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Source: Lancet Neurology
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Total 215 results found since Jan 2013.
In Context News in brief
Early decompressive hemicraniectomy reduces mortality without increasing the risk of severe disability in young patients (60 years or younger) with extensive middle cerebral artery stroke. Results of the DESTINY II trial now show that early hemicraniectomy also increases the probability of survival in older patients (N Engl J Med 2014; 370: 1091–100). 112 patients aged 61 years or older (median 70 years, range 61–82) with malignant middle cerebral artery infarction were randomly assigned to conservative treatment in the intensive care unit (63 patients) or hemicraniectomy (49 patients) within 48 h of symptom onset.
Source: Lancet Neurology - April 15, 2014 Category: Neurology Authors: The Lancet Neurology Tags: In Context Source Type: research
Comment Uric acid for stroke: glimmer of hope or false dawn?
In The Lancet Neurology, Ángel Chamorro and colleagues present the results of the URICO-ICTUS study of intravenous uric acid administered during alteplase treatment for ischaemic stroke. The primary endpoint—the proportion of patients with excellent outcome according to the modified Rankin Scale (mRS) score at 90 days—was not significantly higher with uric acid than with placebo (adjusted risk ratio 1·23 [95% CI 0·96–1·56]; p=0·099), but the investigators concluded that another, larger trial is warranted.
Source: Lancet Neurology - April 15, 2014 Category: Neurology Authors: Bruce CV Campbell, Stephen M Davis, Geoffrey A Donnan Tags: Comment Source Type: research
Personal View Embolic strokes of undetermined source: the case for a new clinical construct
Cryptogenic (of unknown cause) ischaemic strokes are now thought to comprise about 25% of all ischaemic strokes. Advances in imaging techniques and improved understanding of stroke pathophysiology have prompted a reassessment of cryptogenic stroke. There is persuasive evidence that most cryptogenic strokes are thromboembolic. The thrombus is thought to originate from any of several well established potential embolic sources, including minor-risk or covert cardiac sources, veins via paradoxical embolism, and non-occlusive atherosclerotic plaques in the aortic arch, cervical, or cerebral arteries.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Robert G Hart, Hans-Christoph Diener, Shelagh B Coutts, J Donald Easton, Christopher B Granger, Martin J O'Donnell, Ralph L Sacco, Stuart J Connolly, for the Cryptogenic Stroke/ESUS International Working Group Tags: Personal View Source Type: research
Review Outcome markers for clinical trials in cerebral amyloid angiopathy
Efforts are underway for early-phase trials of candidate treatments for cerebral amyloid angiopathy, an untreatable cause of haemorrhagic stroke and vascular cognitive impairment. A major barrier to these trials is the absence of consensus on measurement of treatment effectiveness. A range of potential outcome markers for cerebral amyloid angiopathy can be measured against the ideal criteria of being clinically meaningful, closely representative of biological progression, efficient for small or short trials, reliably measurable, and cost effective.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Steven M Greenberg, Rustam Al-Shahi Salman, Geert Jan Biessels, Mark van Buchem, Charlotte Cordonnier, Jin-Moo Lee, Joan Montaner, Julie A Schneider, Eric E Smith, Meike Vernooij, David J Werring Tags: Review Source Type: research
Review Current concepts and clinical applications of stroke genetics
Driven by innovative technologies, novel analytical methods, and collaborations unimaginable not long ago, our understanding of the role of genetic variation in stroke has advanced substantially in recent years. However, a vast amount of data have accumulated quickly, and increasingly complex methodologies used in studies make keeping up to date on relevant findings difficult. In addition to well known, highly penetrant rare mutations that cause mendelian disorders related to stroke, several common genetic variants have been associated with common stroke subtypes, some of which also affect disease severity and clinical outcome.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Guido J Falcone, Rainer Malik, Martin Dichgans, Jonathan Rosand Tags: Review Source Type: research
Articles Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study
Our findings suggest that systolic blood pressure is substantially raised compared with usual premorbid levels after intracerebral haemorrhage, whereas acute-phase systolic blood pressure after major ischaemic stroke is much closer to the accustomed long-term premorbid level, providing a potential explanation for why the risks and benefits of lowering blood pressure acutely after stroke might be expected to differ.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Urs Fischer, Marie Therese Cooney, Linda M Bull, Louise E Silver, John Chalmers, Craig S Anderson, Ziyah Mehta, Peter M Rothwell Tags: Articles Source Type: research
Comment Embolic stroke of undetermined source: a therapeutic target?
After a diagnosis of stroke, one of the main purposes of further investigation is to establish the probable underlying cause or causes and thus tailor treatment to reduce the risk of recurrence. This risk is highest initially (at least 10% in the first few weeks) and reduces to perhaps 5% per year within 12 months. The higher early risk is mainly in individuals with cardiac embolism or large artery disease, and less in those with lacunar stroke due to cerebral small-vessel disease.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Martin Dennis Tags: Comment Source Type: research
Comment Blood pressure in acute stroke
Although great advances have been made in stroke medicine in the past two decades, some questions about treatment in the acute phase of stroke remain. One such question is how to manage blood pressure? Blood pressure is often increased in acute ischaemic and haemorrhagic stroke, and findings from epidemiological studies suggest that high blood pressure in the acute phase is associated with poor outcome. The results of three large randomised clinical trials on blood pressure lowering in acute stroke—the Chinese Antihypertensive Trial in Acute Ischaemic Stroke, the Intensive Blood Pressure Reduction in Acute Cerebral Haemo...
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: Else Charlotte Sandset Tags: Comment Source Type: research
Editorial Sex differences and stroke prevention
International Women's Day was fast approaching as this issue of The Lancet Neurology went to press, so it seemed appropriate to celebrate the publication of the first set of guidelines to focus exclusively on the prevention of stroke in women. The guidelines from the American Heart Association (AHA) and the American Stroke Association identify stroke risk factors that are unique to or more common in women, or that preferentially increase risk in women compared with men, and provide evidence-based recommendations for stroke prevention across the lifespan.
Source: Lancet Neurology - March 17, 2014 Category: Neurology Authors: The Lancet Neurology Tags: Editorial Source Type: research
Review Connectivity-based approaches in stroke and recovery of function
After focal damage, cerebral networks reorganise their structural and functional anatomy to compensate for both the lesion itself and remote effects. Novel developments in the analysis of functional neuroimaging data enable us to assess in vivo the specific contributions of individual brain areas to recovery of function and the effect of treatment on cortical reorganisation. Connectivity analyses can be used to investigate the effect of stroke on cerebral networks, and help us to understand why some patients make a better recovery than others.
Source: Lancet Neurology - January 20, 2014 Category: Neurology Authors: Christian Grefkes, Gereon R Fink Tags: Review Source Type: research
Articles Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial
Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy. However, the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance, which leaves the clinical relevance in question.
Source: Lancet Neurology - January 20, 2014 Category: Neurology Authors: Verena Klamroth-Marganska, Javier Blanco, Katrin Campen, Armin Curt, Volker Dietz, Thierry Ettlin, Morena Felder, Bernd Fellinghauer, Marco Guidali, Anja Kollmar, Andreas Luft, Tobias Nef, Corina Schuster-Amft, Werner Stahel, Robert Riener Tags: Articles Source Type: research
Review Secondary stroke prevention
Survivors of stroke and transient ischaemic attacks are at risk of a recurrent stroke, which is often more severe and disabling than the index event. Optimum secondary prevention of recurrent stroke needs rapid diagnosis and treatment and prompt identification of the underlying cardiovascular cause. Effective treatments include organised acute assessment and intervention with antithrombotic therapy, carotid revascularisation, and control of causal risk factors, as appropriate. However, effective treatments are not implemented optimally in clinical practice.
Source: Lancet Neurology - January 20, 2014 Category: Neurology Authors: Graeme J Hankey Tags: Review Source Type: research
Comment Effects of robotic therapy of the arm after stroke
The development of robots to help with rehabilitation of paretic arms and legs after stroke is based on translational research. The exoskeleton robot ARMin has seven actuated axes (ie, degrees of freedom), making it the most advanced commercially available robot offering antigravity support for a paretic arm. The efficient gears and sensors in the exoskeleton control the position and interaction force between robot and user, allowing patients with severe impairment to safely practise daily tasks and play games in a virtual environment.
Source: Lancet Neurology - January 20, 2014 Category: Neurology Authors: Gert Kwakkel, Carel G M Meskers Tags: Comment Source Type: research
In Context News in brief
The extent to which the effect of excess weight on cardiovascular disease, including stroke, is mediated by metabolic factors is an important clinical and public health concern. The hazard ratio (HR) of body mass index (BMI) on stroke was calculated from pooled data from 97 prospective studies comprising 1·8 million adult participants (31 093 stroke events) between 1948 and 2005 (Lancet 2013; published online Nov 22. http://dx.doi.org/10.1016/S0140-6736(13)61836-0). The hazard ratio for every 5 kg/m2 increase in BMI was 1·18 (95% CI 1·14–1·22) for stroke.
Source: Lancet Neurology - December 9, 2013 Category: Neurology Authors: The Lancet Neurology Tags: In Context Source Type: research
Articles Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study
Age and racial group, but not sex, affected the risk of arterial ischaemic stroke in children. Investigation of such differences might provide causative insights.
Source: Lancet Neurology - December 9, 2013 Category: Neurology Authors: Andrew A Mallick, Vijeya Ganesan, Fenella J Kirkham, Penny Fallon, Tammy Hedderly, Tony McShane, Alasdair P Parker, Evangeline Wassmer, Elizabeth Wraige, Samir Amin, Hannah B Edwards, Kate Tilling, Finbar J O'Callaghan Tags: Articles Source Type: research
