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Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI
ConclusionsLA enlargement on echocardiogram was associated with SBI in patients with AF and low or moderate embolic risk according to CHADS2 and in the low-risk population according to CHA2DS2VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.
Source: Journal of Neurology - May 13, 2020 Category: Neurology Source Type: research

Ischemic stroke and dose adjustment of oral Factor Xa inhibitors in patients with atrial fibrillation
ConclusionOne in three patients with ischemic stroke during treatment with oral Xa inhibitors used inappropriate dose regimens. Underdosing was associated with lower functional plasma levels, higher clinical stroke severity and worse functional outcome.
Source: Journal of Neurology - March 22, 2020 Category: Neurology Source Type: research

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke
ConclusionsIn this MRI-based analysis of patients with cryptogenic stroke who had received ICM implantation, the detection rate of AF in patients with ICM was not related to the imaging pattern. In addition, the lacunar infarct pattern should not be an exclusion criterion for ICM insertion in patients with cryptogenic stroke. ICM insertion in patients with cryptogenic stroke should not be evaluated solely on the basis of reference to infarct patterns.
Source: Journal of Neurology - September 10, 2019 Category: Neurology Source Type: research

Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists
AbstractBackgroundAlthough direct oral anticoagulants (DOAC) have proven at least equally effective in the prevention of acute ischemic stroke (AIS) in patients with atrial fibrillation as compared to the vitamin K antagonists (VKA), no reliable data on the severity of AIS of DOAC patients as compared to VKA is available.MethodsUsing a prospectively collected cohort of AIS patients, we performed univariate and multivariate (displayed as adjusted Odds Ratios, OR and 95% confidence intervals, 95% CI) analyses regarding the severity of AIS in patients with preceding DOAC (N = 210) versus VKA (N = 173) therapy. Additio...
Source: Journal of Neurology - June 3, 2019 Category: Neurology Source Type: research

Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey
AbstractBackgroundThe overall global burden of stroke is considerable and increasing. In China, stroke is the leading cause of death and disability.MethodsFor this study, we used data from the National Stroke Screening Survey in 2012 and the 2010 Chinese population from sixth National Census of Populations to calculate a standardized (by age, gender, and education) stroke prevalence. Prevalence, risk factors, and management of stroke were compared by gender, age, and site.FindingsThe standardized prevalence rate of survival stroke patients in study population aged 60 and older was 4.94% in total. Hypertension was the most ...
Source: Journal of Neurology - April 14, 2019 Category: Neurology Source Type: research

Effect of small-vessel disease on cognitive trajectory after atrial fibrillation-related ischaemic stroke or  TIA
AbstractPost-stroke dementia is common but has heterogenous mechanisms that are not fully understood, particularly in patients with atrial fibrillation (AF)-related ischaemic stroke or TIA. We investigated the relationship between MRI small-vessel disease markers (including a composite cerebral amyloid angiopathy, CAA, score) and cognitive trajectory over 12  months. We included patients from the CROMIS-2 AF study without pre-existing cognitive impairment and with Montreal Cognitive Assessment (MoCA) data. Cognitive impairment was defined as MoCA<  26. We defined “reverters” as patients with an “acute” MoCA (...
Source: Journal of Neurology - March 6, 2019 Category: Neurology Source Type: research

Management of patients with stroke treated with direct oral anticoagulants
AbstractSince their market approval, direct oral anticoagulants (DOACs) are being increasingly used for stroke prevention in patients with atrial fibrillation. However, the management of DOAC-treated patients with stroke poses several challenges for physicians in everyday clinical practice, both in the acute setting and in long-term care. This has spurred extensive research activity in the field over the past few years, which we review here.
Source: Journal of Neurology - October 6, 2018 Category: Neurology Source Type: research

Occult paroxysmal atrial fibrillation in non-cryptogenic ischemic stroke
ConclusionLong-term monitoring of non-CIS patients detected PAF in a clinically relevant proportion of patients, resulting in stroke prevention therapy optimization. Further study to confirm these findings and refine the subset that would benefit from long-term cardiac monitoring is warranted.
Source: Journal of Neurology - October 1, 2018 Category: Neurology Source Type: research

Patent foramen ovale and stroke
AbstractA patent foramen ovale (PFO) is a highly prevalent finding in cryptogenic ischaemic stroke, particularly in young adults. A common challenge in clinical practice is to distinguish between incidental and pathogenic PFO. Some clinical features and tools such as the Risk of Paradoxical Embolism score may help determining the probability of a stroke-related PFO. Nonetheless, the best therapeutic option to reduce stroke recurrence after a cryptogenic stroke with PFO has been a matter of debate for a long time. We review the mechanisms of stroke-related PFO, together with its clinical features and diagnostic criteria. In...
Source: Journal of Neurology - April 21, 2018 Category: Neurology Source Type: research

Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials
ConclusionsTDC plus anti-thrombotic drugs is superior than medical therapy alone for secondary prevention of stroke, especially for those with male gender and with substantial shunt size of foramen ovale. Though it may increase the risk of postoperative atrial fibrillation, it would not bring higher risk of all-cause mortality, total adverse events and bleeding.
Source: Journal of Neurology - January 30, 2018 Category: Neurology Source Type: research

Stroke-associated infection independently predicts 3-month poor functional outcome and mortality
This study aimed to assess the effects of SAI on patient mortality and functional outcome at 3  months after stroke onset. We retrospectively analyzed 809 consecutive patients with acute stroke (517 men and 292 women; median age, 72 years) who were admitted to our department between September 2014 and June 2016. SAI was defined as an infection diagnosed during the hospitalization period. Po or outcome was defined as a modified Rankin Scale (mRS) score of 3–5 or death (mRS score of 6). The effect of SAI on functional outcome was evaluated using a multivariate logistic regression analysis. SAI occurred in 169 patients (2...
Source: Journal of Neurology - December 16, 2017 Category: Neurology Source Type: research

The clinical relevance of cerebral microbleeds in patients with cerebral ischemia and atrial fibrillation
Abstract The clinical significance of cerebral microbleeds (CMB) in patients hospitalized with atrial fibrillation (AF) and cerebral ischemia is unclear. We aimed to determine the prevalence of CMB in this population and determine the future risk of intracerebral hemorrhage (ICH) and cerebral infarction (CI). The medical records and brain imaging of patients hospitalized with cerebral ischemia due to AF between 2008 and 2011 were reviewed. Followup was obtained through medical record review, mailed survey, and acquisition of death certificates. Prevalence was calculated from those patients with a hemosiderin-sensi...
Source: Journal of Neurology - November 14, 2015 Category: Neurology Source Type: research

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study
Abstract Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days ...
Source: Journal of Neurology - November 14, 2015 Category: Neurology Source Type: research

Influence of previous physical activity on the outcome of patients treated by thrombolytic therapy for stroke
Abstract Physical activity prevents stroke and is associated with less severe strokes. The neuroprotective effect in patients treated with intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA), remains uncertain. We aimed at evaluating the relationship between previous physical activity and outcomes in stroke patients treated with i.v. rt-PA. OPHELIE-SPORT was a prospective observational multicenter study conducted in French and Japanese stroke patients treated with i.v. rt-PA. We evaluated the presence, weekly duration (<2, 2–5, >5 h) and intensity (light, moderate, heavy) of previous leisu...
Source: Journal of Neurology - August 14, 2015 Category: Neurology Source Type: research

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