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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
Stroke in Pregnancy
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States. Other conditions associated with obstetric stroke include post...
Source: Neurologic Clinics - November 21, 2018 Category: Neurology Authors: Erica C. Camargo, Steven K. Feske, Aneesh B. Singhal Source Type: research
Unanswered Questions in Thrombolytic Therapy for Acute Ischemic Stroke
This article reviews some of the current literature in support or against extension of the intravenous tissue plasminogen activator window, use of intra-arterial therapy or devices, as well alternative pharmacologic therapies that may extend the window for treatment of patients with acute ischemic stroke, with consideration of the relative risk of thrombolytic complications, factors for worse outcomes, and unclear stroke onset, as seen in patients with wake-up stroke. The issue of newer concomitant antithrombotic therapies as they affect the decision for acute ischemic stroke thrombolytic therapy is also explored.
Source: Neurologic Clinics - May 13, 2013 Category: Neurology Authors: Adriana Sofia Ploneda Perilla, Michael J. Schneck Source Type: research
Recurrent Stroke while on Antiplatelet Therapy
Of the ≈795,000 strokes in the United States annually, 185,000 are recurrent. A third to half of them occur while on antiplatelet therapy. Multiple reasons could explain breakthrough stroke while on antiplatelet therapy. Management of recurrent stroke requires a meticulous search for the cause and mechanism of stroke. At present, there is no indication for antiplatelet resistance testing in ischemic stroke, or adjusting medications based on its results. Recent trials have shown the effectiveness of dual antiplatelet therapy in the acute period after an ischemic event, but no benefit has been found with this regimen for l...
Source: Neurologic Clinics - February 2, 2015 Category: Neurology Authors: Seby John, Irene Katzan Source Type: research
Stroke and Behavior
This article reviews the more familiar behavioral changes that follow stroke, as well as exotic, less often encountered manifestations. This article acquaints the clinician with the diversity of the behavioral effects of stroke, along with methods for their assessment and management.
Source: Neurologic Clinics - November 26, 2015 Category: Neurology Authors: Victor W. Mark 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
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
Platelet Antiaggregants in Stroke Prevention
Antiplatelet agents are one of the main interventions for recurrent ischemic stroke prevention. Their time of use, dosage, and combination of therapy have different effects in terms of stroke risk reduction and adverse effects. This review provides an evidence-based update of the latest on antiplatelet therapy for stroke prevention.
Source: Neurologic Clinics - June 24, 2013 Category: Neurology Authors: Sarkis G. Morales Vidal, Sean Ruland Source Type: research
Clinical Neurogenetics: Stroke
Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis.
Source: Neurologic Clinics - July 19, 2013 Category: Neurology Authors: Natalia S. Rost Source Type: research
The Therapeutic Value of Laboratory Testing for Hypercoagulable States in Secondary Stroke Prevention
Although screening for hypercoagulable states is commonly performed as part of the evaluation of first arterial ischemic stroke in young adults, available evidence does not support this as a routine practice, even in patients with cryptogenic stroke and a positive family history of early thrombotic events or in patients with a patent foramen ovale. Testing for antiphospholipid antibodies is a possible exception because persistent antibodies are associated with an increased risk of recurrent stroke. Despite the lack of supporting data, screening for hypercoagulable states in recurrent early-onset cryptogenic cerebral ischem...
Source: Neurologic Clinics - February 28, 2015 Category: Neurology Authors: Chandni Kalaria, Steven Kittner Source Type: research
Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo
Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is ve...
Source: Neurologic Clinics - June 13, 2015 Category: Neurology Authors: Seung-Han Lee, Ji-Soo Kim Source Type: research
Epidemiology of Ischemic Stroke
This article reviews salient aspects of ischemic stroke emphasizing the impact of neuroepidemiology and GWAS.
Source: Neurologic Clinics - October 11, 2016 Category: Neurology Authors: Albert S. Favate, David S. Younger 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
