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Association of Ischemic Stroke Incidence, Severity, and Recurrence With Dementia in the ARIC Cohort Study
This cohort study evaluates the association between risk of dementia and incident ischemic stroke by stroke severity and recurrence.
Source: JAMA Neurology - January 24, 2022 Category: Neurology Source Type: research

Infarct on Brain Imaging, Subsequent Ischemic Stroke, and Clopidogrel-Aspirin Efficacy
This post hoc analysis of a randomized clinical trial investigates whether the association of clopidogrel-aspirin treatment with stroke recurrence in patients with minor stroke or high-risk transient ischemic attack is modified by the presence of infarct on imaging attributed to the index event.
Source: JAMA Neurology - January 18, 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

Comparison of Ticagrelor vs Clopidogrel With Aspirin in Minor Ischemic Stroke and Transient Ischemic Attack
This network meta-analysis compares ticagrelor and aspirin with clopidogrel and aspirin in patients with acute minor ischemic stroke or transient ischemic attack in the prevention of recurrent strokes or death.
Source: JAMA Neurology - December 6, 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

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

Poststroke Selective Serotonin Reuptake Inhibitors
In the community, major risk factors for depression include sex, advancing age, lower income, employment status, and illnesses such as stroke that result in disability and affect income, employment, and social status. Poststroke depression affects 1 in every 3 patients in the first year after stroke occurrence and thereafter. Important general treatments for depression include the selective serotonin reuptake inhibitors; these compounds have also been suggested to modulate motor and functional recovery after stroke. The FLAME (Fluoxetine for Motor Recovery After Acute Ischaemic Stroke) trial kindled interest in treatment w...
Source: JAMA Neurology - August 2, 2021 Category: Neurology Source Type: research

Direct to Angiography Suite Without Stopping for Computed Tomography Imaging in Acute Stroke
This randomized clinical trial assesses whether direct transfer to the angiography suite improves clinical outcomes compared with usual imaging workflow among patients within 6 hours from onset of symptoms for large vessel occlusion ischemic stroke.
Source: JAMA Neurology - August 2, 2021 Category: Neurology Source Type: research

Selection of Patients for Thrombectomy in the Extended Time Window
Based on the protocols used in the DAWN (Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trials (RCTs) of thrombectomy in the extended window, current guidelines recommend thrombectomy either in the 6- to 16-hour window in patients with a target perfusion imaging mismatch profile or in the 6- to 24-hour window in patients with a clinical imaging mismatch profile. However, these criteria ...
Source: JAMA Neurology - July 26, 2021 Category: Neurology Source Type: research

Patient Selection for Endovascular Thrombectomy Beyond 6 Hours After Symptom Onset
This pooled analysis uses data from 6 randomized clinical trials to assess the potential benefits of endovascular thrombectomy among patients with ischemic stroke based on 3 baseline imaging profiles.
Source: JAMA Neurology - July 26, 2021 Category: Neurology Source Type: research

Multiple Facial Ulcers Following a Stroke
A 66-year-old man presents with multiple progressive ulcers and hypesthesia on the right side of his face, new-onset hemiplegia and hemianopsia on the left side of his face, and ischemic posterior circulation stroke. What is your diagnosis?
Source: JAMA Neurology - July 19, 2021 Category: Neurology Source Type: research

Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke
This exploratory analysis of the THALES trial evaluates the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale score of 4 to 5).
Source: JAMA Neurology - July 9, 2021 Category: Neurology Source Type: research

Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion
To the Editor We read with great interest the article by Seners and colleagues in which they investigated predictors of early neurological deterioration of presumed ischemic origin (ENDi) in large-vessel occlusion stroke with minor clinical deficits and developed a 4-point risk prediction score of ENDi. This is a common and probably underrecognized problem in large-vessel occlusion stroke, and characterizing patients at risk of ENDi is highly relevant for patient management.
Source: JAMA Neurology - July 6, 2021 Category: Neurology Source Type: research

Questions on Predicting Early Neurological Deterioration in Patients With Minor Stroke and Large-Vessel Occlusion —Reply
In Reply We thank Ospel and colleagues for their thoughtful comments on our article showing that more proximal occlusion and greater thrombus length predict early neurological deterioration of ischemic origin (ENDi) in patients with acute minor ischemic stroke with large-vessel occlusion treated with intravenous thrombolysis, with implications regarding how to best manage these patients. Although the precise pathophysiological links between more proximal occlusion, a longer thrombus, and ENDi are uncertain, we fully agree that a leading hypothesis is in situ thrombus extension leading to secondary hemodynamic compromise vi...
Source: JAMA Neurology - July 6, 2021 Category: Neurology Source Type: research

Streamlining the Path to Endovascular Reperfusion
In this issue of JAMA Neurology, Sarraj et al report on the associations of repeated imaging on arrival at an endovascular thrombectomy (EVT) –capable hospital with clinical outcomes after EVT. They studied an observational cohort of 2533 patients who had ischemic stroke with large vessel occlusion within 24 hours of stroke onset. It is well understood that a favorable outcome depends on the time from stroke onset to reperfusion, and th ere is no doubt that proceeding directly to the angiography suite (DTA) saves time compared with repeating imaging (median time, 26 minutes shorter in Sarraj et al). Direct transfer to th...
Source: JAMA Neurology - June 14, 2021 Category: Neurology Source Type: research

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