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Source: JAMA Neurology

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Total 364 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

Early Recurrent Stroke Prediction With the Recurrence Risk Estimator
Acute ischemic stroke is a medical emergency. Early reperfusion therapy can reduce functional disability, and early secondary prevention therapy can reduce early recurrent stroke. The rate of recurrent stroke in the first month is approximately 9.4% (95% CI, 6%-14%) among patients with ischemic stroke caused by large-artery atherosclerosis and approximately 1.2% (95% CI, 0.4%-3.0%) among patients with ischemic stroke caused by intracranial small vessel disease. Because some effective early prevention therapies may be risky or costly (eg, carotid revascularization or dual antiplatelet therapy) and some patients have a low r...
Source: JAMA Neurology - February 29, 2016 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

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

Stroke Etiologic Classification —Moving From Prediction to Precision
It is a truism of vascular neurology that secondary prevention depends on the cause of an ischemic stroke. We revascularize those with extracranial carotid stenosis, we anticoagulate those with cardioembolic infarcts due to atrial fibrillation, and we treat with antibiotics those with infective endocarditis. Determining the etiologic subtype, or cause, of stroke is therefore rightly considered the main objective of the evaluation of the patient with stroke. Despite the central role of this evaluation, it is surprising that our ability to determine the cause of stroke in many cases is quite limited, and that the process of ...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

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

In-Hospital Stroke
There have been tremendous strides in standardization of the care for acute ischemic stroke since widespread use of thrombolytic therapy began almost 20 years ago. Efficacy is still limited by delayed presentation to the emergency department following stroke symptom onset, although this has also improved in that period with education of emergency medical services and the community at large. The real improvement lies in development of streamlined and standardized protocols for “code stroke,” so that thrombolysis rates of 20% are becoming typical and door-to-needle times are just as typically under 1 hour. These encourag...
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research