Query: stroke

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Source: JAMA Neurology
Condition: Disability

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Total 13 results found since Jan 2013.

Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy
Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS). With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiab...
Source: JAMA Neurology - December 9, 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

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

Treatment of Poststroke Aphasia With Transcranial Direct Current Stimulation
Stroke remains a leading cause of human disability. Important gains have been realized in the setting of acute ischemic stroke, where thrombolytic and catheter-based reperfusion therapies can substantially improve long-term behavioral outcomes. However, most patients with a new stroke are not eligible for such therapies because of delays in diagnosis or hemorrhagic etiology, for example, and many who are treated nonetheless have substantial long-term disability. Additional classes of poststroke therapy are needed.
Source: JAMA Neurology - August 20, 2018 Category: Neurology Source Type: research

Considerations in Assessing Disability Trajectories
To the Editor We thank Dhamoon et al for their prospective longitudinal cohort study assessing the long-term disability trajectory before and after an ischemic stroke compared with myocardial infarction (MI). The authors found that the gradient of increasing disability was significantly steeper after a stroke but remained consistent after MI.
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

Considerations in Assessing Disability Trajectories —Reply
In Reply We agree with Pan et al that endovascular thrombectomy for large vessel occlusions may improve long-term disability trajectories for those who receive this treatment. However, few patients with ischemic stroke currently receive this treatment, and it is not certain how much of an association endovascular thrombectomy will have with long-term disability trajectories for patients with ischemic stroke as a whole. It is certainly hoped that more trained specialists are available to provide the treatment, more capable stroke centers will be developed, and more patients will present within an amenable time window. Howev...
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

Disability Trajectories Before and After Stroke and Myocardial Infarction
This population-based cohort study evaluates the long-term effects of stroke on functional ability in patients before and after stroke compared with before and after myocardial infarction.
Source: JAMA Neurology - October 23, 2017 Category: Neurology Source Type: research

Phenotypic Destiny in Mitochondrial Disease?
Mitochondrial diseases are a group of heterogeneous disorders caused by inherited mutations in the mitochondrial genome (mtDNA) and nuclear genome. Typically, mutations in the mtDNA are maternally inherited and cause respiratory chain defects and account for a substantial fraction of childhood and adult neurometabolic disease, with an estimated prevalence of 1:5000 (0.02%). The most common mtDNA mutation is the mitochondrial 3243A>G mutation (m.3243A>G) in the MTTL1 gene (OMIM 590050), which encodes the transfer RNA tRNALeu(UUR). This mutation is associated with multiple clinical and psychiatric manifestations, including d...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Early Recurrent Stroke Prediction With the Recurrence Risk Estimator
Acute ischemic stroke is a medical emergency. Early reperfusion therapy can reduce functional disability, and early secondary prevention therapy can reduce early recurrent stroke. The rate of recurrent stroke in the first month is approximately 9.4% (95% CI, 6%-14%) among patients with ischemic stroke caused by large-artery atherosclerosis and approximately 1.2% (95% CI, 0.4%-3.0%) among patients with ischemic stroke caused by intracranial small vessel disease. Because some effective early prevention therapies may be risky or costly (eg, carotid revascularization or dual antiplatelet therapy) and some patients have a low r...
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Endovascular Therapy for Acute Ischemic Stroke
Patients with an occlusion of the distal internal carotid or proximal middle cerebral artery have among the most severe types of ischemic stroke that typically produce life-altering disabilities. Prior to a few months ago, the standard of care for such patients included intravenous (IV) alteplase and comprehensive peristroke care to avoid complications, including measures to prevent another stroke and comprehensive rehabilitation.
Source: JAMA Neurology - August 3, 2015 Category: Neurology Source Type: research

Prehospital Thrombolysis for Stroke An Idea Whose Golden Hour Has Arrived
Soon after thrombolytic therapy was established as a therapy for ischemic stroke, our colleague Anthony Furlan, MD, famously circulated a cartoon of a computed tomographic (CT) scanner visible through the back doors of an ambulance, where a happy stroke physician had hung a bottle dripping tissue plasminogen activator (tPA) into the scanned patient’s arm. Because the time interval from stroke onset to initiation of thrombolysis after ischemic stroke is inversely related to the probability of disability-free recovery, prehospital initiation of thrombolytic therapy seemed a compelling and logical ambition, if one could rul...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research