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Thrombolysis-Related Hemorrhage
Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%. Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent...
Source: JAMA Neurology - October 26, 2015 Category: Neurology Source Type: research

Cerebral Microbleeds and Thrombolysis
Using intravenous thrombolysis in a stroke patient with cerebral microbleeds represents one of the most challenging clinical decisions in acute stroke neurology. In this setting, the implications of coexisting ischemic and hemorrhagic cerebrovascular disease (mixed cerebrovascular disease) must be confronted and urgently addressed. The clinical consequences of intervening or not intervening are profound.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Association Between Migraine and Cervical Artery Dissection
This cohort study examines the association between migraine and ischemic stroke due to cervical artery dissection in young patients with ischemic stroke.
Source: JAMA Neurology - March 6, 2017 Category: Neurology Source Type: research

Infarct Progression in Patients During Mechanical Thrombectomy Transfer
This cohort study examines the clinical imaging factors associated with unfavorable imaging profile evolution for thrombectomy in patients with ischemic stroke initially transferred to non –thrombectomy-capable stroke centers.
Source: JAMA Neurology - September 25, 2017 Category: Neurology Source Type: research

Errors in Abstract and Figures 2 and 3
This article was c orrected online.
Source: JAMA Neurology - January 2, 2018 Category: Neurology Source Type: research

Considerations in Assessing Disability Trajectories
To the Editor We thank Dhamoon et al for their prospective longitudinal cohort study assessing the long-term disability trajectory before and after an ischemic stroke compared with myocardial infarction (MI). The authors found that the gradient of increasing disability was significantly steeper after a stroke but remained consistent after MI.
Source: JAMA Neurology - March 12, 2018 Category: Neurology Source Type: research

Thrombectomy in Transferred Patients in the Late Window
This secondary analysis of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 trial evaluates whether the imaging-based selection criteria used in the trial would lead to comparable outcome rates and treatment benefits in transfer vs direct-admission patients with ischemic stroke.
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

SELECTing Patients With Large Ischemic Core Who May Benefit From Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the clinical and radiologic outcomes in an observational cohort of 105 patients who had extensive ischemic changes on noncontrast computed tomographic (CT) scans (Alberta Stroke Program Early CT Scores [ASPECTS] of 0-5) or CT perfusion scans with ischemic core volume greater than 50 mL and who were treated within 24 hours of stroke onset with endovascular thrombectomy or medical management. All but 1 of the patients who received endovascular treatment and were included based on low ASPECTS had a score of 4 or 5. The ASPECTS regions are not volumetrically or functional...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Is Hyperselection of Patients the Right Strategy?
In 2019, intracerebral hemorrhage (ICH) remains the most devastating type of stroke, with a 30-day mortality rate of 40% and 60% of survivors who are dependent 1 year after ICH. Intracerebral hemorrhage volume is one of the main determinants of poor outcome, and the associated estimated risk of death or dependency increases of 5% for each millimeter of growth in the short-term phase. Up to one-third of ICHs enlarge during the first 24 hours, and the predicted probability of growth increases nonlinearly according to the ICH volume at admission, antithrombotic use, and the time window from symptom onset to imaging. Because o...
Source: JAMA Neurology - August 19, 2019 Category: Neurology Source Type: research

Error in Figure
This article was corrected online.
Source: JAMA Neurology - September 30, 2019 Category: Neurology Source Type: research

Correction to Author ’s Name in Byline
This article was corre cted online.
Source: JAMA Neurology - September 8, 2020 Category: Neurology Source Type: research

Cerebral Microbleeds and Antithrombotic Treatments —Stop Worrying About Bleeding
Cerebral microbleeds (CMBs) are found in up to one-third of patients with ischemic stroke. Because of their hemorrhagic histopathological substrate, they have been historically associated with a risk of intracerebral hemorrhage (ICH). This has led to concerns about the safety of anticoagulation use in patients with CMBs even in the context of high risk of recurrent ischemic stroke, such as in atrial fibrillation. However, growing evidence suggests that CMBs are not only markers of bleeding propensity but also markers of future ischemic events. To further evaluate both types of risks, an assessment of the number and anatomi...
Source: JAMA Neurology - October 19, 2020 Category: Neurology Source Type: research

Diagnostic Challenges and Uncertainties of Embolic Strokes of Undetermined Source in Young Adults
Nearly 10% to 15% of acute ischemic strokes occur in young adults, with the incidence steadily increasing over the past few decades. Approximately 20% to 40% of these young patients with stroke are classified as having embolic strokes of undetermined source (ESUS), as the underlying stroke etiology cannot be reliably identified despite recommended diagnostic workup. The young ESUS population is an understudied group, as only a few studies, limited by their small size and the lack of prospective follow-up, have assessed their characteristics and outcomes.
Source: JAMA Neurology - March 14, 2022 Category: Neurology Source Type: research

Acute Ischemic Stroke Therapy
This Viewpoint discusses the future of thrombolysis and thrombectomy for patients with acute brain ischemia.
Source: JAMA Neurology - October 5, 2015 Category: Neurology Source Type: research

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