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Source: Neurology
Condition: Ischemic Stroke

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Total 1519 results found since Jan 2013.

Blood-brain barrier leakage increases with small vessel disease in acute ischemic stroke
Conclusions: Global SVD burden is associated with increased BBB leakage in both acutely ischemic and nonischemic area. Our results support that SVD score has construct validity, and confirm a relation between SVD and BBB disruption also in patients with acute stroke.
Source: Neurology - November 20, 2017 Category: Neurology Authors: Arba, F., Leigh, R., Inzitari, D., Warach, S. J., Luby, M., Lees, K. R., On behalf of the STIR/VISTA Imaging Collaboration Tags: MRI, All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Editors' Note
: In "Risks and benefits of clopidogrel–aspirin in minor stroke or TIA: Time course analysis of CHANCE," authors Pan et al. compared the use of dual antiplatelet therapy (DAPT) with aspirin alone for secondary stroke prevention in patients after a minor stroke or TIA. Drs. Gutierrez and Lekic point out that DAPT appeared to have a greater benefit than aspirin alone in patients with intracranial arterial stenosis (ICAS) in the first 2 weeks and ask the authors to provide a time-course analysis for the risk of ischemic stroke and hemorrhage by ICAS status.
Source: Neurology - November 13, 2017 Category: Neurology Authors: Alcauskas, M., Galetta, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Letter re: Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
We read with interest the article by Pan et al.,1 which reported that the use of dual antiplatelet therapy (DAPT) showed an early benefit, compared to aspirin alone, for secondary ischemic stroke prevention after a minor stroke or TIA. The absolute risk reduction in the first week after the indexed event was 4.5%.1 The authors previously reported a nonsignificant absolute risk reduction in recurrent ischemic stroke of 2.3% with DAPT compared to aspirin alone in Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) participants with intracranial arterial stenosis (ICAS) over the 90-day fo...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Gutierrez, J., Lekic, T. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Author response: Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
We appreciate Drs. Gutierrez and Lekic's emphasis on the time-course analysis of dual antiplatelet therapy (DAPT) by intracranial arterial stenosis (ICAS) in their comments on our article.1 Only 1,089 patients were included in the imaging substudy.2 In patients with ICAS, 19 (8.2%), 3 (1.3%), and 0 ischemic strokes in the DAPT group (n = 231) vs 25 (10.0%), 6 (2.4%), and 0 in the aspirin alone group (n = 250), and 4 (1.7%), 0, and 2 (0.9%) bleeding in the DAPT group vs 1 (0.4%), 0, and 0 in the aspirin alone group, occurred at the first, second, and third week, respectively. In patients without ICAS, 11 (3.7%), 1 (0.3%), a...
Source: Neurology - November 13, 2017 Category: Neurology Authors: Pan, Y., Wang, Y., Wang, Y. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Population-based study of home-time by stroke type and correlation with modified Rankin score
Conclusions: We showed that home-time is an objective and graded indicator that is correlated with disability after stroke. It is obtainable from administrative data, applicable to different stroke types, and a valuable outcome indicator in population-based health services research.
Source: Neurology - November 6, 2017 Category: Neurology Authors: Yu, A. Y. X., Rogers, E., Wang, M., Sajobi, T. T., Coutts, S. B., Menon, B. K., Hill, M. D., Smith, E. E. Tags: Outcome research, Medical care, Infarction, Intracerebral hemorrhage ARTICLE Source Type: research

Increasing prevalence of vascular risk factors in patients with stroke: A call to action
Conclusions: Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004–2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention.
Source: Neurology - November 6, 2017 Category: Neurology Authors: Otite, F. O., Liaw, N., Khandelwal, P., Malik, A. M., Romano, J. G., Rundek, T., Sacco, R. L., Chaturvedi, S. Tags: Stroke prevention, Embolism, Prevalence studies, Risk factors in epidemiology, Infarction ARTICLE Source Type: research

Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study
Conclusions: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.
Source: Neurology - October 30, 2017 Category: Neurology Authors: Zupanic, E., von Euler, M., Kareholt, I., Contreras Escamez, B., Fastbom, J., Norrving, B., Religa, D., Kramberger, M. G., Winblad, B., Johnell, K., Eriksdotter, M., Garcia-Ptacek, S. Tags: Prognosis, All Cognitive Disorders/Dementia, Cohort studies, Infarction ARTICLE Source Type: research

COL4A2 is associated with lacunar ischemic stroke and deep ICH: Meta-analyses among 21,500 cases and 40,600 controls
Conclusions: These results provide evidence of shared genetic determinants and suggest common pathophysiologic mechanisms of distinct ischemic and hemorrhagic cerebral SVD stroke phenotypes, offering new insights into the causal mechanisms of cerebral SVD.
Source: Neurology - October 23, 2017 Category: Neurology Authors: Rannikmäe, K., Sivakumaran, V., Millar, H., Malik, R., Anderson, C. D., Chong, M., Dave, T., Falcone, G. J., Fernandez-Cadenas, I., Jimenez-Conde, J., Lindgren, A., Montaner, J., O'Donnell, M., Pare, G., Radmanesh, F., Rost, N. S., Slowik, A., So& Tags: All Cerebrovascular disease/Stroke, Infarction, Intracerebral hemorrhage, All Genetics, Association studies in genetics ARTICLE Source Type: research

Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy
A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral les...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Smoking cessation and outcome after ischemic stroke or TIA
Conclusion: Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort.
Source: Neurology - October 16, 2017 Category: Neurology Authors: Epstein, K. A., Viscoli, C. M., Spence, J. D., Young, L. H., Inzucchi, S. E., Gorman, M., Gerstenhaber, B., Guarino, P. D., Dixit, A., Furie, K. L., Kernan, W. N., For the IRIS Trial Investigators Tags: Stroke prevention, Prognosis, All Cerebrovascular disease/Stroke, Infarction ARTICLE Source Type: research

Letter re: Ischemic Lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
We appreciated the article by Kidwell et al.1 that showed higher first-recorded blood pressure (BP) and greater delta mean arterial pressure are associated with the development of diffusion-weighted imaging (DWI) lesions in acute intracerebral hemorrhage (ICH). The most desirable BP target and optimal antihypertensive strategy in ICH are controversial.2 The relationship between BP and outcome is more complex than simply linear, and mechanisms other than BP reduction play a role. There is accruing evidence that not only absolute BP levels but their variation over time affect ICH prognosis.3 Besides increasing the risk of he...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lattanzi, S., Silvestrini, M. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research

Teaching NeuroImages: Giant cell arteritis presenting with acute ischemic strokes due to diffuse intracranial stenoses
A 72-year-old woman with unremarkable medical history was admitted with acute ischemic strokes (AIS) in multiple arterial distributions in anterior and posterior circulation (figure 1A and supplemental data at Neurology.org). Elevated erythrocyte sedimentation rate (98 mm/h) prompted the evaluation of superficial temporal arteries (STA) with duplex sonography (halo sign; figure 1B) and contrast angiography (right STA [figure 2A] and multiple intracranial arterial stenoses [figure 2, A–D]). STA biopsy confirmed the diagnosis of giant cell arteritis (GCA; figure 1, C and D).
Source: Neurology - October 9, 2017 Category: Neurology Authors: Kargiotis, O., Safouris, A., Petrou, V. N., Magoufis, G., Stamboulis, E., Tsivgoulis, G. Tags: MRI, Ultrasound, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Some light in the shadows of atrial fibrillation and stroke: To look or not to look
In ischemic stroke, the diagnostic workup determines the best preventive strategy. However, cryptogenic stroke accounts for about 20%–40% of all strokes.1 For these patients, the best preventive treatment remains unknown, and most guidelines recommend risk factor modification and antiplatelet therapy. Given the substantial recurrence rate for cryptogenic stroke, this is not a comfortable situation: just try to tell your stroke patients, "After all these tests, I do not have any clue why you had a stroke"; and about the treatment, "Just take an aspirin and cross fingers you do not have another one."
Source: Neurology - October 9, 2017 Category: Neurology Authors: Ustrell, X., Tagawa, M. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Cardiac, Embolism EDITORIALS Source Type: research

Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3-4.5 hours
Conclusions: In this observational study, unselected patients >80 years of age treated with IVT after 3 hours vs earlier had a slightly higher rate of SICH and similar unadjusted functional outcome but poorer adjusted outcome. The absolute difference between the treatment groups is small, and elderly patients should not be denied IVT in the later time window solely because of age without other contraindications.
Source: Neurology - October 9, 2017 Category: Neurology Authors: Ahmed, N., Lees, K. R., Ringleb, P. A., Bladin, C., Collas, D., Toni, D., Ford, G. A., And the SITS Investigators Tags: All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Teaching NeuroImages: RCVS causing simultaneous convexity subarachnoid hemorrhage and hemimedullary infarction
A 34-year-old previously healthy man presented with thunderclap headache, dysphagia, dysarthria, and oscillopsia. Neurologic examination revealed right-beating nystagmus, dysphagia, hypophonia, right hemianesthesia, and left hemiparesis. Brain imaging showed convexity subarachnoid hemorrhage (figure 1A) and left hemimedullary infarct (figure 1B). Catheter angiography showed tapering of left vertebral artery and diffuse segmental vasoconstriction (figure 2). Routine serum and CSF results were unremarkable. Thorough infectious, immunologic, and coagulopathy workup was negative. Reversible cerebral vasoconstriction syndrome (...
Source: Neurology - September 18, 2017 Category: Neurology Authors: Selvan, P., Levine, S. R. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Infarction, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research