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Source: JAMA Neurology
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Total 364 results found since Jan 2013.
Carotid Stenting—Why Treating an Artery May Not Treat the Patient
In this issue of JAMA Neurology, Jalbert and colleagues present the results of a detailed analysis of Centers for Medicare & Medicaid Services (CMS) administrative data on patients with carotid artery stenosis treated with carotid artery stenting. Their well-written manuscript and timely study included more than 22 000 patients treated and followed up between 2000 and 2009. They analyzed periprocedural complications (defined as stroke, transient ischemic attack [TIA], myocardial infarction [MI], and death within 30 days), as well as long-term stroke and mortality. Important variables that were analyzed included the degre...
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research
Risks of Epilepsy During Pregnancy
Epilepsy is a common disease that affects 1 in 26 individuals in their lifetime. According to a National Institute of Neurological Disorders and Stroke assessment, with 2 million affected individuals, epilepsy ranks only fourth to migraine, stroke, and Alzheimer disease in the prevalence of neurological disorders. Epilepsy affects more people than autism, amyotrophic lateral sclerosis, cerebral palsy, multiple sclerosis, and Parkinson disease combined. Approximately 0.3% to 0.5% of all pregnancies are among women with epilepsy (WWE). The risks during pregnancy in WWE have been uncertain.
Source: JAMA Neurology - July 6, 2015 Category: Neurology Source Type: research
Thrombolysis-Related Hemorrhage
Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%. Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent...
Source: JAMA Neurology - October 26, 2015 Category: Neurology Source Type: research
MELAS Syndrome Presenting in the Late 40s
A man in his 50s presented with a 5-year history of stepwise loss of executive and somato-sensory functions in relation to what was interpreted as 2 previous stroke episodes; he was diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes.
Source: JAMA Neurology - March 7, 2016 Category: Neurology Source Type: research
Cerebral Microbleeds and Thrombolysis
Using intravenous thrombolysis in a stroke patient with cerebral microbleeds represents one of the most challenging clinical decisions in acute stroke neurology. In this setting, the implications of coexisting ischemic and hemorrhagic cerebrovascular disease (mixed cerebrovascular disease) must be confronted and urgently addressed. The clinical consequences of intervening or not intervening are profound.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research
The Dark Matter of Cerebral Microbleeds
To the Editor I read with interest the article by Tsivgoulis et al inJAMA Neurology on cerebral microbleeds (CMBs) and the risk for symptomatic intracerebral hemorrhage (ICH) after intravenous thrombolysis for acute stroke, as well as the accompanying Editorial by Fisher. This work follows and extends previous meta-analyses on a thorny topic for acute stroke neurology, demonstrating again that the presence of any number of CMBs on pretreatment magnetic resonance imaging is associated with more than doubling the risk for postthrombolysis ICH. Of importance, the authors provided new evidence from group-level and individual p...
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research
SSRIs and Intracranial Hemorrhage
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications in the United States. A recent study using the National Health and Nutrition Examination Survey database estimated that in 2012, 8.5% (95% CI, 6.9%-10.4%) of adults 20 years and older were prescribed SSRIs compared with a prevalence of 1.3% (95% CI, 1.0%-1.8%) for tricyclic antidepressants (TCAs). Although most of these prescriptions were likely for depression, SSRIs are being used for other indications; of particular interest to neurologists, SSRIs are being investigated and sometimes used to promote motor recovery after str...
Source: JAMA Neurology - December 5, 2016 Category: Neurology Source Type: research
Hypertension —A Global Neurological Problem
This Viewpoint discusses the gap in hypertension and stroke care between low-income countries and high-income countries and the role neurologists should play in stroke-prevention efforts.
Source: JAMA Neurology - February 6, 2017 Category: Neurology Source Type: research
Association Between Migraine and Cervical Artery Dissection
This cohort study examines the association between migraine and ischemic stroke due to cervical artery dissection in young patients with ischemic stroke.
Source: JAMA Neurology - March 6, 2017 Category: Neurology Source Type: research
What Is in a Match? —Reply
In Reply We appreciate the interest of Phan and Ma in our recent article. We agree that patients may behave differently according to their stroke laterality, and that nondominant hemisphere infarcts with larger volumes may present with relatively lower National Institutes of Health Stroke Scales (NIHSS) scores. However, Fink et al found that infarct volumes were greater on the right side as compared with the left only among patients presenting with mild strokes (NIHSS ≤ 5) with no significant right-left differences detected at higher NIHSS values. By contrast, our patient cohort was exclusively composed of patients ...
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research
Prevalence of Cardiovascular Risk Factors and Strokes in Younger Adults
This analysis of data from the National Inpatient Sample examines whether stroke hospitalization rates have continued to increase and identifies the prevalence of associated stroke risk factors among younger adults aged 18 to 54 years.
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research
Patient Care is All About Stories
“Doc, I think I’m getting my stroke back.” Neurologists and primary care physicians have heard this plaint many times from former patients who experienced a stroke. While writing this Editorial, I received an urgent email from the relative of a young patient who had had a left cerebral hemisph ere infarct several years ago. The email said the patient was having some intermittent weakness in his right foot for the last few days. He also had slight weakness on the right side of the face so he went to the emergency department (ED).
Source: JAMA Neurology - August 7, 2017 Category: Neurology Source Type: research
Infarct Progression in Patients During Mechanical Thrombectomy Transfer
This cohort study examines the clinical imaging factors associated with unfavorable imaging profile evolution for thrombectomy in patients with ischemic stroke initially transferred to non –thrombectomy-capable stroke centers.
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research
Errors in Abstract and Figures 2 and 3
This article was c orrected online.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research
Leaving Against Medical Advice
She was never even supposed to be in the hospital. We got a telephone call from an ophthalmologist who suspected a stroke in a woman in her early 70s after finding a visual field defect. She had gone to the clinic because she was bumping into objects for a few days, but she expected to do a few tests, get a diagnosis, and go home, because whatever was wrong did not even bother her much. Instead, she was treated to an admission to our stroke center and a nothing by mouth designation overnight after she failed the nurse ’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and phys...
Source: JAMA Neurology - February 26, 2018 Category: Neurology Source Type: research
