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Diagnostic Challenges and Uncertainties of Embolic Strokes of Undetermined Source in Young Adults
Nearly 10% to 15% of acute ischemic strokes occur in young adults, with the incidence steadily increasing over the past few decades. Approximately 20% to 40% of these young patients with stroke are classified as having embolic strokes of undetermined source (ESUS), as the underlying stroke etiology cannot be reliably identified despite recommended diagnostic workup. The young ESUS population is an understudied group, as only a few studies, limited by their small size and the lack of prospective follow-up, have assessed their characteristics and outcomes.
Source: JAMA Neurology - March 14, 2022 Category: Neurology Source Type: research

Novel Methods and Technologies for 21st-Century Clinical Trials A Review
Conclusions and RelevanceIncreased use of new tools and approaches in future clinical trials can enhance the design, improve the assessment, and engage participants in the evaluation of novel therapies for neurologic disorders.
Source: JAMA Neurology - March 2, 2015 Category: Neurology Source Type: research

Risk of Stroke at the Time of Carotid Occlusion
This study of patients undergoing carotid ultrasonography reports that the risk of carotid occlusion is well below the risk of carotid stenting or endarterectomy and decreases markedly with more intensive medical therapy.
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

Prediction of Early Recurrence After Acute Ischemic Stroke
This study tests the validity of a prognostic score that was exclusively developed to predict early risk of recurrence in a multicenter setting.
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Obesity, Oral Contraceptive Use, and Cerebral Venous Thrombosis
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that primarily affects young adults. A unique risk factor profile and plurality of presenting features make it an elusive diagnosis unless a high index of suspicion is maintained. It comprises approximately 0.5% to 1% of all strokes, and widespread availability of magnetic resonance imaging has made recognition easier. The International Study on Cerebral Vein and Dural Sinus Thrombosis is the largest prospective, multinational, observational study of patients with CVT to date, including 624 consecutive patients with symptomatic CVT at 89 centers between May ...
Source: JAMA Neurology - March 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

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

Proton Pump Inhibitors and Dementia Incidence
To the Editor I read with interest the article by Gomm and colleagues, which examined the association between the use of proton pump inhibitors (PPIs) and incident dementia in elderly individuals in a prospective study. The authors adopted time-dependent Cox regression analysis, and the time-dependent covariates were polypharmacy and the comorbidities of depression, diabetes, ischemic heart disease, and stroke. Age and sex were also used as confounding factors. The hazard ratio of PPIs for incident dementia was 1.44 (95% CI, 1.36-1.52), and the authors recommended randomized clinical trials to confirm the causal associatio...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Association Between CV Risk Factors and Familial Alzheimer Disease
This cohort study investigates associations between coronary risk factors, stroke, and late-onset Alzheimer dementia in patients with familial disease.
Source: JAMA Neurology - August 15, 2016 Category: Neurology Source Type: research

Cardiovascular Risk Factors and Stroke in Alzheimer Disease
Discussion section.
Source: JAMA Neurology - November 14, 2016 Category: Neurology Source Type: research

Intra-arterial Treatment for Basilar Artery Occlusion —Reply
In Reply We thank Bhatti and Sivakumaran for their comments on our article. First, the authors mention the relatively low mean age of 58 years of our cohort (this includes 1 child of 4 years). The patients in the Basilar Artery International Cooperation Study (BASICS) had a mean age of 63 years. We think it is unlikely that this difference of 5 years has had an important influence on the results. Moreover, BASICS is a prospective patient registry, without stringent inclusion criteria. This suggests that patients with basilar artery occlusion have a lower age compared with patients with anterior circulation stroke.
Source: JAMA Neurology - November 28, 2016 Category: Neurology Source Type: research

Thrombolysis and Thrombectomy vs Thrombectomy Alone for Ischemic Stroke
This study examines whether treatment with intravenous thrombolysis before mechanical thrombectomy with a stent retriever is beneficial in patients undergoing mechanical thrombectomy.
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

Improved Outcomes in Asymptomatic Obstructive Sleep Apnea
This study enrolled 1522 randomly selected, employed research subjects and observed them for 2 decades. The goal of WSCS was to answer one aspect of a US Congressional mandate to determine the overall public burden of sleep d isorders. The WSCS had a surprising finding: mild OSA was seen in 17% of adults, and, most concerning, 6% of adults had moderate to severe OSA. The WSCS finding most relevant to the current USPSTF recommendation statement is that only 35% of WSCS participants with moderate OSA and 37% of participant s with severe OSA reported excessive daytime sleepiness, the cardinal daytime symptom of OSA. This sugg...
Source: JAMA Neurology - January 24, 2017 Category: Neurology Source Type: research

Conscious Sedation vs General Anesthesia for Vertebrobasilar Stroke Thrombectomy
This case-control study compares clinical and angiographic outcomes between monitored anesthesia care and general anesthesia in patients presenting with vertebrobasilar occlusion strokes.
Source: JAMA Neurology - April 10, 2017 Category: Neurology Source Type: research

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