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Bypassing Closest Stroke Center for Intracerebral Hemorrhage
Prehospital stroke triage protocols focus on enabling rapid access to 2 proven time-sensitive short-term treatments: intravenous thrombolysis for all eligible patients with disabling acute ischemic stroke and endovascular therapy (EVT) for select patients with acute ischemic stroke from large vessel occlusion (LVO). As EVT is a particularly powerful treatment with an estimated number needed to treat of 2 to 3, prehospital screening tools and protocols have been developed that prioritize identifying potential patients with LVO in the field and preferentially transporting them to EVT-capable centers, even if this means bypas...
Source: JAMA Neurology - August 21, 2023 Category: Neurology Source Type: research

Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage
This prespecified secondary analysis of a randomized clinical trial conducted in Catalonia, Spain, assesses whether direct transport to an endovascular treatment –capable stroke center vs to the nearest local stroke center benefits patients experiencing intracerebral hemorrhage.
Source: JAMA Neurology - August 21, 2023 Category: Neurology Source Type: research

Reframing Lesional Epilepsy as a Network Disease
The question why some brain lesions cause epilepsy whereas other do not has remained unanswered for the past century. Lesions are the leading identifiable cause of epilepsy in adults, especially in individuals older than 55 years. But, only 6% of those with stroke, 9% of those with intracerebral hemorrhage, and approximately 40% of those with brain tumors have lesional epilepsy. Why do some develop epilepsy whereas others do not?
Source: JAMA Neurology - July 3, 2023 Category: Neurology Source Type: research

Symptomatic Intracranial Hemorrhage With Tenecteplase vs Alteplase in Patients With Acute Ischemic Stroke
This cohort study evaluates rates of symptomatic intracranial hemorrhage following stroke with tenecteplase vs alteplase.
Source: JAMA Neurology - May 30, 2023 Category: Neurology Source Type: research

Limb to Cranial Overflow Dystonia in a Patient After Stroke
This case report describes noncontiguous overflow dystonia in a patient with diabetes, hypertension, and a history of left putaminal hemorrhage and right hemiparesis.
Source: JAMA Neurology - March 6, 2023 Category: Neurology Source Type: research

Building Evidence on Safety of Thrombolysis for Patients Receiving Direct Oral Anticoagulants
Nearly 20% of patients with acute ischemic stroke (AIS) are undergoing direct oral anticoagulant (DOAC) treatment at the time of their stroke. Common indications for DOACs among these patients include stroke prevention from atrial fibrillation, treatment of venous and pulmonary thrombosis, and coronary and peripheral atherosclerotic disease. Novel indications for DOAC use are expected to emerge and may increase the proportion of patients with AIS who are undergoing treatment with DOACs. Current US and European acute stroke treatment guidelines recommend withholding intravenous thrombolysis (thrombolysis), a morbidity- and ...
Source: JAMA Neurology - January 3, 2023 Category: Neurology Source Type: research

Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants
This cohort study evaluates the risk of symptomatic intracranial hemorrhage associated with use of intravenous thrombolysis in patients with recent direct oral anticoagulant ingestion.
Source: JAMA Neurology - January 3, 2023 Category: Neurology Source Type: research

Time for a New Perspective on Intracerebral Hemorrhage
More than 3 million people worldwide experience intracerebral hemorrhage (ICH) each year. Although the incidence of ICH is much lower than that of ischemic stroke, ICH imposes a 50% greater worldwide burden of disability. ICH has a 30-day case fatality rate of more than 40%, and most survivors are left with permanent disabilities. Because of the high likelihood of poor outcomes, physicians caring for patients with ICH tend to use clinical severity scores early on to estimate the risk of mortality or future disability to determine the aggressiveness of medical care and to guide conversations with patients ’ surrogates aro...
Source: JAMA Neurology - July 25, 2022 Category: Neurology Source Type: research

Low-Density Lipoprotein Cholesterol Level After a Stroke
Randomized clinical trials (RCTs) of statins as the primary prevention for patients with a high serum low-density lipoprotein cholesterol (LDL-C) level and as the secondary prevention after an acute coronary event have shown that lowering serum LDL-C levels reduces the risks of myocardial infarction, stroke, and vascular death. These trials included stroke as a secondary end point but not as an entry criterion. The benefit of LDL-C lowering to reduce the risk of ischemic strokes in primary prevention trials and for patients with coronary heart disease is not necessarily seen among patients who have had a stroke. The Stroke...
Source: JAMA Neurology - February 21, 2022 Category: Neurology Source Type: research

Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes
This cohort study assesses secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population.
Source: JAMA Neurology - December 6, 2021 Category: Neurology Source Type: research

Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage
A follow-up of the Restart or Stop Antithrombotics Randomized Trial, this study further examines the long-term effects of antiplatelet therapy after stroke caused by intracerebral hemorrhage.
Source: JAMA Neurology - September 3, 2021 Category: Neurology Source Type: research

Errors in Results and Table 1
This article was corrected online.
Source: JAMA Neurology - August 16, 2021 Category: Neurology Source Type: research

Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events
This analysis of pooled cohort data from 4 popluation-based cohort studies evaluates whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction.
Source: JAMA Neurology - May 3, 2021 Category: Neurology Source Type: research

Insights on Intensive Vs Nonintensive Prerandomization Systolic Blood Pressure Reduction —Reply
In Reply We thank Mahabala et al for their letter. We performed the analysis using postrandomization treatment groups based on systolic blood pressure (SBP) target values (intensive-arm goal, 110-139 mm Hg; standard-arm goal, 140-179 mm Hg). The first SBP level recorded in the emergency department was termed the initial SBP. The protocol permitted initiation of antihypertensive treatment (often by intravenous nicardipine infusion) before randomization to lower the SBP level to less than 180 mm Hg, which was consistent with the contemporary American Stroke Association Stroke Council guidelines, but the SBP level was to be m...
Source: JAMA Neurology - March 15, 2021 Category: Neurology Source Type: research

Risk of Hemorrhagic Stroke in Patients With Coronavirus Disease 2019 —Reply
In Reply We thank Dr Silverman and colleagues for their interest in our study and providing us the opportunity to expand on our results. Among the 1916 patients who visited the emergency department or were hospitalized with coronavirus disease 2019 (COVID-19) in our study, 8 patients (0.4% [95% CI, 0.2%-0.8%]) had hemorrhagic stroke, including 7 with intracerebral hemorrhage and 1 with subarachnoid hemorrhage. Among these 8 patients, 4 strokes were attributed to anticoagulant use.
Source: JAMA Neurology - March 8, 2021 Category: Neurology Source Type: research

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