Query: stroke

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Specialty: Neurology
Source: JAMA Neurology

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Total 259 results found since Jan 2013.

Magnetic Resonance Imaging for Acute Minor Neurological Symptoms
To the Editor An observational study of magnetic resonance imaging (MRI) in acute minor neurological symptoms revealed imaging evidence for acute infarction in 13.5% and revision of clinical diagnosis in 30%. This “implies a considerable percentage of patients’ negative MRI findings resulted in a different diagnosis, likely that a presumed stroke did not exist.” This conclusion is misleading in 2 respects.
Source: JAMA Neurology - April 20, 2020 Category: Neurology Source Type: research

Nomenclature and Potential Causation Classification of Patent Foramen Ovale –Associated Stroke
This Special Communication describes new information on strokes associated with patent foramen ovale from randomized clinical trials and meta-analyses and proposes a new clinical approach to the categorization of such strokes.
Source: JAMA Neurology - April 13, 2020 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

Seven-Year Experience From the NINDS-Supported Network for Excellence in Neuroscience Clinical Trials
This Special Communication discusses the formation of the National Institute of Neurological Disorders and Stroke Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) and what NeuroNEXT has accomplished within the first 7 years.
Source: JAMA Neurology - March 23, 2020 Category: Neurology Source Type: research

Endovascular Treatment for Acute Basilar Artery Occlusion via a Nationwide Prospective Registry
This nonrandomized cohort study evaluates the association between endovascular treatment and the clinical outcomes of patients with stroke and acute basilar artery occlusion, compared with patients who received standard medical treatment only.
Source: JAMA Neurology - February 20, 2020 Category: Neurology Source Type: research

Distributional Validity and Prognostic Power of the NIHSS in US Administrative Claims Data
This cross-sectional study analyzes the distributional, convergent, and predictive validity of National Institutes of Health Stroke Scale (NIHSS) values in the National Inpatient Sample.
Source: JAMA Neurology - February 17, 2020 Category: Neurology Source Type: research

Blood Pressure Thresholds in Endovascular Therapy for Acute Ischemic Stroke
This cohort study investigates whether procedural blood pressure parameters, including specific blood pressure thresholds, are associated with neurological outcomes after endovascular therapy.
Source: JAMA Neurology - January 27, 2020 Category: Neurology Source Type: research

Horizontal and Vertical Boundaries of Hemineglect
This case report describes a 65-year-old woman with a right-hemispheric ischemic stroke in the territory of the middle cerebral artery along with left-sided hemiparesis with dysarthria and left-sided visual hemineglect.
Source: JAMA Neurology - January 27, 2020 Category: Neurology Source Type: research

Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy
Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS). With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiab...
Source: JAMA Neurology - December 9, 2019 Category: Neurology Source Type: research

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 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

Prevention of Dementia —Thinking Beyond the Age and Amyloid Boxes
It is increasingly recognized that the declines in brain structure and function in persons with no clinical brain disease that we call brain aging and the 2 brain diseases that most frequently affect older adults (dementia and stroke) are the theoretically predictable consequences of a lifetime of injury that overcomes genetically and environmentally determined reserve and resilience, a concept encapsulated in the shorthand phrase life-course illness. Despite this insight, details of the various factors that adversely affect the brain health of older adults (and clarity on which times during life have the greatest effect a...
Source: JAMA Neurology - November 4, 2019 Category: Neurology Source Type: research

Error in Figure
This article was corrected online.
Source: JAMA Neurology - September 30, 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

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

Global Orbital Infarction Syndrome After a Carotid Artery Dissection
This case report describes an unusual ophthalmologic emergency after a 59-year-old man experiences an ischemic stroke in the right middle cerebral artery.
Source: JAMA Neurology - October 1, 2018 Category: Neurology Source Type: research

Effect of Dextroamphetamine on Poststroke Motor Recovery
This randomized clinical trial evaluates the effect of dextroamphetamine combined with physiotherapy vs placebo and physiotherapy for improving poststroke motor recovery among patients with ischemic stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Treatment of Poststroke Aphasia With Transcranial Direct Current Stimulation
Stroke remains a leading cause of human disability. Important gains have been realized in the setting of acute ischemic stroke, where thrombolytic and catheter-based reperfusion therapies can substantially improve long-term behavioral outcomes. However, most patients with a new stroke are not eligible for such therapies because of delays in diagnosis or hemorrhagic etiology, for example, and many who are treated nonetheless have substantial long-term disability. Additional classes of poststroke therapy are needed.
Source: JAMA Neurology - August 20, 2018 Category: Neurology Source Type: research

Transcranial Direct Current Stimulation to Treat Aphasia After Stroke
This randomized clinical trial examines the futility of studying anodal transcranial direct current stimulation vs sham stimulation as an adjunctive intervention during speech therapy to improve speech production (naming) for older adults with long-term poststroke aphasia.
Source: JAMA Neurology - August 20, 2018 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

Additional Factors Regarding Clinical Outcomes of General Anesthesia and Conscious Sedation for Acute Ischemic Stroke —Reply
In Reply We thank Chabanne and Futier for the relevant question concerning ventilator parameters in the General or Local Anesthesia in Intra Arterial Therapy (GOLIATH) trial. Unfortunately, it was not possible for us to obtain periprocedural arterial blood gas parameters because of resource constraints. However, we have recently reported the end tidal carbon dioxide (EtCO2) levels in the general anesthesia (GA) arm (4.4 kPa; interquartile range, 4.2-4.8 kPa). Taking the normal arterial to EtCO2 gradient into account, our data indicate a normoventilation, which was the intention in the study protocol. The EtCO2 levels were ...
Source: JAMA Neurology - July 16, 2018 Category: Neurology Source Type: research

Error in Table
The Research Letter titled, “Medical Specialties of Clinicians Providing Mechanical Thrombectomy to Patients with Acute Ischemic Stroke in the United States,” published in the April 2018 print issue included an error in the Table that presented the data for neurosurgeons in the row labeled “Neurology,” and the data for neurologists in the row labeled “Neurosurgery.” This included indicating that 110 thrombectomies were performed by neurosurgeons and 91 by neurologists. The Table has been corrected and now matches the data present in the main text of the article: 91 thrombectomies performed by neurosurgeons an d...
Source: JAMA Neurology - May 21, 2018 Category: Neurology Source Type: research

Arterial Partial Pressure of Carbon Dioxide and Secondary Brain Injury
Secondary brain injury (SBI) occurs when tissue made vulnerable by a primary brain injury (eg, traumatic brain injury [TBI], stroke, or global cerebral ischemia), is exposed to additional insults, such as low blood flow, hypoxia, fever, seizures, or glucose concentration extremes. The prevention and treatment of SBI forms the basis for these conditions ’ neurocritical care management; guidelines emphasize maintaining parameters associated with blood pressure and ventilation thought to limit SBI. Cerebral blood flow (CBF) is regulated by a complex interplay of neurovascular coupling, pressure autoregulation, arterial bloo...
Source: JAMA Neurology - March 19, 2018 Category: Neurology Source Type: research

Considerations in Assessing Disability Trajectories
To the Editor We thank Dhamoon et al for their prospective longitudinal cohort study assessing the long-term disability trajectory before and after an ischemic stroke compared with myocardial infarction (MI). The authors found that the gradient of increasing disability was significantly steeper after a stroke but remained consistent after MI.
Source: JAMA Neurology - March 12, 2018 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

Speak Therapy
In this essay, a medical student reflects on his grandfather ’s experience with stroke and the ways emotions and personal relationships affect a patient’s health.
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

Leaving Against Medical Advice
She was never even supposed to be in the hospital. We got a telephone call from an ophthalmologist who suspected a stroke in a woman in her early 70s after finding a visual field defect. She had gone to the clinic because she was bumping into objects for a few days, but she expected to do a few tests, get a diagnosis, and go home, because whatever was wrong did not even bother her much. Instead, she was treated to an admission to our stroke center and a nothing by mouth designation overnight after she failed the nurse ’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and phys...
Source: JAMA Neurology - February 26, 2018 Category: Neurology Source Type: research

Errors in Abstract and Figures 2 and 3
This article was c orrected online.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Safety and Efficacy of a 3-D Stent Retriever With Aspiration-Based Thrombectomy
This randomized clinical noninferiority trial assesses a novel 3-dimensional stent retriever when used in conjunction with aspiration-based mechanical thrombectomy compared with aspiration-based mechanical thrombectomy alone in patients with acute ischemic stroke.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Evidence-Based Management of Patent Foramen Ovale in Patients With Ischemic Stroke
This Viewpoint describes the results of 5 randomized clinical trials of devices that occlude patent foramen ovale, discusses the cerebrovascular outcomes associated with treatment, and outlines judicious use of closure procedures.
Source: JAMA Neurology - December 26, 2017 Category: Neurology Source Type: research