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Source: Neurologic Clinics
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Total 72 results found since Jan 2013.
Women and Ischemic Stroke
Although men are at higher risk of stroke throughout most of their lifespan, the incidence of stroke in women climbs with age, increasing after menopause and rising sharply after 85 years. This, combined with women's longer life expectancy, results in most of the stroke deaths occurring in women. In addition to accounting for a larger proportion of strokes, women may also suffer a survival disadvantage, which may be due to several factors. In many families, women are the primary caretakers. When they become disabled, there may be limited options to care for them. Others suggest that some of the disparities in stroke outcom...
Source: Neurologic Clinics - February 13, 2023 Category: Neurology Authors: Laurel Cherian Source Type: research
Surgical Indications and Options for Hypertensive Hemorrhages
This article reviews the data surrounding the surgical management of intracerebral hemorrhage, including open and minimally invasive techniques and discusses the controversies and future directions surrounding surgical management.
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Kelsey M. Bowman, Azam S. Ahmed Source Type: research
Decompressive Craniectomy for Stroke: Who, When, and How
Malignant cerebral edema after large hemispheric infarct is a highly morbid condition, and major, randomized trials over the last 2 decades have affirmed the beneficial effect of surgical intervention in the form of decompressive craniectomy. Early (
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: Gregory J. Cannarsa, J. Marc Simard Source Type: research
Current State of the Art in Endovascular Stroke Treatment
Following the successful completion of 5 major trials establishing the clinical efficacy of endovascular thrombectomy for ELVO in the setting of AIS, there has been a tremendous focus on identifying additional patient populations that may benefit from the intervention. Improved imaging modalities and subsequent trials found thrombectomy to be highly efficacious in patients presenting up to 24 hours after stroke onset, particularly with good collaterals and large penumbral regions. Iterative catheter and device development have improved the safety profile and enhanced the efficacy of the procedure with the introduction of...
Source: Neurologic Clinics - March 31, 2022 Category: Neurology Authors: David Dornbos, Adam S. Arthur Source Type: research
Social Determinants of Health in Neurology
Neurologic health disparities are created and perpetuated by structural and social determinants of health. These factors include, but are not limited to, interpersonal bias, institutional factors that lead to disparate access to care, and neighborhood-level factors, such as socioeconomic status, segregation, and access to healthy food. Effects of these determinants of health can be seen throughout neurology, including in stroke, epilepsy, headache, amyotrophic lateral sclerosis, multiple sclerosis, and dementia. Interventions to improve neurologic health equity require multilayered approaches to address these interdependen...
Source: Neurologic Clinics - November 17, 2021 Category: Neurology Authors: Nicole Rosendale Source Type: research
Quality Improvement Metrics and Methods for Neurohospitalists
Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, per...
Source: Neurologic Clinics - November 17, 2021 Category: Neurology Authors: Kathryn A. Kvam, Eric Bernier, Carl A. Gold Source Type: research
Inpatient Management of Acute Stroke and Transient Ischemic Attack
This article focuses on the inpatient evaluation and management of ischemic stroke and transient ischemic attack (TIA). We describe foundational principles including quality metrics, TIA, and stroke as emergencies, TIA/minor stroke management, and standard assessments before discussing tailored evaluation and management strategies by stroke type.
Source: Neurologic Clinics - November 17, 2021 Category: Neurology Authors: Lauren Patrick, Cathra Halabi Source Type: research
Acute Treatment of Ischemic Stroke
This article outlines the evidence to support intravenous thrombolysis with alteplase and tenecteplase, thrombolysis in the setting of DWI/flair mismatch, endovascular treatment in the 6-hour and 6- to 24-hour window, and the use of telemedicine in acute stroke. Current controversies and ongoing trials within endovascular treatment are also detailed. Case presentations are included to provide clinical context and the application of data to practice.
Source: Neurologic Clinics - November 17, 2021 Category: Neurology Authors: Stephanie Lyden, Jana Wold Source Type: research
Emergency Care of Patients with Acute Ischemic Stroke
Stroke is a leading cause of morbidity and mortality and a major cause of long-term disability. Management of acute ischemic stroke in the first hours is critical to patient outcomes. This review provides an overview of acute ischemic stroke management, with a focus on the golden hour. Additional topics discussed include prehospital considerations and initial evaluation of the patient with history, examination, and imaging as well as treatment options, including thrombolysis and endovascular therapy.
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Adeel S. Zubair, Kevin N. Sheth Source Type: research
Aneurysmal Subarachnoid Hemorrhage
Aneurysmal subarachnoid hemorrhage is a neurologic emergency that requires immediate patient stabilization and prompt diagnosis and treatment. Early measures should focus on principles of advanced cardiovascular life support. The aneurysm should be evaluated and treated in a comprehensive stroke center by a multidisciplinary team capable of endovascular and, operative approaches. Once the aneurysm is secured, the patient is best managed by a dedicated neurocritical care service to prevent and manage complications, including a syndrome of delayed neurologic decline. The goal of such specialized care is to prevent secondary ...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: David Y. Chung, Mohamad Abdalkader, Thanh N. Nguyen Source Type: research
Intracerebral Hemorrhage
Intracerebral hemorrhage is a stroke subtype with high mortality and poor functional outcome in survivors. Its main causes are hypertension, cerebral amyloid angiopathy, and anticoagulant treatment. Hematomas have a high frequency of expansion in the first hours after symptom onset, a process associated with neurologic deterioration and poor outcome. Control of severe hypertension, reversal of anticoagulant effect, and management of increased intracranial pressure are the mainstays of management of intracerebral hemorrhage in the acute phase. Surgical evacuation of the hematoma by conventional craniotomy does not improve o...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Carlos S. Kase, Daniel F. Hanley Source Type: research
Anesthesia Considerations in Neurological Emergencies
This article provides a summary of the unique airway management and anesthesia considerations and controversies for neurologic emergencies in general, as well as for specific commonly encountered conditions: elevated intracranial pressure, neuromuscular respiratory failure, acute ischemic stroke, and acute cervical spinal cord injury.
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Anil Ramineni, Erik A. Roberts, Molly Vora, Sohail K. Mahboobi, Ala Nozari Source Type: research
Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic
Although minor neurologic complications of coronavirus disease 2019 are common, life-threatening neurologic emergencies are rare. Acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, seizures, and posterior reversible encephalopathy syndrome have been described. Hospitals have seen significant changes in the volume of patients presenting with neurologic emergencies. We review what has thus far been published about the intersection of coronavirus disease 2019 and neurologic emergencies with particular attention to cerebrovascular disease and seizure. Considerations in managing the acute presentations of...
Source: Neurologic Clinics - March 26, 2021 Category: Neurology Authors: Julie G. Shulman, Thomas Ford, Anna M. Cervantes-Arslanian Source Type: research
Advances and Ongoing Controversies in Patent Foramen Ovale Closure and Cryptogenic Stroke
Up to a third of strokes are cryptogenic. The prevalence of patent foramen ovale (PFO) in patients with cryptogenic stroke is higher than in individuals with stroke of known origin. It has been proposed that some cryptogenic strokes can be caused by paradoxic embolism across a PFO. The treatment of PFO includes medical treatment with antithrombotic agents and percutaneous PFO closure. There is limited evidence to support PFO closure in unselected cases of cryptogenic stroke. However, large randomized clinical trials confirmed the superiority of transcatheter PFO closure compared with medical treatment in young patients wit...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Joaquin B. Gonzalez, Fernando D. Testai Source Type: research
Neurotoxicology Syndromes Associated with Drugs of Abuse
This article focuses on the epidemiology, pharmacology, and complications associated wit h commonly used recreational drugs, including opioids, alcohol, marijuana, cocaine, and hallucinogens.
Source: Neurologic Clinics - October 9, 2020 Category: Neurology Authors: Rachel A. Caplan, Jonah P. Zuflacht, Jed A. Barash, Corey R. Fehnel Source Type: research
