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Complete lingual palsy from bilateral Dejerine syndrome (bilateral medial medullary stroke)
A 63-year-old man with several vascular risk factors presented with sudden left hemiplegia rapidly evolving to quadriparesis, dysarthria, bilateral hypoglossal palsy (video 1 on the Neurology® Web site at Neurology.org), and respiratory failure. IV thrombolysis with recombinant tissue plasminogen activator was administered. MRI confirmed bilateral medial medullary infarction (figure, A), and CT and magnetic resonance angiography showed right vertebral artery V4 occlusion, presumably atherosclerotic (figure, B). Tongue mobility recovered completely after 3 months (video 2).
Source: Neurology - July 31, 2016 Category: Neurology Authors: Tsetsou, S., Beuchat, I., Laginha, I., Michel, P. Tags: MRI, Other cerebrovascular disease/ Stroke, Clinical neurology examination, Other Education VIDEO NEUROIMAGES Source Type: research

Rupture of vertebral artery dissection aneurysm during 3D DSA
A 60-year-old man with a history of headache and vomiting had a subarachnoid hemorrhage on CT scan. On 2-dimensional (2D) digital subtraction angiography (DSA), a possible dissection aneurysm of the vertebral artery was seen (video 1 on the Neurology® Web site at Neurology.org). During 3D DSA, the aneurysm suddenly ruptured (video 2), with intracranial hemorrhage. The pressure of contrast was 200 psi, the rate was 2 mL/s, with a total volume of 12 mL. The patient was transferred to the intensive care unit but died of brain herniation and vasospasm. Few dissection aneurysms rupture during 3D DSA, but the risk is likely ...
Source: Neurology - July 10, 2016 Category: Neurology Authors: Xu, D., Wang, C., Zhang, C., Xiang, S., Xie, X. Tags: All Imaging, All Clinical Neurology, All Cerebrovascular disease/Stroke, Critical care, All Education VIDEO NEUROIMAGES Source Type: research

Journal Club: Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage
Intracerebral hemorrhage (ICH) remains one of the most catastrophic stroke subtypes, with high case-fatality rate and poor functional outcomes. In the Journal Club article "Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage" by Jolink et al.,1 hospital and population registries were used to assess age- and sex-specific trends in incidence and case fatality of patients with ICH in the Netherlands. The study provides a significant epidemiologic contribution examining a large cohort of patients with ICH from 1980 to 2010. The authors report a decline in incidence, case-fatality, and mortality r...
Source: Neurology - May 15, 2016 Category: Neurology Authors: Charidimou, A., Morotti, A., Valenti, R., Giese, A.-K., Boulouis, G., Pasi, M., Roongpiboonsopit, D., Lauer, A., Xiong, L., Van Harten, T. W., Karadeli, H., Fotiadis, P., Jessel, M. J., Viswanathan, A. Tags: All Cerebrovascular disease/Stroke, All Education, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

A call for formal telemedicine training during stroke fellowship
During the 20 years since US Food and Drug Administration approval of IV tissue plasminogen activator for acute ischemic stroke, vascular neurology consultation via telemedicine has contributed to an increased frequency of IV tissue plasminogen activator administration and broadened geographic access to the drug. Nevertheless, a growing demand for acute stroke coverage persists, with the greatest disparity found in rural communities underserved by neurologists. To provide efficient and consistent acute care, formal training in telemedicine during neurovascular fellowship is warranted. Herein, we describe our experiences in...
Source: Neurology - May 8, 2016 Category: Neurology Authors: Jagolino, A. L., Jia, J., Gildersleeve, K., Ankrom, C., Cai, C., Rahbar, M., Savitz, S. I., Wu, T.-C. Tags: All Health Services Research, All Cerebrovascular disease/Stroke, All Education CONTEMPORARY ISSUES: INNOVATIONS IN EDUCATION Source Type: research

Comment: Telemedicine training during stroke fellowship
In 2009, the American Heart Association recommended the implementation of telemedicine within stroke systems of care.1 Telestroke services have expanded throughout the United States, and have led to improvements in access to care, recombinant tissue plasminogen activator utilization, and cost-effectiveness. Medical trainees must be educated to utilize these new technologies and health care delivery models. There is limited information on the training of telemedicine providers and what education is necessary. A recent article recommended telemedicine-related enhancements to Accreditation Council for Graduate Medical Educati...
Source: Neurology - May 8, 2016 Category: Neurology Authors: Lynch, J. Tags: All Health Services Research, All Cerebrovascular disease/Stroke, All Education CONTEMPORARY ISSUES: INNOVATIONS IN EDUCATION Source Type: research

Factors Influencing Oral Anticoagulant Prescribing Practices for Atrial Fibrillation among Cardiologists, Internists, and Vascular Neurologists (P1.227)
Conclusions: Medical specialties differ in their reasons for selecting NOACs over warfarin and in their use of aspirin with warfarin. Educational interventions may prevent misinterpretations of clinical trial results, particularly with regards to comparative efficacy in the prevention of ischemic stroke and intracerebral hemorrhage. Disclosure: Dr. Leung has nothing to disclose. Dr. Mcallister has nothing to disclose. Dr. Selim has nothing to disclose. Dr. Fisher has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Leung, L., Mcallister, M., Selim, M., Fisher, M. Tags: Cardiac Mechanisms and Complications of Stroke Source Type: research

American Indian Participation in Clinical Research: A Cultural Perspective Survey from a CREST-2 Site (P1.239)
Conclusions: These data support our hypothesis that cultural beliefs have a strong impact on AI/AN willingness to participate in research. It is important for researchers to consider cultural beliefs when designing recruitment strategies for AI/AN populations. Future work will address how cultural beliefs affect AI/ANs’ understanding of and willingness to participate in clinical research.Disclosure: Dr. Bennett has nothing to disclose. Dr. Aitken has nothing to disclose. Dr. Longbottom has nothing to disclose. Dr. Brown has nothing to disclose. Dr. De Havenon has nothing to disclose. Dr. Majersik has nothing to discl...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Bennett, A., Aitken, K., Longbottom, M., Brown, R., De Havenon, A., Majersik, J., Robb, D. Tags: Carotid Disease Source Type: research

A Comparative Analysis of Stroke in Haitian and Non-Haitian Populations of South Florida (P1.259)
Conclusions: Multiple factors may play a role in these significant differences, including healthcare disparities and differences in socioeconomic status. Policies aimed at improving access to healthcare, patient education, and health care provider cultural/language comprehension should benefit Haitian stroke patient outcomes. Study Supported by: N/ADisclosure: Dr. Barratt has nothing to disclose. Dr. Brown has nothing to disclose. Dr. Lopez has nothing to disclose. Dr. Sirutis has nothing to disclose. Dr. Lozano has nothing to disclose. Dr. Starosciak has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Barratt, D., Brown, C., Lopez, J., Sirutis, B., Lozano, J., Starosciak, A. Tags: Cerebrovascular Disease: Health Disparities Source Type: research

A Survey on Knowledge of Stroke Subtypes and Etiology at Moi Teaching and Referral Hospital (P1.260)
Conclusions: HS is an under recognized part of stroke subtype at MTRH. Kenya has yet to develop specific national guidelines for HS management. The goal is to utilize the results from this survey to develop education and process improvement initiatives. We hope this will translate into improved care and outcomes for patients with stroke at MTRH.Disclosure: Dr. Lin has nothing to disclose. Dr. Guhwe has nothing to disclose. Dr. Vakani has nothing to disclose. Dr. Kussin has nothing to disclose. Dr. Graffagnino has received personal compensation for activities with Alsius and Medivance as an advisor.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Lin, C., Guhwe, M., Vakani, R., Kussin, P., Graffagnino, C. Tags: Cerebrovascular Disease: Health Disparities Source Type: research

Network dysfunction predicts speech production after left hemisphere stroke
Conclusions: Speech production is dependent on complex interactions among widely distributed brain networks, indicating that residual speech production after stroke depends on more than the restoration of local domain-specific functions. Our understanding of the recovery of function following focal lesions is not adequately captured by consideration of ipsilesional or contralesional brain regions taking over lost domain-specific functions, but is perhaps best considered as the interaction between what remains of domain-specific networks and domain-general systems that regulate behavior.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Geranmayeh, F., Leech, R., Wise, R. J. S. Tags: All Cerebrovascular disease/Stroke, Aphasia ARTICLE Source Type: research

Prognostic Risk Profiles for Dementia: A Machine Learning Approach (P1.091)
Conclusions: These results suggest that vascular factors may play a greater role in dementia pathogenesis than currently thought. Furthermore, using this method we were able to achieve prediction accuracies that compare favorably with the existing literature.Disclosure: Dr. Morgenstern has nothing to disclose. Dr. Daley has nothing to disclose. Dr. Hachinski has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Morgenstern, J., Daley, M., Hachinski, V. Tags: Epidemiology of Aging and Dementias Source Type: research

Temporal and Racial Trends in Post-Stroke Dementia in the "Stroke Buckle" of the United States (P1.099)
CONCLUSIONS: Over the last decade, incidence of PSD significantly increased in South Carolina. Black stroke patients had higher overall rates of PSD than whites, but this difference was largely driven by a comparatively greater burden of Non-AD dementia. Since Non-AD dementia is predominantly composed of vascular dementia, better vascular risk factor control may help bridge this racial disparity.Disclosure: Dr. Boan has nothing to disclose. Dr. Lackland has nothing to disclose. Dr. Feng has nothing to disclose. Dr. Voeks has nothing to disclose. Dr. Adams has received personal compensation for activities with Reach Call In...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Boan, A., Lackland, D., Feng, W., Voeks, J., Adams, R., Bachman, D., Ovbiagele, B. Tags: Neuroepidemiology: Aging and Dementia, Epilepsy, and Education Source Type: research

Formal Education, Socioeconomic Status and Severity of Neglect (P1.119)
Conclusions: These findings suggest that higher years of education do not decrease the severity of neglect in patients after stroke involving the non-dominant hemisphere. Unlike language disorders, neglect does not seem to be affected by education level. Patients from higher SES class showed less severe neglect; further research is needed to determine if this can be explained by differences in stroke characteristics, brain characteristics (e.g. leukoareosis), or interventions.Disclosure: Dr. Kharal has nothing to disclose. Dr. Suneja has nothing to disclose. Dr. Hillis received personal compensation in an editorial capacit...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kharal, A., Suneja, A., Hillis, A. Tags: Cerebrovascular Disease: Epidemiology Source Type: research

Smoking is Associated with All-Cause Mortality after Stroke (P1.121)
Conclusions: Stroke survivors who continue to smoke are nearly 2.5 times more likely to die of all causes compared to those who never smoked and nearly twice as likely to die of all causes compared to former smokers. These findings underscore the importance of smoking cessation counseling in order to improve outcomes after stroke.Disclosure: Dr. MacCallum has nothing to disclose. Dr. Lekoubou Looti has nothing to disclose. Dr. Ovbiagele has nothing to disclose. Dr. Markovic has nothing to disclose. Dr. Towfighi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: MacCallum, H., Lekoubou Looti, A., Ovbiagele, B., Markovic, D., Towfighi, A. Tags: Cerebrovascular Disease: Epidemiology Source Type: research

Increasing Skeletal Muscle Mass Could Prevent Stroke (P1.177)
Conclusion: High SMM group had low WMC/SI, especially in men. Increased SMM by muscle strengthening exercise may prevent stroke.Disclosure: Dr. Minn has nothing to disclose. Dr. Suk has nothing to disclose. Dr. Koh has nothing to disclose. Dr. Hwang has nothing to disclose. Dr. Park has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Song has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Minn, Y. K., Suk, S. H., Koh, I. S., Hwang, S.-H., Park, J. H., Lee, J. H., Song, H. Tags: Cerebrovascular Disease: Risk Factors and Prevention Source Type: research

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