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Endovascular Treatment for Patients With Stroke and Large Ischemic Cores and Mismatch Imaging Profiles
This case-control study compares the outcomes of patients following stroke with large baseline ischemic cores on computed tomographic perfusion undergoing endovascular therapy with the outcomes of matched controls who had medical care alone.
Source: JAMA Neurology - November 7, 2016 Category: Neurology Source Type: research

Endovascular Therapy for Acute Ischemic Stroke
This pooled cohort study evaluates the safety and effectiveness of endovascular therapy for occlusions of the M2 segment of the middle cerebral artery in patients with ischemic stroke.
Source: JAMA Neurology - September 12, 2016 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

Stent Retrievers for Treating Anterior Circulation Acute Ischemic Stroke
To the Editor Touma et al reported a comprehensive systematic review and meta-analysis of 5 randomized clinical trials evaluating the benefits and risks of stent retrievers in addition to recombinant tissue plasminogen activator (rtPA) for the treatment of acute ischemic stroke (AIS). The main conclusion of the study was that “the use of stent retrievers in conjunction with rtPA vs rtPA alone is associated with significant improvement of functional independence 90 days after AIS.” However, as pointed out by the authors, all studies included in their meta-analysis selected only patients with anterior circulation acute i...
Source: JAMA Neurology - July 5, 2016 Category: Neurology Source Type: research

Instrument for Predicting Early Stroke Recurrence
In Reply Our recently published article in JAMA Neurology was the third in a series of studies that assessed the ability of the Recurrence Risk Estimator (RRE) to predict the 90-day risk for recurrence after an ischemic stroke. The first 2 were internal validation studies that demonstrated good discrimination (C statistics, 0.80-0.85). The last assessed the validity of RRE in an international multicenter setting and revealed a comparable discriminative value (C statistic, 0.76), confirming the results of prior studies.
Source: JAMA Neurology - June 27, 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

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

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

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

Blood Pressure, Blood Glucose, and Temperature After Childhood Stroke
This cohort study aims to determine the prevalence of abnormal blood pressure, blood glucose levels, and temperature in pediatric patients with acute arterial ischemic stroke and to explore any association between these measures and neurological outcome.
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Factors Affecting Preventability of Stroke
In Reply We appreciate the interest of Kawada in our work. Our study was designed to analyze the association between ischemic stroke prevention and treatment; we defined our variables and conducted our data analysis accordingly. We disagree with Kawada’s statement that the “empirical method is not suitable for scientific research.” We look forward to further investigations of how stroke prevention and treatment are associated.
Source: JAMA Neurology - May 2, 2016 Category: Neurology Source Type: research

Imaging and Recurrent Cerebrovascular Events in Patients After Stroke
This cohort study seeks to determine predictors of early recurrent cerebrovascular events among patients with transient ischemic attacks and minor strokes and National Institutes of Health Stroke Scale scores of 0 to 3.
Source: JAMA Neurology - March 21, 2016 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

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

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