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Source: JAMA Neurology
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Total 157 results found since Jan 2013.

Monogenic Stroke —Can We Overcome Nature With Nurture?
Although genetic underpinnings of several neurological disorders like epilepsy have been described as early as fourth century bce in the Corpus Hippocraticum, discoveries in stroke have been more recent. One of the first reports demonstrating the importance of heredity in stroke pathogenesis occurred in 1974 with the generation of the stroke-prone spontaneously hypertensive rat. This strain was created using selective breeding and has endured as a valuable asset in contemporary stroke research. Nonetheless, half a century later, the precise genetic determinants even in this single, highly specific rodent stroke phenotype h...
Source: JAMA Neurology - October 27, 2022 Category: Neurology Source Type: research

Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis A Retrospective Analysis of the Get With the Guidelines–Stroke Registry
Conclusions and RelevanceMany patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.
Source: JAMA Neurology - February 2, 2015 Category: Neurology Source Type: research

Cerebral Microbleeds and Early Recurrent Stroke After Transient Ischemic Attack Results from the Korean Transient Ischemic Attack Expression Registry
Conclusions and RelevanceImmediate and optimal management seems to modify the risk of recurrent stroke after TIA. Cerebral microbleeds may be novel predictors of stroke recurrence, which needs further validation.
Source: JAMA Neurology - January 12, 2015 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

Endovascular Therapy for Childhood Stroke —Working Together to Reach Prime Time
The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset. The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disabili...
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Effects of Golden Hour Thrombolysis A Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) Substudy
ImportanceThe effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour.ObjectiveTo determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome.Design, Setting, and ParticipantsThe prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availabilit...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research

Implementing a Mobile Stroke Unit Program in the United States Why, How, and How Much?
Conclusions and RelevanceThe MSU strategy could dramatically transform the way acute stroke is managed in the United States. A prospective study evaluating the logistics, outcomes, and cost-effectiveness of this approach is needed and under way.
Source: JAMA Neurology - December 8, 2014 Category: Neurology Source Type: research

Recombinant Tissue Plasminogen Activator Stroke Therapy
The results of recently completed clinical trials of acute ischemic stroke that report a clear and unequivocal benefit of stent-retriever devices used with intravenous recombinant tissue plasminogen activator (rtPA) vs rtPA alone are the second revolutionary therapeutic breakthrough in acute stroke care in the last 50 years. This breakthrough makes the case for a new standard of care for the treatment of acute ischemic stroke. When we look back at the controversy surrounding interventional acute stroke therapies after multiple trials of interventional treatment, most notably International Management of Stroke III (IMS III)...
Source: JAMA Neurology - January 25, 2016 Category: Neurology Source Type: research

Vital Sign and Glucose Abnormalities and Outcome in Childhood Stroke
Childhood stroke studies often cite differences in risk factors between adult and pediatric patients, namely that traditional adult stroke risk factors, such as hypertension and hyperglycemia, are not common causes of childhood stroke. In a study of 83 children from the United Kingdom, only 8 children (10%) with available blood pressure data at admission were classified as having hypertension. The authors stated that this could be an overestimate because follow-up blood pressure data were not available, but they acknowledged that elevated blood pressure could be important in some children. In a multinational cohort of 676 ...
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients With Suspected LVO Stroke
This preimplementation-postimplementation study evaluates the association of a regional prehospital transport policy for comprehensive stroke center triage for patients with suspected acute ischemic stroke and large vessel occlusion with rates of endovascular therapy.
Source: JAMA Neurology - August 9, 2021 Category: Neurology Source Type: research

Factors Associated With Neurological Outcome After Childhood Stroke
In Reply We thank Goh and Sivakumaran for their interest in and comments on our article, which was a retrospective study of blood pressure, blood glucose, and fever and their associations with outcome after arterial ischemic stroke (AIS) in children. Although we did not find a significant association between hypertension and neurological outcome or death at 3 months after stroke, we found that when carefully tracked, vital sign abnormalities were very common in the poststroke period. In our future directions section, we proposed a larger prospective study precisely because of the limitations of our study design and conflic...
Source: JAMA Neurology - August 22, 2016 Category: Neurology Source Type: research

Cardiovascular Risk Factors and Stroke in Alzheimer Disease
To the Editor I read with interest the article by Tosto et al studying the influence of cardiovascular risk factors and stroke in familial late-onset Alzheimer disease (LOAD). The main findings were that history of stroke increased the risk for LOAD, while hypertension decreased the risk for LOAD. The study suggests that stroke mediates the influence of cardiovascular risk factors on increased risk for LOAD.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Primary Stroke Center Protocol for Suspected Stroke by Large-Vessel Occlusion
This cohort study reports on the association of a primary stroke center protocol with the efficiency of care and the outcomes of patients with suspected emergent large-vessel occlusion who first present to a primary stroke center.
Source: JAMA Neurology - May 8, 2017 Category: Neurology Source Type: research

Stroke Quality of Care in GWTG-Stroke Hospitals
This longitudinal cohort study compares quality of stroke care measures for patients admitted to hospitals participating and not participating in Get With The Guidelines –Stroke.
Source: JAMA Neurology - August 6, 2018 Category: Neurology Source Type: research