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Specialty: Neurology
Source: JAMA Neurology
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Total 364 results found since Jan 2013.
Cirrhosis and Stroke in a Nationally Representative Cohort
This cohort study of Medicare claims data investigates the association between cirrhosis and various stroke types.
Source: JAMA Neurology - June 5, 2017 Category: Neurology Source Type: research
Rapid Treatment and Interfacility Transport for Patients With Stroke
The former chairman of the board and chief executive officer of IBM, Lou Gerstner, once said that “It is not about bits, bytes and protocols, but profits, losses and margins.”(p325) While Gerstner may have been referencing the financial profits and margins of a large company like IBM, how much more does this principle hold in the business of medicine and health? A protocol is not of any inherent value until we are able to appreciate its results and see its impact on patient outcomes.
Source: JAMA Neurology - May 8, 2017 Category: Neurology Source Type: research
Primary Stroke Center Protocol for Suspected Stroke by Large-Vessel Occlusion
This cohort study reports on the association of a primary stroke center protocol with the efficiency of care and the outcomes of patients with suspected emergent large-vessel occlusion who first present to a primary stroke center.
Source: JAMA Neurology - May 8, 2017 Category: Neurology Source Type: research
Managing Patients With Large Ischemic Core
To the Editor We read with interest the article by Rebello and colleagues on endovascular treatment. There is still uncertainty on how best to manage patients who have a large ischemic core and a large artery clot. Using matched controls is an excellent approach when the study is not a randomized clinical trial. The authors modified the approach of Mandava and colleagues, who had proposed matching controls based on the National Institutes of Health Stroke Scales, age, and pretreatment glucose level. The authors had substituted an “ischemic core on computed tomography perfusion” for the National Institutes of Health Str...
Source: JAMA Neurology - April 10, 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
Conscious Sedation vs General Anesthesia for Vertebrobasilar Stroke Thrombectomy
This case-control study compares clinical and angiographic outcomes between monitored anesthesia care and general anesthesia in patients presenting with vertebrobasilar occlusion strokes.
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research
Primary Stroke Centers vs Comprehensive Stroke Centers
During all but the last 5 years of the 20th century, life was rather simple for health care planners who were concerned with care for patients with stroke. There was no proven effective treatment; therefore, no special guidelines were required. Stroke care changed significantly in 1995, when intravenous (IV) tissue plasminogen activator (tPA) was found to be an effective treatment when given soon after stroke onset. With the intent of improving care, hospitals were encouraged to develop primary stroke centers (PSCs) that had sufficient medical personnel, technology, and protocols that would enable them to deliver IV tPA efficiently.
Source: JAMA Neurology - March 20, 2017 Category: Neurology Source Type: research
Endovascular Thrombectomy for Acute Ischemic Stroke
This study compares the functional independence at 3 months between patients treated for acute ischemic stroke under the drip-and-ship paradigm and those treated on site (mothership paradigm).
Source: JAMA Neurology - March 20, 2017 Category: Neurology Source Type: research
Migraine and the Risk of Carotid Artery Dissection
Stroke incidence is increasing among patients aged 40 to 60 years —faster than in older age cohorts. Preliminary evidence suggests that ischemic stroke—not hemorrhage or subarachnoid hemorrhage—accounts for the increase. Many speculate that increasing incidences of classic vascular risk factors among young patients contribute to the increased incidence of st roke. Certainly, we are all aware of the obesity epidemic and continued prevalence of smoking, leading to premature atherosclerosis. Furthermore, equally relevant causes of stroke in the young include migraine, drug abuse, cervical arterial dissections, patent fo...
Source: JAMA Neurology - March 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
Stroke Etiologic Classification —Moving From Prediction to Precision
It is a truism of vascular neurology that secondary prevention depends on the cause of an ischemic stroke. We revascularize those with extracranial carotid stenosis, we anticoagulate those with cardioembolic infarcts due to atrial fibrillation, and we treat with antibiotics those with infective endocarditis. Determining the etiologic subtype, or cause, of stroke is therefore rightly considered the main objective of the evaluation of the patient with stroke. Despite the central role of this evaluation, it is surprising that our ability to determine the cause of stroke in many cases is quite limited, and that the process of ...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research
Not All Middle Cerebral Artery M2 Segments Are the Same
To the Editor In the research article “Endovascular Therapy for Acute Ischemic Stroke With Occlusion of the Middle Cerebral Artery M2 Segment,” Sarraj and colleagues describe the advantage of endovascular therapy in addition to best medical therapy for patients with acute M2 occlusions. The article does not describe the distribution of the left- and right-sided lesions. It would be of interest to know whether the overall benefits hold true regardless of lesion lateralization or whether the results are primarily driven by benefits on one side.
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research
Response to Endovascular Therapy for Acute Ischemic Stroke
To the Editor Recent data from randomized clinical trials provide clear evidence that endovascular treatment for acute ischemic stroke because of large vessel anterior circulation occlusion improves clinical outcomes for patients. These studies reported that most patients had an occlusion of the first segment (M1) of the middle cerebral artery and less than 10% in the M2 segment. The retrospective multicenter study conducted by Sarraj et al reports that endovascular treatment is safe and effective for an occlusion of the M2 segment. However, the literature reports different definitions for the M1 and M2 segments, which may...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research
Response to Endovascular Therapy for Acute Ischemic Stroke —Reply
In Reply We thank Silver and Morelli for their interest in our article. We agree that is it always of interest to look into the side of the lesion, specifically into dominance more than right vs left. Although this was not addressed in the recent randomized clinical trials, we looked into this aspect in our initial analyses. When performing our univariate analysis, we looked at factors that independently correlated with good outcomes with endovascular therapy (EVT) as detailed in the Results section of our article and further discussed in eTable 2 in our Supplement. The side of the lesion was tested in the univariate analy...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research
