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Specialty: Neurology
Source: JAMA Neurology
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Total 364 results found since Jan 2013.
Which Patients With Ischemic Stroke and Insulin Resistance May Benefit From Pioglitazone?
The Insulin Resistance Intervention After Stroke (IRIS) trial has reported that treating insulin resistance with the peroxisome proliferator –activated receptor γ agonist pioglitazone hydrochloride reduced recurrent stroke or myocardial infarction (MI) by about one-fourth compared with placebo (pioglitazone, 9.0% vs placebo, 11.8%; hazard ratio [HR], 0.76; 95% CI, 0.62-0.93) in 3876 patients with recent (<6 months) ischemic stroke or transient ischemic attack and insulin resistance but without diabetes, heart failure, or bladder cancer. Pioglitazone was also associated with less incident diabetes vs placebo (3.8% vs ...
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research
Targeting Pioglitazone Therapy After Stroke or Transient Ischemic Attack
This secondary analysis of the Insulin Resistance Intervention After Stroke trial estimates the relative and absolute effectiveness of pioglitazone after ischemic stroke or transient ischemic attack in subgroups of patients defined by pretreatment risk for stroke or myocardial infarction.
Source: JAMA Neurology - September 18, 2017 Category: Neurology Source Type: research
Anticoagulation Timing for Atrial Fibrillation in Acute Ischemic Stroke
Most stroke physicians will have been asked the best time to start anticoagulation for a patient with atrial fibrillation (AF) and acute ischemic stroke. There is no question that long-term anticoagulation with a direct oral anticoagulant or warfarin sodium reduces the risk of strokes in patients with AF, but the right time to start anticoagulation is uncertain.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research
Rivaroxaban vs Warfarin Sodium Early After AF-Related Mild Ischemic Stroke
This randomized clinical trial examines whether rivaroxaban or warfarin sodium is safer and more effective for preventing early recurrent stroke in patients with atrial fibrillation –related acute ischemic stroke.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research
Presenting to Primary Stroke Centers for Thrombolysis
To the Editor The study by Gerschenfeld et al attempted to address the topical question of whether patients should be brought to a primary stroke center (PSC) for early thrombolysis or be directly transported, despite a longer traveling distance, to a comprehensive stroke center (CSC) that was capable of performing a mechanical thrombectomy (ME). The study found no difference in 24-hour, discharge, or 3-month outcomes between groups of those presenting to a PSC who received thrombolysis and transferred to a CSC for ME and those who presented first to CSC and received thrombolysis and ME. The study concludes “that patient...
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research
Presenting to Primary Stroke Centers for Thrombolysis —Reply
In Reply We thank Uchino for his letter on our recently published article in which he discusses potential limitations of our study. The first criticism concerns the unexpected less favorable outcome in the mothership (MS) group despite significantly shorter onset-to-needle and onset-to-recanalization times. It is true that even though the difference was not statistically significant, the MS group had fewer patients with a 3-month favorable functional outcome (50.8%) when compared with the drip-and-ship (DS) group (61 [61.0%];P = .26). As we mentioned in our article, patients in the MS group had slightly but significant...
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research
Childhood Body Mass Index and First Adult Ischemic Stroke
This population-based cohort study of schoolchildren born from the 1930s through the 1980s in Denmark investigates whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and assesses whether the associations are age dependent or influenced by birth weight.
Source: JAMA Neurology - August 21, 2017 Category: Neurology Source Type: research
Longitudinal Care for Young Adults With Stroke
This Viewpoint discusses a longitudinal care program designed to explore and address unmet needs of stroke survivors.
Source: JAMA Neurology - August 21, 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
Recrudescence of Deficits After Stroke
This crossover cohort, case-control study uses medical records from the Research Patient Data Repository to determine the features, triggers, and risk factors of poststroke recrudescence among patients with a previous stroke.
Source: JAMA Neurology - August 7, 2017 Category: Neurology Source Type: research
Impact of Birth Place and Geographic Location on Risk Disparities in Cerebrovascular Disease
The geographic disparities in stroke and cerebrovascular disease have long been recognized with high-risk areas, such as the states in the Southeast with the greatest risk and identified as the Stroke Belt. These epidemiologic observations have facilitated the identification of risk factors associated with the excess disease burden as well as the benefits of interventions focused on disease control. The geographic disparities in stroke risks prompted specific investigations and conferences to determine the factors associated with the excess risk burden for specific geographic areas, such as the southeastern United States, ...
Source: JAMA Neurology - July 31, 2017 Category: Neurology Source Type: research
Birth in a High Stroke Mortality State, Race, and Risk of Dementia
This cohort study examines the risk of dementia in individuals who are born in the Stroke Belt but later reside in California.
Source: JAMA Neurology - July 31, 2017 Category: Neurology Source Type: research
Mechanical Thrombectomy in Acute Stroke
To the Editor In their recent article, Coutinho et al address whether patients who have had an acute stroke with proximal occlusion should undergo intravenous thrombolysis (IVT) before a mechanical thrombectomy (MT). In this analysis of pooled data from the SWIFT and STAR trials, MT after IVT did not appear to provide clinical benefits over MT alone. The authors concluded that randomized clinical trials should confirm their observation.
Source: JAMA Neurology - July 10, 2017 Category: Neurology Source Type: research
Mechanical Thrombectomy in Acute Stroke —Reply
In Reply We read with interest the letter by Seners and colleagues regarding our recent publication. The possibility of early recanalization among patients with acute ischemic stroke and a proximal intracranial occlusion was underestimated in the recent trials on mechanical thrombectomy (MT) because vascular imaging was in part done after starting intravenous thrombolysis (IVT), particularly in the MR CLEAN trial. However, Seners et al observed higher recanalization rates for M1 and M2 occlusions at an early stage, but this was not the case for carotid occlusions. Additionally, they defined early recanalization as happenin...
Source: JAMA Neurology - July 10, 2017 Category: Neurology Source Type: research
Crowdsourcing the Million Brains Initiative —Reply
In Reply The enthusiasm expressed for the Million Brains Initiative and the thoughtful consideration of ethical facets by Byram and Illes are much appreciated. The authors underscore a few of the inevitable ramifications that will undoubtedly parallel the realization of precision stroke medicine and the transformation from blissful ignorance to big data in stroke medicine. The current paradigm for cerebrovascular disorders from stroke to dementia is founded on individual clinical symptoms that prompt the acquisition, routine interpretation, and archiving of neuroimaging results. Impressions are readily generated and docume...
Source: JAMA Neurology - June 12, 2017 Category: Neurology Source Type: research
