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New Insights into Nonvitamin K Antagonist Oral Anticoagulants' Reversal of Intracerebral Hemorrhage.
Authors: Yasaka M Abstract The nonvitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban are associated with an equal or lower incidence of stroke and systemic embolism and a much lower incidence of intracranial hemorrhage and hemorrhagic stroke than warfarin is, without the need for routine laboratory monitoring. However, reversal strategies are not currently established in the case of NOAC-related hemorrhagic stroke. In emergency situations, well-defined management for NOAC-related hemorrhagic stroke may improve clinical outcomes. Thus, in this chapter, general measures i...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Cerebral Microbleeds: Detection, Associations and Clinical Implications.
Authors: Yakushiji Y Abstract Vigorous investigations for cerebral microbleeds (CMBs) have been made since the late 1990s. CMBs on paramagnetic-sensitive magnetic resonance sequences correspond pathologically to clusters of hemosiderin-laden macrophages and have emerged as an important new imaging marker of cerebral small vessel disease, including intracerebral hemorrhage (ICH). The prevalence of CMBs varies according to the specific disease settings (stroke subtypes and dementing disorders) and is highest (60%) in ICH patients. The associations of CMBs with aging, hypertension and apolipoprotein E genotype are con...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Reperfusion-Related Intracerebral Hemorrhage.
Authors: Hayakawa M Abstract The efficacy of intravenous thrombolysis (IVT) for acute ischemic stroke patients has been well established worldwide, with endovascular therapy performed in patients who have failed or are ineligible for IVT and who have major vessel occlusion. The most feared complication of acute stroke reperfusion therapy is intracerebral hemorrhage (ICH), as these patients have a poor clinical outcome and high mortality. The fundamental mechanisms responsible for reperfusion-related ICH include increased permeability and disruption of the blood-brain barrier. Recombinant tissue plasminogen activato...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Sonothrombolysis.
Authors: Meairs S Abstract Ultrasound (US) applied as an adjunct to thrombolytic therapy improves the recanalization of occluded vessels, and microbubbles can amplify this effect. New data suggests that the combination of US and microbubbles without tissue plasminogen activator may achieve recanalization with a lower risk of hemorrhage. Further possibilities include specific targeting of thrombus with immunobubbles as well as local drug delivery with US-sensitive liposomes. Clinical studies support the use of US for ischemic stroke therapy, and the first trials of enhancing sonothrombolysis with microbubbles have b...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Intracranial perfusion imaging with ultrasound.
Authors: Meairs S, Kern R Abstract In the last several years, great progress has been made in ultrasound perfusion imaging of the brain. Different approaches have been assessed and shown to be capable of the early detection of cerebral perfusion deficits in stroke patients. Real-time low-mechanical index imaging simplifies the acquisition of perfusion parameters and alleviates many of the previous imaging problems related to shadowing, uniplanar analysis, and temporal resolution. With the advent of this new, highly sensitive contrast-specific imaging technique, new possibilities of the real-time visualization of br...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Hippocampal stroke.
Authors: Szabo K Abstract The first to link disturbance of memory and lesions of the medial temporal lobe was the Russian neurologist von Bechterew, who in 1989 presented the brain of a 60-year-old man who had suffered from severe amnesia. Autopsy showed bilateral damage of the medial temporal lobe. Several following postmortem case studies confirmed the association between permanent amnesia and bitemporal stroke. Reports of transient memory deficits in unilateral stroke in combination with other neurological and neuropsychological deficits followed. With the advent of brain imaging, persistent or transient amnesia...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Conventional and diffusion-weighted MRI of the hippocampus.
Authors: Szabo K, Förster A, Gass A Abstract The human hippocampus is a highly complex structure located on the medial surface of the cerebral hemispheres as a part of the intralimbic gyrus. For clinical purposes, in addition to routine transverse MRI slices, acquisitions parallel and perpendicular to the long axis of the hippocampus need to be performed to fully appreciate its curved anatomy. Clinicians should be acquainted with the normal appearance of the hippocampus regarding size, shape, symmetry, and signal as well as with the width and form of the cerebrospinal fluid spaces surrounding the hippocampus to be...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Antithrombotic therapy in transient ischemic attack patients.
Authors: Held VE, Wolf ME, Hennerici MG Abstract Historically, studies of antithrombotic therapy in ischemic cerebrovascular disease have included both stroke and transient ischemic attack (TIA). Thus, therapy regimes are very similar. Aspirin (75-325 mg within 48 h after onset of symptoms) is still the standard antithrombotic treatment because other agents have performed similarly (or worse). Combinations of agents have shown mixed results. Aspirin combined with clopidogrel has failed to show a significant reduction of stroke/TIA recurrences but increased the bleeding risk if taken for more than several months. Th...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Stroke subtypes and interventional studies for transient ischemic attack.
Authors: Lavallée P, Amarenco P Abstract Transient ischemic attack (TIA) is the most important risk factor for ischemic stroke. The risk is the highest in the first hours after symptom onset, and treatment must be initiated in emergency. In the acute phase, antithrombotic agent is probably the most important treatment, but it is not excluded that lipid-lowering agents and/or antihypertensive drugs are also important. For current guidelines, monotherapy of antiplatelet agent remains the gold standard in emergency. However, most recent data and meta-analysis support a combination therapy of clopidogrel and aspirin. ...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Neurosonological examinations of transient ischemic attack.
Authors: Sharma VK, Wong KS Abstract Cerebrovascular ultrasonography is the only modality that provides real-time information about blood flow in various cervicocerebral arteries. Continuous information can be obtained over extended periods with high resolution and excellent spatial display. Hemodynamic changes in the cerebral circulation due to various physiological or pathological states can be monitored reliably. The information obtained from cerebrovascular ultrasonography carries diagnostic, therapeutic as well as prognostic potential in various conditions. Cervical duplex sonography evaluates blood flow as we...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Radiological examinations of transient ischemic attack.
Authors: Tung CE, Olivot JM, Albers GW Abstract Neuroimaging is critical in the evaluation of patients with TIA. CT and MRI are the two available options for imaging. Head CT is more widely available and commonly used. Diffusion MRI is the recommended modality to image an ischemic lesion. The presence of a diffusion lesion in a patient with transient neurological symptoms is an indicator of a high risk of recurrent stroke. Perfusion imaging with perfusion MRI or CT perfusion may improve the detection of ischemic lesions. Noninvasive vessel imaging may detect a symptomatic vessel lesion associated with an increased ...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Guidelines for management of patients with transient ischemic attack.
Authors: Uehara T, Minematsu K Abstract A transient ischemic attack (TIA) is a medical emergency that is associated with a high risk of early ischemic stroke and other vascular events. Several evidence-based guidelines have been published to provide recommendations for the evaluation and treatment of patients with TIA. These guidelines underline the need for the urgent referral of patients with TIA so that they can access expert evaluation and immediate treatment. The distinction between TIA and ischemic stroke has recently become less important because these two conditions share pathophysiological mechanisms and m...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Symptoms of transient ischemic attack.
Authors: Kim JS Abstract Transient ischemic attack (TIA) is a cerebrovascular disease with temporary (<24 h) neurological symptoms. The symptoms of TIA patients are largely similar to those of ischemic stroke patients and include unilateral limb weakness, speech disturbances, sensory symptoms, visual disturbances, and gait difficulties. As these symptoms are transient, they are frequently evaluated based on patients' subjective reports, which are less precise than those of patients with stroke whose longer-lasting symptoms and signs can be reliably assessed by physicians. Some symptoms, such as monocular blindne...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Epidemiology of transient ischemic attack.
Authors: Kokubo Y Abstract Few epidemiologic data are available regarding the prevalence and incidence of transient ischemic attack (TIA). Here, the incidence of TIA and that of subsequent stroke events were reviewed. The incidences of TIA in Europe were 0.52-2.37 and 0.05-1.14 in men and women aged 55-64, 0.94-3.39 and 0.71-1.47 in those aged 65-74, and 3.04-7.20 and 2.18-6.06 in those aged 75-84, respectively. The corresponding incidences are similar in the United States, and lower in Japan. Higher incidences were revealed in men compared with women. The incidence of TIA increased very markedly with age, regardle...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Risk scores for transient ischemic attack.
Authors: Wolf ME, Held VE, Hennerici MG Abstract The risk of recurrent ischemic stroke after a transient ischemic attack (TIA) has been reported to be 5-10%, and is elevated especially within the first days after the index event. Since TIA primarily has a good outcome without persisting new deficits, interest has been growing to predict stroke recurrence after TIA. This has led to the development of scores, initially for long-term prognosis such as the Stroke Prognosis Instrument (SPI) or the Hankey score, which both have shown a good predictive value at 1 or 2 years after TIA. Risk factors such as age, hypertensio...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

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