Query: stroke

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Specialty: Neurology
Source: JAMA Neurology

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Total 259 results found since Jan 2013.

Emergency Department Stroke Care
To the Editor In his Editorial, Caplan comments on the article by Topcuoglu and colleagues. Caplan writes:
Source: JAMA Neurology - December 11, 2017 Category: Neurology Source Type: research

Informing vs Changing the Practice of Carotid Revascularization
The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) was a multicenter randomized clinical trial directly comparing the risks and benefits of stenting with those of endarterectomy for symptomatic and asymptomatic high-grade stenosis. Involving 2502 patients across the United States and Canada followed-up for up to 10 years, the trial did not detect significant differences in the end point of perioperative stroke, myocardial infarction, or death or ipsilateral ischemic stroke after the perioperative period. Primary results were published in 2010. CREST clearly informed practice guidelines, but the extent t...
Source: JAMA Neurology - December 4, 2017 Category: Neurology Source Type: research

Infarct Progression in Patients During Mechanical Thrombectomy Transfer
This cohort study examines the clinical imaging factors associated with unfavorable imaging profile evolution for thrombectomy in patients with ischemic stroke initially transferred to non –thrombectomy-capable stroke centers.
Source: JAMA Neurology - September 25, 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

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

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

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

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

Are More Young People Having Strokes?
If a headline such as “Stroke Tsunami: 30 000 More Strokes in the Young” pops into your Twitter feed based on a study in this month’s issue ofJAMA Neurology, should the claim be taken seriously? Is urgent action needed to reverse this trend? While that headline would certainly be eye-catching, the best short answer makes for a lede begging to be buried, “Maybe, but the evidence is pretty cloudy.”
Source: JAMA Neurology - April 10, 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

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

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 —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

Hypertension —A Global Neurological Problem
This Viewpoint discusses the gap in hypertension and stroke care between low-income countries and high-income countries and the role neurologists should play in stroke-prevention efforts.
Source: JAMA Neurology - February 6, 2017 Category: Neurology Source Type: research

Improved Outcomes in Asymptomatic Obstructive Sleep Apnea
This study enrolled 1522 randomly selected, employed research subjects and observed them for 2 decades. The goal of WSCS was to answer one aspect of a US Congressional mandate to determine the overall public burden of sleep d isorders. The WSCS had a surprising finding: mild OSA was seen in 17% of adults, and, most concerning, 6% of adults had moderate to severe OSA. The WSCS finding most relevant to the current USPSTF recommendation statement is that only 35% of WSCS participants with moderate OSA and 37% of participant s with severe OSA reported excessive daytime sleepiness, the cardinal daytime symptom of OSA. This sugg...
Source: JAMA Neurology - January 24, 2017 Category: Neurology Source Type: research

Thrombolysis and Thrombectomy vs Thrombectomy Alone for Ischemic Stroke
This study examines whether treatment with intravenous thrombolysis before mechanical thrombectomy with a stent retriever is beneficial in patients undergoing mechanical thrombectomy.
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

SSRIs and Intracranial Hemorrhage
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications in the United States. A recent study using the National Health and Nutrition Examination Survey database estimated that in 2012, 8.5% (95% CI, 6.9%-10.4%) of adults 20 years and older were prescribed SSRIs compared with a prevalence of 1.3% (95% CI, 1.0%-1.8%) for tricyclic antidepressants (TCAs). Although most of these prescriptions were likely for depression, SSRIs are being used for other indications; of particular interest to neurologists, SSRIs are being investigated and sometimes used to promote motor recovery after str...
Source: JAMA Neurology - December 5, 2016 Category: Neurology Source Type: research

Intra-arterial Treatment for Basilar Artery Occlusion —Reply
In Reply We thank Bhatti and Sivakumaran for their comments on our article. First, the authors mention the relatively low mean age of 58 years of our cohort (this includes 1 child of 4 years). The patients in the Basilar Artery International Cooperation Study (BASICS) had a mean age of 63 years. We think it is unlikely that this difference of 5 years has had an important influence on the results. Moreover, BASICS is a prospective patient registry, without stringent inclusion criteria. This suggests that patients with basilar artery occlusion have a lower age compared with patients with anterior circulation stroke.
Source: JAMA Neurology - November 28, 2016 Category: Neurology Source Type: research

Cardiovascular Risk Factors and Stroke in Alzheimer Disease
Discussion section.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Association Between Calcium Level and Hematoma Size and Expansion
Intracerebral hemorrhage (ICH) is a common and deadly type of stroke, with high rates of morbidity and mortality (40%-50% in most series). There are several well-described and validated risk factors and diseases that increase the risk of ICH, including race, hypertension, use of anticoagulants, amyloid angiopathy, renal insufficiency, thrombolytic therapy, and drug abuse. However, not all ICHs are associated with one of these risk factors. This suggests that there might be some other modifying factors involved.
Source: JAMA Neurology - September 6, 2016 Category: Neurology Source Type: research

The Dark Matter of Cerebral Microbleeds
To the Editor I read with interest the article by Tsivgoulis et al inJAMA Neurology on cerebral microbleeds (CMBs) and the risk for symptomatic intracerebral hemorrhage (ICH) after intravenous thrombolysis for acute stroke, as well as the accompanying Editorial by Fisher. This work follows and extends previous meta-analyses on a thorny topic for acute stroke neurology, demonstrating again that the presence of any number of CMBs on pretreatment magnetic resonance imaging is associated with more than doubling the risk for postthrombolysis ICH. Of importance, the authors provided new evidence from group-level and individual p...
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Association Between CV Risk Factors and Familial Alzheimer Disease
This cohort study investigates associations between coronary risk factors, stroke, and late-onset Alzheimer dementia in patients with familial disease.
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Computed Tomography Perfusion and Diffusion-Weighted Imaging in Acute Stroke
In Reply We thank Luo and colleagues for their interest and comments regarding our article on patients presenting lacunar syndrome with altered brain computed tomography perfusion (CTP) and normal magnetic resonance imaging (MRI) findings.
Source: JAMA Neurology - June 27, 2016 Category: Neurology Source Type: research

Phenotypic Destiny in Mitochondrial Disease?
Mitochondrial diseases are a group of heterogeneous disorders caused by inherited mutations in the mitochondrial genome (mtDNA) and nuclear genome. Typically, mutations in the mtDNA are maternally inherited and cause respiratory chain defects and account for a substantial fraction of childhood and adult neurometabolic disease, with an estimated prevalence of 1:5000 (0.02%). The most common mtDNA mutation is the mitochondrial 3243A>G mutation (m.3243A>G) in the MTTL1 gene (OMIM 590050), which encodes the transfer RNA tRNALeu(UUR). This mutation is associated with multiple clinical and psychiatric manifestations, including d...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Proton Pump Inhibitors and Dementia Incidence
To the Editor I read with interest the article by Gomm and colleagues, which examined the association between the use of proton pump inhibitors (PPIs) and incident dementia in elderly individuals in a prospective study. The authors adopted time-dependent Cox regression analysis, and the time-dependent covariates were polypharmacy and the comorbidities of depression, diabetes, ischemic heart disease, and stroke. Age and sex were also used as confounding factors. The hazard ratio of PPIs for incident dementia was 1.44 (95% CI, 1.36-1.52), and the authors recommended randomized clinical trials to confirm the causal associatio...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Mitochondrial 3243A>G Mutation in 2 Pairs of Monozygotic Twins
This case series describes 2 pairs of monozygotic twins with mitochondrial 3243A>G mutation who developed mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome.
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Dementia After Intracerebral Hemorrhage
As acute management of intracerebral hemorrhage (ICH) has improved, more patients survive ICH but are left with significant deficits. In the past, primary evaluations of outcomes after ICH have focused on mortality and levels of functional dependence, with a relatively modest number of patients experiencing true functional independence after ICH or returning to their previous level of functioning. Cognitive outcomes after ICH have thus not been a primary focus of either treatment or natural history studies of ICH, despite their known importance after ischemic stroke and their importance in predicting return to previous functioning.
Source: JAMA Neurology - June 13, 2016 Category: Neurology Source Type: research

Worsening Stroke Symptoms in an 80-Year-Old Man
An 80-year-old man presented to the hospital with new-onset slurred speech and left-sided facial droop. Magnetic resonance imaging scans of the head were visually interpreted to show an acute infarct involving the posterior right frontal lobe. What is your diagnosis?
Source: JAMA Neurology - June 6, 2016 Category: Neurology Source Type: research

Cerebral Microbleeds, Cognition and Therapeutic Implications
A recent major clinical advance in magnetic resonance imaging (MRI) of the brain is the development of paramagnetic-sensitive sequences such as T2-weighted gradient-recalled echo and susceptibility-weighted images for the detection of cerebral microbleeds (CMBs). On brain MRI, CMBs are small (≤5 to 10 mm in diameter), round, dark-signaled lesions that consist of extravasation of blood components through fragile microvascular walls that neuropathologically represent hemosiderin-laden macrophages. Magnetic resonance imaging–detected CMBs are common in elderly individuals, coexist with ischemic stroke and intracerebral he...
Source: JAMA Neurology - June 6, 2016 Category: Neurology Source Type: research

Cerebral Microbleeds and Thrombolysis
Using intravenous thrombolysis in a stroke patient with cerebral microbleeds represents one of the most challenging clinical decisions in acute stroke neurology. In this setting, the implications of coexisting ischemic and hemorrhagic cerebrovascular disease (mixed cerebrovascular disease) must be confronted and urgently addressed. The clinical consequences of intervening or not intervening are profound.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Hemodynamics in Atherosclerotic Vertebrobasilar Occlusive Disease
In Reply We read with interest the letter by Walcott et al and thank them for their insightful comments. They note that whereas in carotid stenosis, artery-to-artery embolism is a common culprit, hypoperfusion as determined by the Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke protocol is the main pathological mechanism in patients with vertebrobasilar disease and low-flow status. In their experience, a number of patients with medically refractory vertebrobasilar disease symptoms were successfully treated with surgical revascularization in the form of a microsurgical bypass and they make t...
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Potential Association Between Atrial Fibrillation and Dementia
In Reply We thank Chen and colleagues for their interest in our work and are pleased that our report triggers debate about the optimal treatment of atrial fibrillation (AF) to prevent dementia, in addition to stroke and other thromboembolic complications of AF.
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

Obesity, Oral Contraceptive Use, and Cerebral Venous Thrombosis
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that primarily affects young adults. A unique risk factor profile and plurality of presenting features make it an elusive diagnosis unless a high index of suspicion is maintained. It comprises approximately 0.5% to 1% of all strokes, and widespread availability of magnetic resonance imaging has made recognition easier. The International Study on Cerebral Vein and Dural Sinus Thrombosis is the largest prospective, multinational, observational study of patients with CVT to date, including 624 consecutive patients with symptomatic CVT at 89 centers between May ...
Source: JAMA Neurology - March 15, 2016 Category: Neurology Source Type: research

MELAS Syndrome Presenting in the Late 40s
A man in his 50s presented with a 5-year history of stepwise loss of executive and somato-sensory functions in relation to what was interpreted as 2 previous stroke episodes; he was diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes.
Source: JAMA Neurology - March 7, 2016 Category: Neurology Source Type: research

Strokelike Episode Management in Patients With Mitochondrial Syndromes
This review details the current understanding of the cause of strokelike episodes in mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS) and presents recommendations to assist in the identification and treatment of patients with MELAS presenting with stroke.
Source: JAMA Neurology - March 7, 2016 Category: Neurology Source Type: research

Prediction of Early Recurrence After Acute Ischemic Stroke
This study tests the validity of a prognostic score that was exclusively developed to predict early risk of recurrence in a multicenter setting.
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Omitted Author Affiliation
This article was corrected online.
Source: JAMA Neurology - February 22, 2016 Category: Neurology Source Type: research

Affiliation Error in Group Information Listing
This article was corrected online and in print.
Source: JAMA Neurology - February 8, 2016 Category: Neurology Source Type: research

Place of Neuroimaging in Cerebral Small Vessel Disease
The burden of cerebrovascular disease is high: each year, approximately 795 000 people in the United States experience a new or recurrent stroke, leading to death in 128 824 individuals or being associated with death in 215 864 cases. However, the number of silent infarcts and microhemorrhages is much higher, causing cognitive and behavioral impairment in 17% of the population older than 65 years. These usually primarily asymptomatic events are often caused by cerebral small vessel disease (SVD) detected as white matter hyperintensities, lacunas, microbleeds, and cortical and subcortical atrophy in magnetic resonance...
Source: JAMA Neurology - February 1, 2016 Category: Neurology Source Type: research

The High Risk of Low Distal Flow
Symptomatic atherosclerosis of the vertebral artery remains a challenging condition with no proven interventional therapy. Completed randomized trials of angioplasty with or without stenting involving patients with symptomatic vertebral artery stenosis include Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS), and Vertebral Artery Stenting Trial (VAST). As the largest (N = 115) completed trial, VAST illustrates many of the challenges of developing interventional therapy for this patient pop...
Source: JAMA Neurology - December 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

Coexistent Small Vessel Disease and Intracranial Arterial Stenosis
This post hoc analysis of a clinical trial evaluated the risk of ischemic stroke in patients with large artery atherosclerosis and coexistent small vessel disease.
Source: JAMA Neurology - November 30, 2015 Category: Neurology Source Type: research

Thrombolysis-Related Hemorrhage
Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%. Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent...
Source: JAMA Neurology - October 26, 2015 Category: Neurology Source Type: research

Acute Ischemic Stroke Therapy
This Viewpoint discusses the future of thrombolysis and thrombectomy for patients with acute brain ischemia.
Source: JAMA Neurology - October 5, 2015 Category: Neurology Source Type: research