Query: stroke

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Source: JAMA Neurology

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Total 225 results found since Jan 2013.

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography
To the Editor In a secondary analysis of the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source trial, Healey and colleagues determined that for patients with embolic stroke of undetermined source and left atrial enlargement rivaroxaban treatment was associated with a 74% reduction in recurrent stroke. The authors suggest that left atrial enlargement could become a new determinant in secondary stroke prevention.
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

Prevention of Dementia —Thinking Beyond the Age and Amyloid Boxes
It is increasingly recognized that the declines in brain structure and function in persons with no clinical brain disease that we call brain aging and the 2 brain diseases that most frequently affect older adults (dementia and stroke) are the theoretically predictable consequences of a lifetime of injury that overcomes genetically and environmentally determined reserve and resilience, a concept encapsulated in the shorthand phrase life-course illness. Despite this insight, details of the various factors that adversely affect the brain health of older adults (and clarity on which times during life have the greatest effect a...
Source: JAMA Neurology - November 4, 2019 Category: Neurology Source Type: research

Association of Endovascular Treatment With Ischemic Stroke and Clinical Outcome in Pediatric Patients
This cohort study examines the use of endovascular recanalization in pediatric patients with arterial ischemic stroke and clinical outcomes.
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Endovascular Therapy for Childhood Stroke —Working Together to Reach Prime Time
The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset. The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disabili...
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Error in Figure
This article was corrected online.
Source: JAMA Neurology - September 30, 2019 Category: Neurology Source Type: research

Trends in Stroke Incidence Rates in Older US Adults
This cohort study evaluates whether stroke incidence declined among older adults from 1987 to 2011 vs 2011 to 2017 in the Atherosclerosis Risk in Communities study.
Source: JAMA Neurology - September 30, 2019 Category: Neurology Source Type: research

Benefits of MRI for Patients With Low-risk Transient or Persistent Minor Neurologic Deficits
More than 1 million patients receive a diagnosis of stroke or transient ischemic attack (TIA) in the United States each year. These patients are at increased risk of stroke during the first few weeks after the initial event, with the greatest risk during the first 2 days. Evidence-based secondary preventive measures are available to lower the risk of recurrent ischemic events, but for these measures to be effectively implemented, patients with stroke or TIA must be rapidly and correctly identified. Accurate diagnosis is important because some secondary preventive strategies carry risks of their own and are usually not appr...
Source: JAMA Neurology - September 23, 2019 Category: Neurology Source Type: research

Association Between Low-Dose Rivaroxaban With or Without Aspirin and Ischemic Stroke Subtypes
This secondary analysis of a multinational randomized clinical trial of 27  395 participants with systemic atherosclerotic disease examines the association low-dose rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone and the risk of different ischemic stroke subtypes.
Source: JAMA Neurology - September 16, 2019 Category: Neurology Source Type: research

Prehospital Stroke Management Optimized by the Use of Clinical Scoring vs Mobile Stroke Unit
This randomized clinical trial explores how prehospital management optimized by the use of the Los Angeles Motor Scale compares with prehospital management in a mobile stroke unit that includes vascular imaging in accurately triaging patients with stroke to the appropriate target hospital providing (comprehensive stroke center) or not providing (primary stroke center) neurointerventional treatment.
Source: JAMA Neurology - September 3, 2019 Category: Neurology Source Type: research

Safety and Efficacy of Dabigatran vs Warfarin After CVT
This randomized clinical trial conducted in 9 countries compares the use of dabigatran with warfarin in stroke prevention among patients who just experienced cerebral venous thrombosis.
Source: JAMA Neurology - September 3, 2019 Category: Neurology Source Type: research

Outcomes Associated With Clopidogrel-Aspirin Use in Minor Stroke or Transient Ischemic Attack
This pooled analysis combines data from 2 randomized clinical trials to estimate the efficacy and risk of dual antiplatelet therapy after minor ischemic stroke or transient ischemic attack.
Source: JAMA Neurology - August 19, 2019 Category: Neurology Source Type: research

Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke
This randomized clinical trial tests the hypothesis that targeting intensive blood pressure lowering of systolic and diastolic blood pressure less than 120 mm Hg and less than 80 mm Hg, respectively, reduces the rate of stroke recurrence compared with a standard blood pressure –lowering regimen.
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
This cohort assesses the clinical effectiveness of direct oral anticoagulants vs warfarin for stroke prevention in patients with atrial fibrillation.
Source: JAMA Neurology - July 22, 2019 Category: Neurology Source Type: research

Effect of Stroke Education Pamphlets vs a 12-Minute Culturally Tailored Stroke Film
This cluster randomized clinical trial of stroke preparedness among black and Hispanic churchgoers evaluates the effect of culturally tailored 12-minute stroke films on stroke preparedness vs the usual care practice of distributing stroke education pamphlets.
Source: JAMA Neurology - July 1, 2019 Category: Neurology Source Type: research

Efficacy of Home-Based Telerehabilitation In-Clinic Therapy After Stroke
This randomized clinical trial examines whether a treatment targeting arm movement delivered via a home-based telerehabilitation system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic setting for adults following stroke.
Source: JAMA Neurology - June 24, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Quality Improvement Intervention for Hospital Adherence to Therapies for Patients With Stroke
This cluster randomized clinical trial assesses the effect of a multifaceted quality improvement intervention compared with routine care on adherence to evidence-based therapy among patients with acute ischemic stroke and transient ischemic attack.
Source: JAMA Neurology - May 6, 2019 Category: Neurology Source Type: research

Tailoring the Approach to Embolic Stroke of Undetermined Source
This narrative review examines the existing evidence of the differing response of embolic stroke of undetermined source to anticoagulation therapy and hypothesizes about pathophysiological factors that may underlie such variations.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Recurrent Stroke With Rivaroxaban Compared With Aspirin
This secondary analysis of a randomized clinical trial investigates whether rivaroxaban is associated with a reduction in recurrent stroke among patients with embolic stroke of undetermined source who have an increased risk of atrial fibrillation.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Endovascular Thrombectomy as a Means to Improve Survival in Acute Ischemic Stroke
This meta-analysis examines 90-day mortality and 90-day intracranial hemorrhage reported in trials of endovascular thrombectomy vs medical therapy cited in the 2018 American Stroke Association/American Heart Association guidelines for acute ischemic stroke.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke
This validation study describes the development of a prognostic model to predict swallowing recovery and guide the decision for enteral tube feeding in people with dysphagia after ischemic stroke.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

ABCB1 Polymorphisms and Outcomes of Clopidogrel Treatment for Minor Stroke or Transient Ischemic Attack
This secondary analysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) randomized clinical trial investigates the association ofABCB1 polymorphisms with efficacy of clopidogrel plus aspirin vs aspirin alone in patients with minor stroke or transient ischemic attack.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

Pioglitazone Therapy in Patients With Stroke and Prediabetes
This post hoc analysis of Insulin Resistance Intervention After Stroke (IRIS) randomized clinical trial assesses the association of pioglitazone vs placebo with recurrent stroke, myocardial infarction, and other cardiovascular events.
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

Association of Time From Stroke Onset to Groin Puncture With Quality of Reperfusion After Mechanical Thrombectomy
This meta-analysis of individual patient data from 7 randomized clinical trials analyzes the rate of reperfusion after endovascular thrombectomy started at different intervals after symptom onset in patients with acute ischemic stroke.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

Clinical Care and In-Hospital Outcomes of Asian American Patients With Acute Ischemic Stroke
This analysis compares the characteristics, care, and outcomes of Asian American and white patients with acute ischemic stroke at hospitals participating in the Get With The Guidelines –Stroke program.
Source: JAMA Neurology - January 22, 2019 Category: Neurology Source Type: research

Hypothermia in Addition to Decompressive Hemicraniectomy in Malignant Middle Cerebral Artery Stroke
This randomized clinical trial assesses whether moderate hypothermia after early hemicraniectomy reduces mortality in patients with malignant MCA stroke, compared with standard treatment.
Source: JAMA Neurology - January 18, 2019 Category: Neurology Source Type: research

Follow-up Infarct Volume and Functional Outcome After Endovascular Therapy in Acute Ischemic Stroke
This pooled data analysis of 7 randomized clinical trials of thrombectomy for acute ischemic stroke examines whether follow-up infarct volume mediates the relationship between endovascular therapy and functional outcome in patients with acute ischemic stroke.
Source: JAMA Neurology - January 7, 2019 Category: Neurology Source Type: research

Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
This cohort study of 25  789 black and white individuals in the United States examines the incidence and risk factors for ischemic stroke by sex and race.
Source: JAMA Neurology - December 10, 2018 Category: Neurology Source Type: research

Effect of Cerebellar Stimulation on Gait and Balance Recovery in Patients With Hemiparetic Stroke
This randomized clinical trial determines whether cerebellar intermittent θ-burst stimulation can improve balance and gait functions in patients with hemiparesis due to stroke.
Source: JAMA Neurology - November 26, 2018 Category: Neurology Source Type: research

A Promising Skills-Based Intervention to Reduce Blood Pressure in Individuals With Stroke and Transient Ischemic Attack
Globally, stroke is the second leading cause of death and third leading cause of disability. More than 74% of the burden of stroke has been attributed to smoking, poor diet, and low physical activity, while more than 72% has been attributed to metabolic risk factors (high plasma glucose, high cholesterol, high blood pressure, overweight and obesity, and kidney disease). These are all risk factors that are modifiable with appropriate treatment or change in lifestyle behaviors.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Discharge Educational Strategies for Reduction of Vascular Risk in Stroke and Transient Ischemic Attack
This randomized clinical trial determines the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

A Promising Skills-Based Intervention to Reduce Blood Pressure in Individuals With Stroke and Transient Ischemic Attack
Globally, stroke is the second leading cause of death and third leading cause of disability. More than 74% of the burden of stroke has been attributed to smoking, poor diet, and low physical activity, while more than 72% has been attributed to metabolic risk factors (high plasma glucose, high cholesterol, high blood pressure, overweight and obesity, and kidney disease). These are all risk factors that are modifiable with appropriate treatment or change in lifestyle behaviors.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Discharge Educational Strategies for Reduction of Vascular Risk in Stroke and Transient Ischemic Attack
This randomized clinical trial determines the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack.
Source: JAMA Neurology - October 8, 2018 Category: Neurology Source Type: research

Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Modeling Stroke Patient Transport for All Suspected Large-Vessel Occlusion Patients
This modeling study examines strategies for optimal triage and transport of patients with suspected large-vessel occlusion stroke to the appropriate center to achieve optimal care.
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Association of Medication Nonadherence Among Survivors of Stroke After Affordable Care Act Implementation
This study investigates whether the US Affordable Care Act is associated with medication affordability and adherence among middle-aged to older adults who have had a stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Advances in Understanding the Pathophysiology of Lacunar Stroke
This narrative review of studies of cerebral small vessel disease published since 2012 investigates progress in understanding the pathogenesis, imaging characteristics, and genetic basis of lacunar stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Stroke Quality of Care in GWTG-Stroke Hospitals
This longitudinal cohort study compares quality of stroke care measures for patients admitted to hospitals participating and not participating in Get With The Guidelines –Stroke.
Source: JAMA Neurology - August 6, 2018 Category: Neurology Source Type: research

Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke
This exploratory analysis of 1690 patients enrolled in the Field Administration of Stroke Therapy-Magnesium Trial assesses the frequency, predictors, and outcomes of the neurological deterioration that occurs among patients during the ultra-early period after ischemic stroke or intracranial hemorrhage.
Source: JAMA Neurology - July 23, 2018 Category: Neurology Source Type: research

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke
To the Editor Simonsen et al concluded that general anesthesia (GA) did not influence infarct growth compared with conscious sedation in endovascular-treated patients with acute stroke. This is an interesting study that addresses topical questions. However, we would like to point out some limitations.
Source: JAMA Neurology - July 16, 2018 Category: Neurology Source Type: research

Presentation After TIA and Minor Stroke in Relation to the UK FAST Public Education Campaign
This population-based study investigates the association of public education with improving delays and failure in seeking medical attention among consecutive patients with first transient ischemic attack or stroke.
Source: JAMA Neurology - July 2, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke
To the Editor In his Viewpoint, Kamel addresses some issues with the randomized clinical trials (RCTs) of patent foramen ovale (PFO) closure for preventing recurrent stroke and urges a judicious and evidence-based approach for patient selection. I would like to point out additional factors that further demonstrate need for extreme caution in selecting patients to undergo this procedure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke —Reply
In Reply Powers raises several important issues that I did not address in detail in my Viewpoint about managing patent foramen ovale in patients with ischemic stroke. These additional points further highlight that many patients who are fully informed about the available data will reasonably choose medical therapy rather than patent foramen ovale closure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Association of Sickle Cell Trait With Ischemic Stroke Among African Americans
This meta-analysis examines whether sickle cell trait is associated with a higher risk of incident ischemic stroke among African Americans.
Source: JAMA Neurology - April 23, 2018 Category: Neurology Source Type: research

Dual Antiplatelet Therapy in Transient Ischemic Attack and Minor Stroke
This imaging substudy of a randomized clinical trial investigates whether infarction patterns can be used to stratify the risk of recurrent stroke within 3 months of a transient ischemic attack or minor ischemic stroke.
Source: JAMA Neurology - March 26, 2018 Category: Neurology Source Type: research

Keeping Faith With Patients After Stroke or Transient Ischemic Attack
I recently recommended statin therapy to a 68-year-old patient, explaining that it would reduce his risk of a major coronary event or stroke in the next 10 years from 18% to 15%. He asked, “But how will we know if it works?” I confessed we never would because success would be an uneventful walk through good health. He was not sold.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Care Quality for Veterans With Transient Ischemic Attack and Stroke
This cohort study assesses the quality of guideline-recommended transient ischemic attack and minor stroke care across the Veterans Health Administration system nationwide.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research