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Race/Ethnicity Considerations in the Prevention and Treatment of Stroke
AbstractPurpose of reviewTo describe racial and ethnic considerations that exist for the prevention and treatment of ischemic and hemorrhagic stroke.Recent findingsMultiple studies have characterized stroke disparities. The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) found that Black individuals have nearly twice the rates of stroke compared to White individuals. Differences in the incidence of stroke risk factors, both inherited and acquired, contribute to these disparities. Black individuals have an earlier age of onset, a longer duration, and greater severity of hypertension compared to White individuals....
Source: Current Treatment Options in Neurology - September 27, 2021 Category: Neurology Source Type: research

Advanced Imaging in the Era of Tissue-Based Treatment for Acute Ischemic Stroke —a Practical Review
AbstractPurpose of the reviewAdvanced imaging is now used to identify acute ischemic stroke (AIS) patients for treatment with tissue plasminogen activator or mechanical thrombectomy, who are either out of the traditional treatment window or have an unknown last known well time. Current guidelines recommend adapting the complex inclusion criteria used in the clinical trials to provide optimal individual patient decisions in clinical practice. This review aims to facilitate such integration by organizing the available data in a practical clinical context.Recent findingsWe review two clinical vignettes of advanced imaging for...
Source: Current Treatment Options in Neurology - September 20, 2021 Category: Neurology Source Type: research

Neurocritical Care of the Pregnant Patient
AbstractPurpose of reviewTo summarize recent changes in management and emerging therapies for pregnant neurocritical care patients.Recent findingsDiagnostic and treatment options for managing neurologic emergencies in pregnant patients have expanded with both greater understanding of the effects of imaging modalities and medications on pregnancy and application of standard treatments for non-pregnant patients to pregnant populations. Specifically, this includes cerebrovascular diseases (pregnancy-associated ischemic stroke, pregnancy-associated intracerebral hemorrhage, cerebral venous sinus thrombosis), post-maternal card...
Source: Current Treatment Options in Neurology - June 21, 2021 Category: Neurology Source Type: research

Severe Neurologic Complications of SARS-CoV-2
We present readers with a review of the literature of severe neurologic complications of SARS-CoV-2 and cases from our institution to illustrate these conditions.Recent FindingsNeurologic manifestations are being increasingly recognized in the literature. Some patients can have severe neurologic manifestations, though the true prevalence is unknown.SummarySevere neurologic complications of COVID-19 include large vessel occlusion ischemic stroke, intracranial hemorrhage, encephalitis, myelitis, Guillain-Barre syndrome, status epilepticus, posterior reversible encephalopathy syndrome, and hypoxic-ischemic encephalopathy. The...
Source: Current Treatment Options in Neurology - March 31, 2021 Category: Neurology Source Type: research

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review
AbstractPurposeExtracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists.Recent findingsThe most common neurologic injuries include intracerebral hemorrhage, ischemic stroke, seizure, cerebral edema, intracranial hypertension, global cerebra...
Source: Current Treatment Options in Neurology - March 31, 2021 Category: Neurology Source Type: research

Stroke Treatment in the Setting of Systemic Disease
AbstractWhile the possible stroke risks for more prevalent conditions, such as cardiac disease or cancer, are important to recognize, there are other equally devastating systemic diseases that can affect younger adults and, if not cautious, may be misdiagnosed if stroke is the initial presentation.Purpose of reviewWe aim to discuss treatments of three rarer, but important systemic diseases associated with an increased incidence of ischemic stroke, specifically sickle cell anemia, human immunodeficiency virus (HIV), and Takayasu ’s arteritis.Recent findingsGiven that individuals with these diseases are now living longer, ...
Source: Current Treatment Options in Neurology - November 13, 2020 Category: Neurology Source Type: research

COVID-19 Era Stroke Service: Virtually Normal
ConclusionsZoom conferences are a promising technology for stroke services. Further studies are needed to further elucidate their benefits and drawbacks.
Source: Current Treatment Options in Neurology - October 8, 2020 Category: Neurology Source Type: research

Vascular Events, Vascular Disease and Vascular Risk Factors —Strongly Intertwined with COVID-19
AbstractPurpose of reviewTo elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19.Recent findingsStrokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and over...
Source: Current Treatment Options in Neurology - October 8, 2020 Category: Neurology Source Type: research

Thrombolysis Before Thrombectomy in Acute Large Vessel Occlusion: a Risk/Benefit Assessment and Review of the Evidence
AbstractPurpose of ReviewRecent evidence has shown an overwhelming benefit of mechanical thrombectomy for acute anterior circulation large vessel occlusion (LVO). Whether there is any additional benefit of IV tPA treatment prior to thrombectomy over thrombectomy alone is unproven in randomized trials. In this review, we summarize the available evidence for and against pre-thrombectomy treatment with IV tPA.Recent FindingsIn clinical trials demonstrating efficacy of thrombectomy, the majority of included patients were eligible for (and treated with) IV tPA. Systemic thrombolysis prior to thrombectomy is fraught with potenti...
Source: Current Treatment Options in Neurology - June 28, 2020 Category: Neurology Source Type: research

Management of Cognitive Impairment After Stroke
AbstractPurpose of ReviewIn this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of  PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques.Recent FindingsAdvanced MRI techniques and newer PET tracers are being utilized h...
Source: Current Treatment Options in Neurology - June 15, 2020 Category: Neurology Source Type: research

Is there Still a Time Window in the Treatment of Acute Stroke?
AbstractPurpose of reviewIt has become evident that strict time-based criteria are not optimal in selecting patients for acute stroke intervention, leaving the majority of patients untreated due to missing universal time-based criteria. We discuss the pathophysiologic basis for a shift of focus from time to the imaging evidence of salvageable tissue, as well as clinical and imaging tools.Recent findingsThere is strong evidence for the benefit of thrombectomy in patients with a sustained salvageable tissue presenting within 24  h. Although evidence of benefit is limited in patients presenting longer than 24 h, those patie...
Source: Current Treatment Options in Neurology - June 2, 2020 Category: Neurology Source Type: research

Advancements in the Treatment of Cerebrovascular Complications of Cancer
AbstractPurpose of reviewTo present the new guidelines and therapeutic options regarding cerebrovascular complications of cancer, mainly ischemic stroke, cerebral venous thrombosis (CVT), and leptomeningeal carcinomatosis (LMC).Recent findingsA temporal trend study (2019) revealed that clinicians are still reluctant to apply thrombolysis to cancer patients, although two new studies (2018) reported no increased mortality. Several clinical trials on direct oral anticoagulants (DOACs) showed their superiority or, at least, non-inferiority compared with low molecular weight heparins in the treatment of venous thromboembolism (...
Source: Current Treatment Options in Neurology - April 29, 2020 Category: Neurology Source Type: research

Mobile Stroke Units: Bringing Treatment to the Patient
AbstractPurpose of reviewMobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.Recent findingsMultiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30  min faster than conventional care. The 90-day modified Rankin Scores ...
Source: Current Treatment Options in Neurology - February 5, 2020 Category: Neurology Source Type: research

Transcranial Magnetic Stimulation for the Treatment of Pediatric Neurological Disorders
AbstractPurpose of reviewRepetitive transcranial magnetic stimulation (rTMS) is a form of noninvasive brain stimulation that is used for the treatment of migraine and major depression in adults and is now being evaluated for use in other disorders. The purpose of this review is to summarize the physiology underlying TMS, the safety and tolerability in pediatric patients, and the evidence for TMS efficacy in the treatment of pediatric neurologic disorders.Recent findingsStudies investigating rTMS for adolescent depression, hemiparesis due to pediatric stroke, autism, and tics/Tourette syndrome have demonstrated some therape...
Source: Current Treatment Options in Neurology - November 12, 2019 Category: Neurology Source Type: research

Treatment of Extracranial Arterial Dissection: the Roles of Antiplatelet Agents, Anticoagulants, and Stenting
AbstractPurpose of reviewCervicocephalic arterial dissection (CeAD) is the most commonly identified cause of stroke in young healthy individuals. The management of acute ischemic stroke due to the diagnosed or suspected CeAD is well established and is appropriate for thrombolysis. There is a substantial risk of stroke recurrence in the early post-stroke period. The optimum method of stroke prevention in the subacute period remains debatable. In our review, we focused on the management of recurrent stroke in CeAD, the choice of various antithrombotic agents for stroke risk reduction with regard to specific pathogenetic mech...
Source: Current Treatment Options in Neurology - September 25, 2019 Category: Neurology Source Type: research

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