Query: stroke

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Specialty: Neurology
Source: JAMA Neurology

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Total 259 results found since Jan 2013.

Modeling Stroke Patient Transport for All Suspected Large-Vessel Occlusion Patients
This modeling study examines strategies for optimal triage and transport of patients with suspected large-vessel occlusion stroke to the appropriate center to achieve optimal care.
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Association of Medication Nonadherence Among Survivors of Stroke After Affordable Care Act Implementation
This study investigates whether the US Affordable Care Act is associated with medication affordability and adherence among middle-aged to older adults who have had a stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Advances in Understanding the Pathophysiology of Lacunar Stroke
This narrative review of studies of cerebral small vessel disease published since 2012 investigates progress in understanding the pathogenesis, imaging characteristics, and genetic basis of lacunar stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Stroke Quality of Care in GWTG-Stroke Hospitals
This longitudinal cohort study compares quality of stroke care measures for patients admitted to hospitals participating and not participating in Get With The Guidelines –Stroke.
Source: JAMA Neurology - August 6, 2018 Category: Neurology Source Type: research

Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke
This exploratory analysis of 1690 patients enrolled in the Field Administration of Stroke Therapy-Magnesium Trial assesses the frequency, predictors, and outcomes of the neurological deterioration that occurs among patients during the ultra-early period after ischemic stroke or intracranial hemorrhage.
Source: JAMA Neurology - July 23, 2018 Category: Neurology Source Type: research

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke
To the Editor Simonsen et al concluded that general anesthesia (GA) did not influence infarct growth compared with conscious sedation in endovascular-treated patients with acute stroke. This is an interesting study that addresses topical questions. However, we would like to point out some limitations.
Source: JAMA Neurology - July 16, 2018 Category: Neurology Source Type: research

Presentation After TIA and Minor Stroke in Relation to the UK FAST Public Education Campaign
This population-based study investigates the association of public education with improving delays and failure in seeking medical attention among consecutive patients with first transient ischemic attack or stroke.
Source: JAMA Neurology - July 2, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke
To the Editor In his Viewpoint, Kamel addresses some issues with the randomized clinical trials (RCTs) of patent foramen ovale (PFO) closure for preventing recurrent stroke and urges a judicious and evidence-based approach for patient selection. I would like to point out additional factors that further demonstrate need for extreme caution in selecting patients to undergo this procedure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Additional Factors in Considering Patent Foramen Ovale Closure to Prevent Recurrent Ischemic Stroke —Reply
In Reply Powers raises several important issues that I did not address in detail in my Viewpoint about managing patent foramen ovale in patients with ischemic stroke. These additional points further highlight that many patients who are fully informed about the available data will reasonably choose medical therapy rather than patent foramen ovale closure.
Source: JAMA Neurology - May 14, 2018 Category: Neurology Source Type: research

Association of Sickle Cell Trait With Ischemic Stroke Among African Americans
This meta-analysis examines whether sickle cell trait is associated with a higher risk of incident ischemic stroke among African Americans.
Source: JAMA Neurology - April 23, 2018 Category: Neurology Source Type: research

Dual Antiplatelet Therapy in Transient Ischemic Attack and Minor Stroke
This imaging substudy of a randomized clinical trial investigates whether infarction patterns can be used to stratify the risk of recurrent stroke within 3 months of a transient ischemic attack or minor ischemic stroke.
Source: JAMA Neurology - March 26, 2018 Category: Neurology Source Type: research

Keeping Faith With Patients After Stroke or Transient Ischemic Attack
I recently recommended statin therapy to a 68-year-old patient, explaining that it would reduce his risk of a major coronary event or stroke in the next 10 years from 18% to 15%. He asked, “But how will we know if it works?” I confessed we never would because success would be an uneventful walk through good health. He was not sold.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Care Quality for Veterans With Transient Ischemic Attack and Stroke
This cohort study assesses the quality of guideline-recommended transient ischemic attack and minor stroke care across the Veterans Health Administration system nationwide.
Source: JAMA Neurology - February 5, 2018 Category: Neurology Source Type: research

Medical Specialties and Thrombectomy for Patients With Acute Ischemic Stroke
This cross-sectional analysis of Medicare data determined the specialty of physicians providing mechanical thrombectomy to patients with ischemic stroke.
Source: JAMA Neurology - January 25, 2018 Category: Neurology Source Type: research

Reperfusion and Brain Edema in Patients With Acute Ischemic Stroke
This study examines the association between reperfusion and brain edema in patients with acute ischemic stroke.
Source: JAMA Neurology - January 24, 2018 Category: Neurology Source Type: research

Effect of General Anesthesia and Conscious Sedation on Infarct Growth and Outcomes in Stroke
This randomized clinical trial analyzes the effect of general anesthesia and conscious sedation on infarct growth and clinical outcome of patients who underwent endovascular therapy for acute ischemic stroke.
Source: JAMA Neurology - January 16, 2018 Category: Neurology Source Type: research

Enoxaparin vs Aspirin in Patients With Cancer and Ischemic Stroke
This randomized clinical trial compares anticoagulation vs antiplatelet therapy in patients with cancer and acute ischemic stroke.
Source: JAMA Neurology - January 8, 2018 Category: Neurology Source Type: research

Thrombectomy for Acute Ischemic Stroke
In this issue ofJAMA Neurology, Nogueira et al report the results of a trial comparing aspiration-assisted stent retrieval with aspiration alone in patients with acute ischemic stroke. In a few years ’ time, mechanical thrombectomy has become a standard for treatment of acute ischemic stroke caused by proximal intracranial thromboembolic occlusions. This progress is amazing when one considers where we stood in 2013, with 3 neutral trials of intra-arterial treatment for stroke. The next 5 trial s that were published in quick succession in early 2015 and 2 later ones all indicated that early thrombectomy has a strong benef...
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Prevalence of Systematic Atherosclerosis Burdens and Overlapping Stroke Etiologies
This study explores the frequency of intracranial atherosclerotic disease in patients who have had a stroke and whether it coexists with systemic atherosclerotic lesions and other stroke etiologies.
Source: JAMA Neurology - December 26, 2017 Category: Neurology Source Type: research

Emergency Department Stroke Care
To the Editor In his Editorial, Caplan retells a story of a patient he encountered in 1962 as he provides an opinion on the article by Topcuoglu et al on stroke recrudescence. Caplan suggests that taking a careful history and administering a physical examination could reduce unnecessary testing and treatments. He also suggests that “inexperienced doctors” in emergency departments (EDs) who follow checklists contribute to indiscriminate care.
Source: JAMA Neurology - December 11, 2017 Category: Neurology Source Type: research

Emergency Department Stroke Care —Reply
In Reply I agree with Meurer et al that the optimal management of patients who present to emergency departments with suspected strokes is best managed by a dedicated team of emergency physicians, trained and experienced stroke neurologists, and nurses. These teams are capable of thinking about what is wrong with the patient and the best management rather than blindly following recipes and guidelines.
Source: JAMA Neurology - December 11, 2017 Category: Neurology Source Type: research

Disability Trajectories Before and After Stroke and Myocardial Infarction
This population-based cohort study evaluates the long-term effects of stroke on functional ability in patients before and after stroke compared with before and after myocardial infarction.
Source: JAMA Neurology - October 23, 2017 Category: Neurology Source Type: research

Low-Dose vs Standard-Dose Alteplase for Patients With Acute Ischemic Stroke
This secondary analysis reports on the association of low-dose and standard-dose intravenous alteplase treatment with age, ethnicity (Asian vs non-Asian), and severity of acute ischemic stroke among patients in the ENCHANTED randomized clinical trial.
Source: JAMA Neurology - October 2, 2017 Category: Neurology Source Type: research

Stroke Imaging
In this issue ofJAMA Neurology, Boulouis et al report on the crucial influence of pretreatment collateral blood vessel status in determining the benefit of transfer for endovascular thrombectomy for large vessel acute ischemic stroke. All patients had relatively little evidence of irreversible injury on noncontrast computed tomography (CT) at their referring hospitals. However, when imaging was repeated at the comprehensive stroke center, a substantial proportion of patients had evolved large infarcts that caused them not to proceed to endovascular therapy or foreshadowed a poor outcome. These data contribute to the weight...
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

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

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

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

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

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

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

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

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

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

Predictive Validity of Etiologic Stroke Classification
This study examines whether etiologic stroke subtyping using 3 different classification systems identifies different disease processes that can be recognized through their different clinical courses.
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Association of Collateral Blood Vessels With Neurological Outcome After Stroke
This cohort study assesses the association between the presence of collateral vessels identified using arterial spin labeling magnetic resonance imaging and neurologic outcome in patients after acute ischemic stroke.
Source: JAMA Neurology - February 13, 2017 Category: Neurology Source Type: research

Stroke Diagnosis and Treatment in the Emergency Department
To the Editor We are somewhat perplexed after having read the Viewpoint by Avasarala, as it questions the role of the neurologist in the emergency department for acute stroke diagnosis. Although it is clear that the author is being deliberately provocative, we can only strongly disagree with the idea that a sudden-onset focal neurological deficit may be diagnosed as a stroke on the basis of a pattern-recognition algorithm alone, without a neurological assessment.
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Stroke Diagnosis and Treatment in the Emergency Department —Reply
In Reply I thank Rota and colleagues for their comments on my Viewpoint, which challenged the status quo concerning the requirement of a neurologist to initiate the tissue plasminogen activator (tPA) protocol for an obvious diagnosis of acute stroke in the emergency department (ED). In today ’s world of Instagram, Facebook, and Twitter feeds, we all need to embrace change. A few years ago, for instance, no one knew what Altmetric represented. Today, all of us crave the statistics reported by Altmetric, which recognizes our work via the number of tweets and “cross-talk” across mult iple platforms. Funding, data collec...
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Recurrence of Posterior Circulation Childhood Arterial Ischemic Stroke
This cohort study investigates the incidence of the recurrence of childhood arterial ischemic stroke in the posterior and anterior circulations to determine if the risk differs between the 2 locations.
Source: JAMA Neurology - January 23, 2017 Category: Neurology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke
Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory –adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and their report appears in this issue ofJAMA Neurology. Given that 85% of the patients in mechanical thrombectomy (MT) trials received intravenous thrombolysis (IVT), they highlight an important group of patients in whom MT was successful without IVT. The recent IVT and MT trials have clearly established the new standard in therapy for...
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research