Query: stroke

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Source: JAMA Neurology

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Total 227 results found since Jan 2013.

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

Effects of Golden Hour Thrombolysis A Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) Substudy
ImportanceThe effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour.ObjectiveTo determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome.Design, Setting, and ParticipantsThe prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availabilit...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research

Implementing a Mobile Stroke Unit Program in the United States Why, How, and How Much?
Conclusions and RelevanceThe MSU strategy could dramatically transform the way acute stroke is managed in the United States. A prospective study evaluating the logistics, outcomes, and cost-effectiveness of this approach is needed and under way.
Source: JAMA Neurology - December 8, 2014 Category: Neurology Source Type: research

Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack Results from the Korean Transient Ischemic Attack Expression Registry
Conclusions and RelevanceImmediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research

Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis A Retrospective Analysis of the Get With the Guidelines–Stroke Registry
Conclusions and RelevanceMany patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.
Source: JAMA Neurology - February 2, 2015 Category: Neurology Source Type: research

Microbleeds, Mortality, and Stroke in Alzheimer Disease The MISTRAL Study
Conclusions and RelevanceIn patients with AD, the presence of nonlobar microbleeds was associated with an increased risk for cardiovascular events and cardiovascular mortality. Patients with lobar microbleeds had an increased risk for stroke and stroke-related mortality, indicating that these patients should be treated with the utmost care.
Source: JAMA Neurology - March 23, 2015 Category: Neurology Source Type: research

In-Hospital Stroke
There have been tremendous strides in standardization of the care for acute ischemic stroke since widespread use of thrombolytic therapy began almost 20 years ago. Efficacy is still limited by delayed presentation to the emergency department following stroke symptom onset, although this has also improved in that period with education of emergency medical services and the community at large. The real improvement lies in development of streamlined and standardized protocols for “code stroke,” so that thrombolysis rates of 20% are becoming typical and door-to-needle times are just as typically under 1 hour. These encourag...
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Care and Outcomes of Patients With In-Hospital Stroke
This prospective cohort study examines stroke care delivery and outcomes for patients with in-hospital vs community-onset stroke.
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Genetic Variants Associated With Risk of Ischemic Stroke
This genome-wide association study identifies 2 novel genes, PDE4DIP and ACOT4, that are associated with an increased risk for ischemic stroke.
Source: JAMA Neurology - May 11, 2015 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

Selection Criteria for Stroke Patients Likely to Benefit From Thrombectomy
This cohort study of patients with anterior circulation ischemic stroke compared outcomes after thrombectomy of patients classified as likely vs unlikely to benefit from the procedure based on clinical criteria and MRI findings.
Source: JAMA Neurology - November 2, 2015 Category: Neurology Source Type: research

Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke
This observational study using data from the Get With the Guidelines–Stroke registry investigates the risks and benefits associated with long-term antiplatelet therapy among adult patients with ischemic stroke who receive intravenous tissue plasminogen activator.
Source: JAMA Neurology - November 9, 2015 Category: Neurology Source Type: research

Definition and Implications of the Preventable Stroke
This study tests whether most patients with acute stroke exhibited some degree of stroke preventability.
Source: JAMA Neurology - December 7, 2015 Category: Neurology Source Type: research

Telemedicine in Prehospital Stroke Evaluation and Thrombolysis
This observational study tested whether telemedicine is reliable and remote physician presence adequate for acute stroke treatment using a mobile stroke treatment unit.
Source: JAMA Neurology - December 7, 2015 Category: Neurology Source Type: research

Effect of Hemodynamics on Stroke Risk
This longitudinal cohort study evaluates the risk for posterior circulation stroke in patients with symptomatic occlusive disease of the vertebrobasilar system.
Source: JAMA Neurology - December 21, 2015 Category: Neurology Source Type: research

Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke
This randomized clinical trial evaluates the influence of time from stroke onset to the start of treatment and from onset to reperfusion on the effect of intra-arterial treatment in a population of patients with acute ischemic stroke.
Source: JAMA Neurology - December 21, 2015 Category: Neurology Source Type: research

Recurrent Ischemic Stroke Factors in the SAMMPRIS Medical Group
This post hoc analysis of a randomized clinical trial aims to determine baseline features that were associated with a high rate of the primary end point in the medical arm of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.
Source: JAMA Neurology - January 4, 2016 Category: Neurology Source Type: research

Recombinant Tissue Plasminogen Activator Stroke Therapy
The results of recently completed clinical trials of acute ischemic stroke that report a clear and unequivocal benefit of stent-retriever devices used with intravenous recombinant tissue plasminogen activator (rtPA) vs rtPA alone are the second revolutionary therapeutic breakthrough in acute stroke care in the last 50 years. This breakthrough makes the case for a new standard of care for the treatment of acute ischemic stroke. When we look back at the controversy surrounding interventional acute stroke therapies after multiple trials of interventional treatment, most notably International Management of Stroke III (IMS III)...
Source: JAMA Neurology - January 25, 2016 Category: Neurology Source Type: research

Stent Retrievers for Acute Ischemic Stroke
This meta-analysis of randomized clinical trials aims to quantify the benefits and risks of using stent retrievers in addition to recombinant tissue plasminogen activator for the treatment of acute ischemic stroke.
Source: JAMA Neurology - January 25, 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

The Challenges of Stroke Prediction Scores
Transient ischemic attack (TIA) and stroke prediction scores have been a topic of both clinical and research interest for decades. The goal of these scores is to identify high-risk patients for both prognostic and clinical management purposes. There are several TIA and stroke prediction scores that aim to prognosticate recurrence or worsening of cerebrovascular events (CVEs). Some are purely clinical scales (eg, California, ABCD, ABCD2, and ABCD3), while others incorporate cerebral parenchyma and/or vascular imaging (eg, Clinical and Imaging-based Predictive model, Recurrence Risk Estimator at 90 Days, ABCDE+, ABCD-I, ABCD...
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

Imaging and Recurrent Cerebrovascular Events in Patients After Stroke
This cohort study seeks to determine predictors of early recurrent cerebrovascular events among patients with transient ischemic attacks and minor strokes and National Institutes of Health Stroke Scale scores of 0 to 3.
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

Symptomatic Intracerebral Hemorrhage After IV Thrombolysis in Acute Stroke
This meta-analysis investigates the association of high cerebral microbleed burden with the risk of symptomatic intracerebral hemorrhage in patients with acute ischemic stroke treated with intravenous thrombolysis.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Factors Affecting Preventability of Stroke
To the Editor Fisher and colleagues conducted an evaluation of factors affecting the preventability of stroke, with special reference to treatment and comorbidity. Preventability of the presenting stroke was scored and univariate analysis was selected for the limited number of patients. I have some queries on their study approach.
Source: JAMA Neurology - May 2, 2016 Category: Neurology Source Type: research

Precision Medicine for Ischemic Stroke
This Viewpoint discusses the future of precision medicine in the field of ischemic stroke, first looking at the current status of genetic approaches and then exploring the status of phenotype-based delineations.
Source: JAMA Neurology - May 2, 2016 Category: Neurology Source Type: research

Vital Sign and Glucose Abnormalities and Outcome in Childhood Stroke
Childhood stroke studies often cite differences in risk factors between adult and pediatric patients, namely that traditional adult stroke risk factors, such as hypertension and hyperglycemia, are not common causes of childhood stroke. In a study of 83 children from the United Kingdom, only 8 children (10%) with available blood pressure data at admission were classified as having hypertension. The authors stated that this could be an overestimate because follow-up blood pressure data were not available, but they acknowledged that elevated blood pressure could be important in some children. In a multinational cohort of 676 ...
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Blood Pressure, Blood Glucose, and Temperature After Childhood Stroke
This cohort study aims to determine the prevalence of abnormal blood pressure, blood glucose levels, and temperature in pediatric patients with acute arterial ischemic stroke and to explore any association between these measures and neurological outcome.
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Computed Tomography Perfusion and Diffusion-Weighted Imaging in Acute Stroke
To the Editor In JAMA Neurology, Rudilosso and colleagues presented 2 cases using computed tomography perfusion (CTP) and diffusion-weighted imaging (DWI). They suggested that CTP was superior to DWI in the identification of ischemic changes in acute stroke. In most patients, DWI findings appear positive within several minutes to several hours of the onset of acute cerebral infarction. Positive DWI findings depend on cytotoxic edema. The morphology of the brain maintains intact when cerebral blood flow is decreased to 30% of its normal level. If perfusion is returned to normal, no abnormality will be detected by DWI. When ...
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research

Instrument for Predicting Early Stroke Recurrence
To the Editor The Recurrence Risk Estimator has been put forward as a web-based prognostic score that integrates clinical and imaging information available in the acute setting to quantify early risk for recurrence of stroke. The validity of a prognostic score was examined in a multicenter study by Arsava et al, which aptly assessed the external validity and transferability of the Recurrence Risk Estimator. We would like to put forward the following fallacies we noted in this study.
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research

Stent Retrievers for Treating Anterior Circulation Acute Ischemic Stroke
To the Editor Touma et al reported a comprehensive systematic review and meta-analysis of 5 randomized clinical trials evaluating the benefits and risks of stent retrievers in addition to recombinant tissue plasminogen activator (rtPA) for the treatment of acute ischemic stroke (AIS). The main conclusion of the study was that “the use of stent retrievers in conjunction with rtPA vs rtPA alone is associated with significant improvement of functional independence 90 days after AIS.” However, as pointed out by the authors, all studies included in their meta-analysis selected only patients with anterior circulation acute i...
Source: JAMA Neurology - July 5, 2016 Category: Neurology Source Type: research

Recruiting Patients With Stroke Into Cell Therapy Trials
This review examines ethical issues surrounding the recruitment of patients with stroke into cell therapy studies.
Source: JAMA Neurology - July 18, 2016 Category: Neurology Source Type: research

Racial Differences in Utilization of Inpatient Procedures After Stroke
This study compares racial differences in the use of 6 common nondiagnostic inpatient procedures after stroke.
Source: JAMA Neurology - July 25, 2016 Category: Neurology Source Type: research

Factors Associated With Neurological Outcome After Childhood Stroke
To the Editor We thank Grelli et al for their study investigating the factors associated with neurological outcome following childhood stroke. The authors reported an association between hyperglycemia and poor neurological outcome in their cohort.
Source: JAMA Neurology - August 22, 2016 Category: Neurology Source Type: research

Neurologists and the Diagnosis of Acute Stroke in the ED
This Viewpoint proposes that acute stroke can be managed in the emergency department without the expertise of a neurologist.
Source: JAMA Neurology - September 6, 2016 Category: Neurology Source Type: research

Mechanical Thrombectomy for Stroke
The publication of 5 randomized trials in 2015 unequivocally established that mechanical thrombectomy is the new standard of care for patients with acute ischemic stroke and an occlusion of the proximal anterior circulation. Although those trials mark a huge advancement in the field of stroke, important questions regarding the implementation of mechanical thrombectomy in routine clinical care remain. One of the more important of these questions is what constitutes the definition of a proximal occlusion. In those trials, most of the patients had an occlusion of the distal internal carotid artery or of the first segment (M1)...
Source: JAMA Neurology - September 12, 2016 Category: Neurology Source Type: research

Endovascular Therapy for Acute Ischemic Stroke
This pooled cohort study evaluates the safety and effectiveness of endovascular therapy for occlusions of the M2 segment of the middle cerebral artery in patients with ischemic stroke.
Source: JAMA Neurology - September 12, 2016 Category: Neurology Source Type: research

Risk of Pregnancy-Associated Stroke Across Age Groups
This population-based cohort study uses data from the New York State SPARCS database to examine the risk of stroke in women of childbearing age who are pregnant or post partum compared with the risk in those who are not pregnant.
Source: JAMA Neurology - October 24, 2016 Category: Neurology Source Type: research

Lesion Size and Perspective in Acute Ischemic Stroke
The computed tomographic (CT) or magnetic resonance imaging (MRI) findings of early cerebral ischemia are literally, and figuratively, shades of gray in decision making regarding the triage of patients with acute ischemic stroke for revascularization. The subtleties and areas of uncertainty on imaging of this dynamic process, where an arterial occlusion is mitigated by collateral perfusion in the brain, defy concrete rules or thresholds that are equally consequential across individual patients. Imaging criteria, whether more than one-third of the middle cerebral artery territory, Alberta Stroke Program Early CT (ASPECT) sc...
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

Endovascular Treatment for Patients With Stroke and Large Ischemic Cores and Mismatch Imaging Profiles
This case-control study compares the outcomes of patients following stroke with large baseline ischemic cores on computed tomographic perfusion undergoing endovascular therapy with the outcomes of matched controls who had medical care alone.
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

Cardiovascular Risk Factors and Stroke in Alzheimer Disease
To the Editor I read with interest the article by Tosto et al studying the influence of cardiovascular risk factors and stroke in familial late-onset Alzheimer disease (LOAD). The main findings were that history of stroke increased the risk for LOAD, while hypertension decreased the risk for LOAD. The study suggests that stroke mediates the influence of cardiovascular risk factors on increased risk for LOAD.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Associations Between Sex-Specific Risk Factors and Stroke
This systematic review and meta-analysis examines sex-specific risk factors for ischemic stroke, hemorrhagic stroke, any stroke, and stroke mortality.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke
Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory –adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and their report appears in this issue ofJAMA Neurology. Given that 85% of the patients in mechanical thrombectomy (MT) trials received intravenous thrombolysis (IVT), they highlight an important group of patients in whom MT was successful without IVT. The recent IVT and MT trials have clearly established the new standard in therapy for...
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

Stroke Diagnosis and Treatment in the Emergency Department
To the Editor We are somewhat perplexed after having read the Viewpoint by Avasarala, as it questions the role of the neurologist in the emergency department for acute stroke diagnosis. Although it is clear that the author is being deliberately provocative, we can only strongly disagree with the idea that a sudden-onset focal neurological deficit may be diagnosed as a stroke on the basis of a pattern-recognition algorithm alone, without a neurological assessment.
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Stroke Diagnosis and Treatment in the Emergency Department —Reply
In Reply I thank Rota and colleagues for their comments on my Viewpoint, which challenged the status quo concerning the requirement of a neurologist to initiate the tissue plasminogen activator (tPA) protocol for an obvious diagnosis of acute stroke in the emergency department (ED). In today ’s world of Instagram, Facebook, and Twitter feeds, we all need to embrace change. A few years ago, for instance, no one knew what Altmetric represented. Today, all of us crave the statistics reported by Altmetric, which recognizes our work via the number of tweets and “cross-talk” across mult iple platforms. Funding, data collec...
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Recurrence of Posterior Circulation Childhood Arterial Ischemic Stroke
This cohort study investigates the incidence of the recurrence of childhood arterial ischemic stroke in the posterior and anterior circulations to determine if the risk differs between the 2 locations.
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research