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Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation
Publication date: Available online 8 November 2018Source: The Lancet NeurologyAuthor(s): David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo NorrvingSummaryBackgroundAbout 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population,...
Source: The Lancet Neurology - November 9, 2018 Category: Neurology Source Type: research

Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial
This study is registered with ClinicalTrials.gov, number NCT01436487. Findings The study was done between Oct 24, 2011, and Dec 7, 2015. After safety assessments in eight patients in group 1, 129 patients were randomly assigned (67 to receive multipotent adult progenitor cells and 62 to receive placebo) in groups 2 and 3 (1200 million cells). The ITT populations consisted of 65 patients who received multipotent adult progenitor cells and 61 patients who received placebo. There were no dose-limiting toxicity events in either group. There were no infusional or allergic reactions and no difference in treatment-emergent advers...
Source: The Lancet Neurology - March 17, 2017 Category: Neurology Source Type: research

Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial
Publication date: Available online 27 March 2015 Source:The Lancet Neurology Background Brain scans are essential to exclude haemorrhage in patients with suspected acute ischaemic stroke before treatment with alteplase. However, patients with early ischaemic signs could be at increased risk of haemorrhage after alteplase treatment, and little information is available about whether pre-existing structural signs, which are common in older patients, affect response to alteplase. We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase. Methods IST-3 was a multicentre, randomised ...
Source: The Lancet Neurology - March 27, 2015 Category: Neurology Source Type: research

Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
We report the effect of intravenous alteplase on long-term survival after ischaemic stroke of participants in the Third International Stroke Trial (IST-3). Methods In IST-3, done at 156 hospitals in 12 countries (Australia, Europe, and the UK), participants (aged >18 years) were randomly assigned with a telephone voice-activated or web-based system in a 1:1 ratio to treatment with intravenous 0·9 mg/kg alteplase plus standard care or standard care alone within 6 h of ischaemic stroke. We followed up participants in the UK and Scandinavia (Sweden and Norway) for survival up to 3 years after randomisation using data...
Source: The Lancet Neurology - July 19, 2016 Category: Neurology Source Type: research

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial
Publication date: Available online 22 May 2019Source: The Lancet NeurologyAuthor(s): Rustam Al-Shahi Salman, David P Minks, Dipayan Mitra, Mark A Rodrigues, Priya Bhatnagar, Johann C du Plessis, Yogish Joshi, Martin S Dennis, Gordon D Murray, David E Newby, Peter A G Sandercock, Nikola Sprigg, Jacqueline Stephen, Cathie L M Sudlow, David J Werring, William N Whiteley, Joanna M Wardlaw, Philip M White, Colin Baigent, Daniel LassersonSummaryBackgroundFindings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antipl...
Source: The Lancet Neurology - May 23, 2019 Category: Neurology Source Type: research

Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial
Publication date: May 2016 Source:The Lancet Neurology, Volume 15, Issue 6 Author(s): Thorsten Steiner, Sven Poli, Martin Griebe, Johannes Hüsing, Jacek Hajda, Anja Freiberger, Martin Bendszus, Julian Bösel, Hanne Christensen, Christian Dohmen, Michael Hennerici, Jennifer Kollmer, Henning Stetefeld, Katja E Wartenberg, Christian Weimar, Werner Hacke, Roland Veltkamp Background Haematoma expansion is a major cause of mortality in intracranial haemorrhage related to vitamin K antagonists (VKA-ICH). Normalisation of the international normalised ratio (INR) is recommended, but optimum haemostatic managemen...
Source: The Lancet Neurology - April 19, 2016 Category: Neurology Source Type: research

The glymphatic pathway in neurological disorders
Publication date: November 2018Source: The Lancet Neurology, Volume 17, Issue 11Author(s): Martin Kaag Rasmussen, Humberto Mestre, Maiken NedergaardSummaryBackgroundThe glymphatic (glial-lymphatic) pathway is a fluid-clearance pathway identified in the rodent brain in 2012. This pathway subserves the flow of CSF into the brain along arterial perivascular spaces and subsequently into the brain interstitium, facilitated by aquaporin 4 (AQP4) water channels. The pathway then directs flow towards the venous perivascular and perineuronal spaces, ultimately clearing solutes from the neuropil into meningeal and cervical lymphatic...
Source: The Lancet Neurology - October 19, 2018 Category: Neurology Source Type: research

Diagnosis of Parkinson's disease on the basis of clinical and genetic classification: a population-based modelling study
Publication date: Available online 10 August 2015 Source:The Lancet Neurology Author(s): Mike A Nalls, Cory Y McLean, Jacqueline Rick, Shirley Eberly, Samantha J Hutten, Katrina Gwinn, Margaret Sutherland, Maria Martinez, Peter Heutink, Nigel M Williams, John Hardy, Thomas Gasser, Alexis Brice, T Ryan Price, Aude Nicolas, Margaux F Keller, Cliona Molony, J Raphael Gibbs, Alice Chen-Plotkin, Eunran Suh, Christopher Letson, Massimo S Fiandaca, Mark Mapstone, Howard J Federoff, Alastair J Noyce, Huw Morris, Vivianna M Van Deerlin, Daniel Weintraub, Cyrus Zabetian, Dena G Hernandez, Suzanne Les...
Source: The Lancet Neurology - August 11, 2015 Category: Neurology Source Type: research

Dementia risk after spontaneous intracerebral haemorrhage: a prospective cohort study
Publication date: July 2016 Source:The Lancet Neurology, Volume 15, Issue 8 Author(s): Solène Moulin, Julien Labreuche, Stéphanie Bombois, Costanza Rossi, Gregoire Boulouis, Hilde Hénon, Alain Duhamel, Didier Leys, Charlotte Cordonnier Background Dementia occurs in at least 10% of patients within 1 year after stroke. However, the risk of dementia after spontaneous intracerebral haemorrhage that accounts for about 15% of all strokes has not been investigated in prospective studies. We aimed to determine the incidence of dementia and risk factors after an intracerebral haemorrhage. Methods We did a prospective...
Source: The Lancet Neurology - June 6, 2016 Category: Neurology Source Type: research

Association between plasma GFAP concentrations and MRI abnormalities in patients with CT-negative traumatic brain injury in the TRACK-TBI cohort: a prospective multicentre study
This study is registered with ClinicalTrials.gov, number NCT02119182.FindingsBetween Feb 26, 2014, and June 15, 2018, we recruited 450 patients with normal head CT scans (of whom 330 had negative MRI scans and 120 had positive MRI scans), 122 orthopaedic trauma controls, and 209 healthy controls. AUC for GFAP in patients with CT-negative and MRI-positive findings versus patients with CT-negative and MRI-negative findings was 0·777 (95% CI 0·726–0·829) over 24 h. Median plasma GFAP concentration was highest in patients with CT-negative and MRI-positive findings (414·4 pg/mL, 25–75th percentile 139·3–813·4), foll...
Source: The Lancet Neurology - August 24, 2019 Category: Neurology Source Type: research