Query: stroke

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Specialty: Neurology
Source: JAMA Neurology

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Total 230 results found since Jan 2013.

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

Current Risks of Asymptomatic Carotid Stenosis
In the past 2 decades, 2 large multicenter trials have demonstrated the efficacy of carotid endarterectomy (CEA) for patients with asymptomatic carotid stenosis: the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). These trials found that CEA, compared with best medical therapy, was associated with a significant relative risk reduction of 50% during 5 years but only an absolute reduction in ipsilateral stroke of 0.5% to 1% per year. With the number needed to treat to prevent 1 stroke in 1 year approaching 100 to 200, whether this degree of stroke reduction is clinically s...
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

Risk of Stroke at the Time of Carotid Occlusion
This study of patients undergoing carotid ultrasonography reports that the risk of carotid occlusion is well below the risk of carotid stenting or endarterectomy and decreases markedly with more intensive medical therapy.
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

Stereotypy After Acute Thalamic Infarct
This Images in Neurology article summarizes clinical features, diagnosis, and management of post-stroke stereotypy.
Source: JAMA Neurology - July 13, 2015 Category: Neurology Source Type: research

Risks of Epilepsy During Pregnancy
Epilepsy is a common disease that affects 1 in 26 individuals in their lifetime. According to a National Institute of Neurological Disorders and Stroke assessment, with 2 million affected individuals, epilepsy ranks only fourth to migraine, stroke, and Alzheimer disease in the prevalence of neurological disorders. Epilepsy affects more people than autism, amyotrophic lateral sclerosis, cerebral palsy, multiple sclerosis, and Parkinson disease combined. Approximately 0.3% to 0.5% of all pregnancies are among women with epilepsy (WWE). The risks during pregnancy in WWE have been uncertain.
Source: JAMA Neurology - July 6, 2015 Category: Neurology Source Type: research

Progress in Intravenous Thrombolytic Therapy for Acute Stroke
This review traces the development of intravenous thrombolysis to date, considers the shortcomings of alteplase, and examines alternative thrombolytic approaches currently in the pipeline, including the role of neuroimaging and the possibility of combination therapies.
Source: JAMA Neurology - June 1, 2015 Category: Neurology Source Type: research

Novel Methods and Technologies for 21st-Century Clinical Trials A Review
Conclusions and RelevanceIncreased use of new tools and approaches in future clinical trials can enhance the design, improve the assessment, and engage participants in the evaluation of novel therapies for neurologic disorders.
Source: JAMA Neurology - March 2, 2015 Category: Neurology Source Type: research

Carotid Stenting—Why Treating an Artery May Not Treat the Patient
In this issue of JAMA Neurology, Jalbert and colleagues present the results of a detailed analysis of Centers for Medicare & Medicaid Services (CMS) administrative data on patients with carotid artery stenosis treated with carotid artery stenting. Their well-written manuscript and timely study included more than 22 000 patients treated and followed up between 2000 and 2009. They analyzed periprocedural complications (defined as stroke, transient ischemic attack [TIA], myocardial infarction [MI], and death within 30 days), as well as long-term stroke and mortality. Important variables that were analyzed included the degre...
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research

Outcomes After Carotid Artery Stenting in Medicare Beneficiaries, 2005 to 2009
Conclusions and RelevanceCompeting risks may limit the benefits of CAS in certain Medicare beneficiaries, particularly among older and symptomatic patients who have higher periprocedural and long-term mortality risks. The generalizability of trials like the SAPPHIRE or CREST to the Medicare population may be limited, underscoring the need to evaluate real-world effectiveness of carotid stenosis treatments.
Source: JAMA Neurology - January 12, 2015 Category: Neurology Source Type: research

Diagnostic Value of Somatosensory Evoked Potential Changes During Carotid Endarterectomy A Systematic Review and Meta-analysis
Conclusions and RelevanceIntraoperative SSEP is a highly specific test in predicting neurological outcome following CEA. Patients with perioperative neurological deficits are 14 times more likely to have had changes in SSEPs during the procedure. The use of SSEPs to design prevention strategies is valuable in reducing perioperative cerebral infarctions during CEA.
Source: JAMA Neurology - November 10, 2014 Category: Neurology Source Type: research