Query: stroke

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Source: JAMA Neurology

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Total 226 results found since Jan 2013.

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

Is Hyperselection of Patients the Right Strategy?
In 2019, intracerebral hemorrhage (ICH) remains the most devastating type of stroke, with a 30-day mortality rate of 40% and 60% of survivors who are dependent 1 year after ICH. Intracerebral hemorrhage volume is one of the main determinants of poor outcome, and the associated estimated risk of death or dependency increases of 5% for each millimeter of growth in the short-term phase. Up to one-third of ICHs enlarge during the first 24 hours, and the predicted probability of growth increases nonlinearly according to the ICH volume at admission, antithrombotic use, and the time window from symptom onset to imaging. Because o...
Source: JAMA Neurology - August 19, 2019 Category: Neurology Source Type: research

SELECTing Patients With Large Ischemic Core Who May Benefit From Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the clinical and radiologic outcomes in an observational cohort of 105 patients who had extensive ischemic changes on noncontrast computed tomographic (CT) scans (Alberta Stroke Program Early CT Scores [ASPECTS] of 0-5) or CT perfusion scans with ischemic core volume greater than 50 mL and who were treated within 24 hours of stroke onset with endovascular thrombectomy or medical management. All but 1 of the patients who received endovascular treatment and were included based on low ASPECTS had a score of 4 or 5. The ASPECTS regions are not volumetrically or functional...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Inclusivity of Diverse Patient Groups —Reply
In Reply We thank Reddy for his commendation of our report examining risk factors for incident stroke in black and white men and women in the US National Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. His comments align with our call for more epidemiologic studies to report sex-specific and race/ethnicity-specific research findings. Other epidemiologic studies, including the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study, examined sex differences in the association of risk factors with cardiovascular outcomes (but not stroke alone) in blacks and white individu...
Source: JAMA Neurology - June 3, 2019 Category: Neurology Source Type: research

Error in Author Byline
This article was corrected online.
Source: JAMA Neurology - May 28, 2019 Category: Neurology Source Type: research

Risk for Major Hemorrhages in Patients Receiving Clopidogrel and Aspirin Compared With Aspirin Alone
This secondary analysis of a randomized clinical trial examines the short-term risk of hemorrhage in treating patients in North America, Europe, and Australasia with acute transient ischemic attack or minor acute ischemic stroke with clopidogrel plus aspirin or aspirin alone.
Source: JAMA Neurology - April 29, 2019 Category: Neurology Source Type: research

Variations in Modeling for Treating Acute Stroke —Reply
In Reply We thank Maas et al for commenting on our recent article. We would like to emphasize that this modeling is intended to be a framework for prehospital decision making, particularly for systemwide planning. Our approach comes from the reality that transport decision making must be made with system and geographic context and the realization that there can never be randomized clinical trials of drip and ship vs mothership in all regions globally. The main advantage of a modeling approach is that these context-specific factors can be considered, entered into a model, and varied appropriately to ensure that the models r...
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Variations in Modeling for Treating All Patients With Stroke With Suspected Large Vessel Occlusion
To the Editor We read the article by Holodinsky et al, who reported the results of a modeling study to identify the optimal triage and transport strategy for patients suspected of having large-vessel occlusion, with interest.
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Thrombolysis Works in Lacunar Infarct, Complicating Imaging Selection
A new, exploratory analysis of the Efficacy and Safety of MRI-Based Thrombolysis in Wake-up Stroke (WAKE-UP) trial by Barow and colleagues in this issue ofJAMA Neurology provides unique and compelling data suggesting that thrombolysis improves clinical outcomes after acute lacunar infarction. The European Union –commissioned, 500-patient, randomized, double-blind, placebo-controlled WAKE-UP trial of alteplase captured the magnetic resonance imaging (MRI) and magnetic resonance angiography of patients with acute ischemic stroke prior to thrombolysis. This allowed categorization of infarcts as lacunar vs n onlacunar, using...
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Error in Discussion Section
This article was corrected online.
Source: JAMA Neurology - March 18, 2019 Category: Neurology Source Type: research

Antiplatelet Therapy vs Anticoagulation in Cervical Artery Dissection
This randomized clinical trial examines whether antiplatelent or anticoagulant therapy is more effective in preventing stroke in cervical dissection and the risk of recurrent stroke in a randomized clinical trial setting.
Source: JAMA Neurology - February 25, 2019 Category: Neurology Source Type: research

Errors in Multiple Sections
The Original Investigation, “Outcomes of Hypothermia in Addition to Decompressive Hemicraniectomy in Treatment of Malignant Middle Cerebral Artery Stroke: A Randomized Clinical Trial,” published online January 18, 2019, contained several errors. In the byline, an additional degree, MSc, was added after the name of Eric Jü ttler, MD. In the Results section, the phrase “enrolled in the trial between August 2011 and September 2016” has been edited to end with “September 2015”; enrollment ended in that month, although data collection continued for an additional year. In addition, the sentence “Cardiovascular an ...
Source: JAMA Neurology - February 25, 2019 Category: Neurology Source Type: research

Thrombectomy in Transferred Patients in the Late Window
This secondary analysis of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 trial evaluates whether the imaging-based selection criteria used in the trial would lead to comparable outcome rates and treatment benefits in transfer vs direct-admission patients with ischemic stroke.
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

Potential New Horizons for the Prevention of Cerebrovascular Diseases and Dementia
In this issue ofJAMA Neurology, Spence et al discuss the effect of pioglitazone, an insulin-sensitizing agent that has been shown to reduce the risk of recurrent stroke and myocardial infarction in patients with insulin resistance, in patients with prediabetes. Prediabetes was defined according to the American Diabetes Association criteria, ie, a hemoglobin A1c level of 5.7% to 6.4% or a fasting plasma glucose level of 100 to 125 mg/dL. Data were taken from the Insulin Resistance Intervention after Stroke (IRIS) study, an international randomized clinical trial performed in patients with previous stroke or transient ischem...
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

Association of Thrombectomy With Stroke Outcomes Among Patient Subgroups
This secondary analysis of a randomized clinical trial determines the association of thrombectomy among patients by age, symptom severity, time to randomization, arterial occlusive lesion location, and imaging modality.
Source: JAMA Neurology - January 28, 2019 Category: Neurology Source Type: research

Potential Benefits of Migraine —What Is It Good For?
Migraine is a painful neurological disease that causes substantial suffering for millions of people. Most individuals with migraine develop it when they are relatively young, and the condition persists for decades. Although migraine often improves with age, some individuals will continue to experience well into old age. Disease activity is highest in the otherwise productive middle years of life, with the result that the economic, social, and personal costs of migraine are out of proportion to its prevalence. As if this were not enough, migraine is associated with an increased risk of serious health conditions, including s...
Source: JAMA Neurology - December 17, 2018 Category: Neurology Source Type: research

Current Understanding and Gaps in Research of Carotid Webs in Ischemic Strokes
This narrative review addresses the current understanding of carotid webs as a modifiable risk factor for stroke.
Source: JAMA Neurology - November 5, 2018 Category: Neurology Source Type: research

Redundant Wording in Results and P Value Discrepancy in Figure 1
In the Brief Report titled “Association of Medication Nonadherence Among Adult Survivors of Stroke After Implementation of the US Affordable Care Act,” published online August 27, 2018, wording in the first sentence of the Results section “, and 61.9% were aged 65 years or older” should have been deleted. In the fourt h sentence of the Results section, “; uninsurance decreased (from 13.7%...)” also should have been deleted. In Figure 1, theP value given as .001 for comparisons across the 4 rightmost bars should have beenP <  .001. The article has been corrected online.
Source: JAMA Neurology - October 29, 2018 Category: Neurology Source Type: research

Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury
This systematic review and meta-analysis investigates the clinical and therapeutic significance of magnetic resonance imaging markers of covert vascular brain injury (white matter hyperintensities, brain infarcts, and cerebral microbleeds) associated with stroke, dementia, and death in community-dwelling older adults.
Source: JAMA Neurology - October 22, 2018 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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