin Nakahara Source Type: research

Intravenous Thrombolysis and Mechanical Thrombectomy in Patients with Stroke after TAVI: A Report of Two Cases
We describe 2 cases of patients with stroke after TAVI who received tPA therapy and mechanical thrombectomy.
Source: Journal of Stroke and Cerebrovascular Diseases - July 17, 2019 Category: Neurology Authors: Lucio D'Anna, Ozan Demir, Soma Banerjee, Iqbal Malik Tags: Case Report Source Type: research

Thrombectomy recovers an aortic wall fragment from middle cerebral artery immediately after TAVI
An 80-year-old woman underwent transcatheter aortic valve implantation (TAVI) using an Edward Sapien S3 device to treat symptomatic severe aortic stenosis, with a 0.8 cm2 aortic valve area.
Source: Neurology - May 29, 2016 Category: Neurology Authors: Wollenweber, F. A., Remi, J., Bauer, A., Theiss, H., Massberg, S., Patzig, M., Faber, C., Dieterich, M., Janssen, H. Tags: All Clinical Neurology, All Cerebrovascular disease/Stroke, Cardiac, Embolism, Infarction CLINICAL/SCIENTIFIC NOTES Source Type: research

Cerebral Ischemic Events Associated with Transcatheter Aortic Valve Replacement (TAVR): A Systematic Review (P2.275)
Conclusions: In comparison to SAVR, existing data indicates marginally higher incidence of stroke with TAVR during the peri-procedural period. Inconsistencies were noted in long term clinical outcomes including stroke/TIA incidence with TAVR. Future research should focus on patient selection, improvement in valve technology and procedural techniques to minimize the observed risk.Disclosure: Dr. Herial has nothing to disclose. Dr. Mohammad has nothing to disclose. Dr. Morad has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Herial, N., Mohammad, N., Morad, C., Qureshi, M., Qureshi, A. Tags: Cerebrovascular Disease and Interventional Neurology: PFO and Other Cardiac Disease Source Type: research

Stroke after Cardiac Valve Replacement: Distribution, Etiology, and Risk Factors (S47.002)
CONCLUSIONS: The principal mechanism of acute ischemic infarct on MRI after AVR is embolism. Prior white matter infarct and moderate-to-severe aortic arch atheroma are predictive of embolic infarct. ICA stenosis 蠅70[percnt] is a predictor of watershed infarct and these patients may benefit from higher intraoperative blood pressure goals.Disclosure: Dr. Massaro has nothing to disclose. Dr. Messe has received personal compensation for activities with GlaxoSmithKline as a consultant. Dr. Messe has received research support from WL Gore and GlaxoSmithKline. Dr. Acker has nothing to disclose. Dr. Kasner has nothing to di...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Massaro, A., Messe, S., Acker, M., Kasner, S., Torres, J., Fanning, M., Giovannetti, T., Ratcliffe, S., Bilello, M., Szeto, W., Bavaria, J., Hargrove III, W. C., Mohler III, E., Floyd, T. Tags: Cerebrovascular Disease and Interventional Neurology 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

Post-Surgical Cognitive Outcomes (S62.001)
CONCLUSIONS:Patients who undergo AVR demonstrate persistent cognitive decline characterized by diminished learning on tests of memory and language and related to perioperative clinical stroke. These findings underscore the importance of ischemic neurologic complications of surgery and the need for improved stroke prevention and treatment strategies.Study Supported by: R01HL084375 to T.F.F.Disclosure: Dr. Giovannetti has nothing to disclose. Dr. Fanning has nothing to disclose. Dr. Ratcliffe has nothing to disclose. Dr. Price has nothing to disclose. Dr. Messe has received personal compensation for activities with GlaxoSmit...
Source: Neurology - April 9, 2014 Category: Neurology Authors: Giovannetti, T., Fanning, M., Ratcliffe, S., Price, C., Messe, S., Selnes, O., Acker, M., Floyd, T., Szeto, W., Bavaria, J. Tags: Cerebrovascular Disease and Interventional Neurology: Cognitive and Behavioral Source Type: research