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Noncontrast CT vs CT Perfusion or MRI Selection in Late Presentation of Large-Vessel –Occlusion Stroke
This cohort study compares the clinical outcomes of patients with stroke who presented 6 to 24 hours after symptom onset and were selected for mechanical thrombectomy by noncontrast computed tomography vs those selected by computed tomography perfusion or magnetic resonance imaging.
Source: JAMA Neurology - November 8, 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

Magnetic Resonance Imaging for Acute Minor Neurological Symptoms
To the Editor An observational study of magnetic resonance imaging (MRI) in acute minor neurological symptoms revealed imaging evidence for acute infarction in 13.5% and revision of clinical diagnosis in 30%. This “implies a considerable percentage of patients’ negative MRI findings resulted in a different diagnosis, likely that a presumed stroke did not exist.” This conclusion is misleading in 2 respects.
Source: JAMA Neurology - April 20, 2020 Category: Neurology Source Type: research

Association of Collateral Blood Vessels With Neurological Outcome After Stroke
This cohort study assesses the association between the presence of collateral vessels identified using arterial spin labeling magnetic resonance imaging and neurologic outcome in patients after acute ischemic stroke.
Source: JAMA Neurology - February 13, 2017 Category: Neurology Source Type: research

The Dark Matter of Cerebral Microbleeds
To the Editor I read with interest the article by Tsivgoulis et al inJAMA Neurology on cerebral microbleeds (CMBs) and the risk for symptomatic intracerebral hemorrhage (ICH) after intravenous thrombolysis for acute stroke, as well as the accompanying Editorial by Fisher. This work follows and extends previous meta-analyses on a thorny topic for acute stroke neurology, demonstrating again that the presence of any number of CMBs on pretreatment magnetic resonance imaging is associated with more than doubling the risk for postthrombolysis ICH. Of importance, the authors provided new evidence from group-level and individual p...
Source: JAMA Neurology - August 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

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

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