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Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion —Reply
In Reply We thank Ospel and colleagues for their thoughtful comments on our article showing that more proximal occlusion and greater thrombus length predict early neurological deterioration of ischemic origin (ENDi) in patients with acute minor ischemic stroke with large-vessel occlusion treated with intravenous thrombolysis, with implications regarding how to best manage these patients. Although the precise pathophysiological links between more proximal occlusion, a longer thrombus, and ENDi are uncertain, we fully agree that a leading hypothesis is in situ thrombus extension leading to secondary hemodynamic compromise vi...
Source: JAMA Neurology - July 6, 2021 Category: Neurology Source Type: research

Progressive Ataxia and Downbeat Nystagmus in the Adult
A 63-year-old man presented with a history of vomiting, hypertension, dyslipidemia, type 2 diabetes, dilated ischemic cardiomyopathy, alcohol use, and stroke; physical examination found appendicular dysmetria with truncal ataxia and downbeat nystagmus. Brain magnetic resonance imaging revealed a hyperintensity on T2-weighted and fluid-attenuated inversion recovery sequences without reduced diffusion in the cerebellar nodule. What is your diagnosis?
Source: JAMA Neurology - May 17, 2021 Category: Neurology Source Type: research

Thrombolysis Works in Lacunar Infarct, Complicating Imaging Selection
A new, exploratory analysis of the Efficacy and Safety of MRI-Based Thrombolysis in Wake-up Stroke (WAKE-UP) trial by Barow and colleagues in this issue ofJAMA Neurology provides unique and compelling data suggesting that thrombolysis improves clinical outcomes after acute lacunar infarction. The European Union –commissioned, 500-patient, randomized, double-blind, placebo-controlled WAKE-UP trial of alteplase captured the magnetic resonance imaging (MRI) and magnetic resonance angiography of patients with acute ischemic stroke prior to thrombolysis. This allowed categorization of infarcts as lacunar vs n onlacunar, using...
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Association of Collateral Blood Vessels With Neurological Outcome After Stroke
This cohort study assesses the association between the presence of collateral vessels identified using arterial spin labeling magnetic resonance imaging and neurologic outcome in patients after acute ischemic stroke.
Source: JAMA Neurology - February 13, 2017 Category: Neurology Source Type: research

Lesion Size and Perspective in Acute Ischemic Stroke
The computed tomographic (CT) or magnetic resonance imaging (MRI) findings of early cerebral ischemia are literally, and figuratively, shades of gray in decision making regarding the triage of patients with acute ischemic stroke for revascularization. The subtleties and areas of uncertainty on imaging of this dynamic process, where an arterial occlusion is mitigated by collateral perfusion in the brain, defy concrete rules or thresholds that are equally consequential across individual patients. Imaging criteria, whether more than one-third of the middle cerebral artery territory, Alberta Stroke Program Early CT (ASPECT) sc...
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

The Dark Matter of Cerebral Microbleeds
In Reply We thank Charidimou for reading our recently published article in JAMA Neurology on the risk for symptomatic intracerebral hemorrhage after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and high cerebral microbleed (CMB) burden on pre-IVT magnetic resonance imaging (MRI) screening, and for his timely discussion on the topic.
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Cerebral Microbleeds, Cognition and Therapeutic Implications
A recent major clinical advance in magnetic resonance imaging (MRI) of the brain is the development of paramagnetic-sensitive sequences such as T2-weighted gradient-recalled echo and susceptibility-weighted images for the detection of cerebral microbleeds (CMBs). On brain MRI, CMBs are small (≤5 to 10 mm in diameter), round, dark-signaled lesions that consist of extravasation of blood components through fragile microvascular walls that neuropathologically represent hemosiderin-laden macrophages. Magnetic resonance imaging–detected CMBs are common in elderly individuals, coexist with ischemic stroke and intracerebral he...
Source: JAMA Neurology - June 6, 2016 Category: Neurology Source Type: research

Microbleeds, Mortality, and Stroke in Alzheimer Disease The MISTRAL Study
Conclusions and RelevanceIn patients with AD, the presence of nonlobar microbleeds was associated with an increased risk for cardiovascular events and cardiovascular mortality. Patients with lobar microbleeds had an increased risk for stroke and stroke-related mortality, indicating that these patients should be treated with the utmost care.
Source: JAMA Neurology - March 23, 2015 Category: Neurology Source Type: research