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Risk of Hemorrhagic Stroke in Patients With Coronavirus Disease 2019
To the Editor We read with interest the article by Merkler et al regarding the increased incidence of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) compared with those with influenza. The authors also reported that 13% of patients with COVID-19 were receiving anticoagulation at the time of the stroke. Could the authors comment on the rate of anticoagulant use in patients with COVID-19 who did not have an ischemic stroke? This would also be helpful to assess the possibility that anticoagulation may have been protective.
Source: JAMA Neurology - March 8, 2021 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

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

Risk for Major Hemorrhages in Patients Receiving Clopidogrel and Aspirin Compared With Aspirin Alone
This secondary analysis of a randomized clinical trial examines the short-term risk of hemorrhage in treating patients in North America, Europe, and Australasia with acute transient ischemic attack or minor acute ischemic stroke with clopidogrel plus aspirin or aspirin alone.
Source: JAMA Neurology - April 29, 2019 Category: Neurology Source Type: research

Endovascular Thrombectomy as a Means to Improve Survival in Acute Ischemic Stroke
This meta-analysis examines 90-day mortality and 90-day intracranial hemorrhage reported in trials of endovascular thrombectomy vs medical therapy cited in the 2018 American Stroke Association/American Heart Association guidelines for acute ischemic stroke.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Treatment of Poststroke Aphasia With Transcranial Direct Current Stimulation
Stroke remains a leading cause of human disability. Important gains have been realized in the setting of acute ischemic stroke, where thrombolytic and catheter-based reperfusion therapies can substantially improve long-term behavioral outcomes. However, most patients with a new stroke are not eligible for such therapies because of delays in diagnosis or hemorrhagic etiology, for example, and many who are treated nonetheless have substantial long-term disability. Additional classes of poststroke therapy are needed.
Source: JAMA Neurology - August 20, 2018 Category: Neurology Source Type: research

Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke
This exploratory analysis of 1690 patients enrolled in the Field Administration of Stroke Therapy-Magnesium Trial assesses the frequency, predictors, and outcomes of the neurological deterioration that occurs among patients during the ultra-early period after ischemic stroke or intracranial hemorrhage.
Source: JAMA Neurology - July 23, 2018 Category: Neurology Source Type: research

Migraine and the Risk of Carotid Artery Dissection
Stroke incidence is increasing among patients aged 40 to 60 years —faster than in older age cohorts. Preliminary evidence suggests that ischemic stroke—not hemorrhage or subarachnoid hemorrhage—accounts for the increase. Many speculate that increasing incidences of classic vascular risk factors among young patients contribute to the increased incidence of st roke. Certainly, we are all aware of the obesity epidemic and continued prevalence of smoking, leading to premature atherosclerosis. Furthermore, equally relevant causes of stroke in the young include migraine, drug abuse, cervical arterial dissections, patent fo...
Source: JAMA Neurology - March 6, 2017 Category: Neurology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke
Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory –adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and their report appears in this issue ofJAMA Neurology. Given that 85% of the patients in mechanical thrombectomy (MT) trials received intravenous thrombolysis (IVT), they highlight an important group of patients in whom MT was successful without IVT. The recent IVT and MT trials have clearly established the new standard in therapy for...
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

SSRIs and Intracranial Hemorrhage
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications in the United States. A recent study using the National Health and Nutrition Examination Survey database estimated that in 2012, 8.5% (95% CI, 6.9%-10.4%) of adults 20 years and older were prescribed SSRIs compared with a prevalence of 1.3% (95% CI, 1.0%-1.8%) for tricyclic antidepressants (TCAs). Although most of these prescriptions were likely for depression, SSRIs are being used for other indications; of particular interest to neurologists, SSRIs are being investigated and sometimes used to promote motor recovery after str...
Source: JAMA Neurology - December 5, 2016 Category: Neurology Source Type: research

Associations Between Sex-Specific Risk Factors and Stroke
This systematic review and meta-analysis examines sex-specific risk factors for ischemic stroke, hemorrhagic stroke, any stroke, and stroke mortality.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Association Between Calcium Level and Hematoma Size and Expansion
Intracerebral hemorrhage (ICH) is a common and deadly type of stroke, with high rates of morbidity and mortality (40%-50% in most series). There are several well-described and validated risk factors and diseases that increase the risk of ICH, including race, hypertension, use of anticoagulants, amyloid angiopathy, renal insufficiency, thrombolytic therapy, and drug abuse. However, not all ICHs are associated with one of these risk factors. This suggests that there might be some other modifying factors involved.
Source: JAMA Neurology - September 6, 2016 Category: Neurology Source Type: research

The Dark Matter of Cerebral Microbleeds
To the Editor I read with interest the article by Tsivgoulis et al inJAMA Neurology on cerebral microbleeds (CMBs) and the risk for symptomatic intracerebral hemorrhage (ICH) after intravenous thrombolysis for acute stroke, as well as the accompanying Editorial by Fisher. This work follows and extends previous meta-analyses on a thorny topic for acute stroke neurology, demonstrating again that the presence of any number of CMBs on pretreatment magnetic resonance imaging is associated with more than doubling the risk for postthrombolysis ICH. Of importance, the authors provided new evidence from group-level and individual p...
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Dementia After Intracerebral Hemorrhage
As acute management of intracerebral hemorrhage (ICH) has improved, more patients survive ICH but are left with significant deficits. In the past, primary evaluations of outcomes after ICH have focused on mortality and levels of functional dependence, with a relatively modest number of patients experiencing true functional independence after ICH or returning to their previous level of functioning. Cognitive outcomes after ICH have thus not been a primary focus of either treatment or natural history studies of ICH, despite their known importance after ischemic stroke and their importance in predicting return to previous functioning.
Source: JAMA Neurology - June 13, 2016 Category: Neurology Source Type: research

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