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Specialty: Neurology
Source: JAMA Neurology
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Total 364 results found since Jan 2013.
Changing Health Care Markets Have the Potential to Undermine Stroke Systems of Care
This Viewpoint discusses the importance of prioritizing quality of care for patients with stroke in a changing health care environment.
Source: JAMA Neurology - September 11, 2023 Category: Neurology Source Type: research
The Power of Clinical Registries and Quality Improvement Collaboratives
The American Heart Association established the American Stroke Association in 1998 to improve stroke care and speed the implementation of evidence-based stroke treatments. In 2001, the Centers for Disease Control and Prevention funded the Paul Coverdell National Acute Stroke Registry pilot programs. The Massachusetts pilot program, 1 of 4, was modeled after the Get With the Guidelines –Coronary Artery Disease program and was called Get With the Guidelines–Stroke (GWTG-Stroke). GWTG-Stroke is a collaborative disease-specific clinical data registry and quality improvement program and includes evidence-based quality measu...
Source: JAMA Neurology - August 6, 2018 Category: Neurology Source Type: research
In-Hospital Acute Strokes —Opportunities to Optimize Care and Improve Outcomes
Stroke is a well-known complication of acute medical or surgical illnesses. Prior work has shown that patients with stroke occurring in the hospital are more likely to encounter delays in diagnosis, have gaps in care, and experience worse outcomes compared with patients with stroke occurring out of the hospital. Delay in the recognition of symptoms of stroke is particularly relevant for extremely short-term revascularization therapies, which was previously limited to a relatively narrow time window for treatment with intravenous thrombolysis. Patients with in-hospital stroke may be more likely than patients with community-...
Source: JAMA Neurology - September 21, 2020 Category: Neurology Source Type: research
Poststroke Selective Serotonin Reuptake Inhibitors
In the community, major risk factors for depression include sex, advancing age, lower income, employment status, and illnesses such as stroke that result in disability and affect income, employment, and social status. Poststroke depression affects 1 in every 3 patients in the first year after stroke occurrence and thereafter. Important general treatments for depression include the selective serotonin reuptake inhibitors; these compounds have also been suggested to modulate motor and functional recovery after stroke. The FLAME (Fluoxetine for Motor Recovery After Acute Ischaemic Stroke) trial kindled interest in treatment w...
Source: JAMA Neurology - August 2, 2021 Category: Neurology Source Type: research
Outcomes After Carotid Artery Stenting in Medicare Beneficiaries, 2005 to 2009
Conclusions and RelevanceCompeting risks may limit the benefits of CAS in certain Medicare beneficiaries, particularly among older and symptomatic patients who have higher periprocedural and long-term mortality risks. The generalizability of trials like the SAPPHIRE or CREST to the Medicare population may be limited, underscoring the need to evaluate real-world effectiveness of carotid stenosis treatments.
Source: JAMA Neurology - January 12, 2015 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
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
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
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
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
Triage Based on Preclinical Scores
Current guidelines state that patients who experienced a stroke should usually be transferred to the nearest stroke-treating hospital. In accordance with these guidelines, most patients with large-vessel occlusion (LVO) are transported to a primary stroke center (PSC) that does not offer thrombectomy. From there, these patients must undergo a secondary interhospital transport to a thrombectomy-capable comprehensive stroke center (CSC). Such secondary transfers cause considerable treatment delays, ranging from 96 to 111 minutes. Even when the distance between the PSC and a CSC is only 15 miles, transfer times of 104 minutes have been reported.
Source: JAMA Neurology - April 6, 2020 Category: Neurology Source Type: research
Building Evidence on Safety of Thrombolysis for Patients Receiving Direct Oral Anticoagulants
Nearly 20% of patients with acute ischemic stroke (AIS) are undergoing direct oral anticoagulant (DOAC) treatment at the time of their stroke. Common indications for DOACs among these patients include stroke prevention from atrial fibrillation, treatment of venous and pulmonary thrombosis, and coronary and peripheral atherosclerotic disease. Novel indications for DOAC use are expected to emerge and may increase the proportion of patients with AIS who are undergoing treatment with DOACs. Current US and European acute stroke treatment guidelines recommend withholding intravenous thrombolysis (thrombolysis), a morbidity- and ...
Source: JAMA Neurology - January 3, 2023 Category: Neurology Source Type: research
Diagnostic Value of Somatosensory Evoked Potential Changes During Carotid Endarterectomy A Systematic Review and Meta-analysis
Conclusions and RelevanceIntraoperative SSEP is a highly specific test in predicting neurological outcome following CEA. Patients with perioperative neurological deficits are 14 times more likely to have had changes in SSEPs during the procedure. The use of SSEPs to design prevention strategies is valuable in reducing perioperative cerebral infarctions during CEA.
Source: JAMA Neurology - November 10, 2014 Category: Neurology Source Type: research
Current Risks of Asymptomatic Carotid Stenosis
In the past 2 decades, 2 large multicenter trials have demonstrated the efficacy of carotid endarterectomy (CEA) for patients with asymptomatic carotid stenosis: the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). These trials found that CEA, compared with best medical therapy, was associated with a significant relative risk reduction of 50% during 5 years but only an absolute reduction in ipsilateral stroke of 0.5% to 1% per year. With the number needed to treat to prevent 1 stroke in 1 year approaching 100 to 200, whether this degree of stroke reduction is clinically s...
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research
Switched On
In an ideal world, a vascular neurologist excludes contraindications and starts treatment the minute a stroke occurs. While the first minute seems unrealizable, the first hour is not. Considerable time savings have been achieved with specialized stroke ambulances equipped with a computed tomography system and a neurologist on board. However, these specialized ambulances come at a certain cost, especially personnel costs. Can telemedicine replace the physical presence of a physician in a prehospital stroke setting?
Source: JAMA Neurology - December 7, 2015 Category: Neurology Source Type: research
