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Endovascular thrombectomy: Time is still brain
The "Time is brain" concept should be familiar to anyone who cares for patients with acute ischemic stroke. IV tissue plasminogen activator (tPA) reduces disability after stroke when administered within 4.5 hours of symptom onset, but the benefit of IV tPA is time-dependent.1 Earlier treatment improves functional outcomes. Quantified many ways, studies provide estimates in terms of functional outcome at 90 days, neurons saved, and days of disability-free life gained.1–3 As a result, door-to-needle time, defined as the time from hospital arrival to the initiation of IV tPA, has become an important quality metric for s...
Source: Neurology - May 29, 2017 Category: Neurology Authors: Mullen, M. T., Chaturvedi, S. Tags: Outcome research, Quality of life, All Cerebrovascular disease/Stroke, Models of care, Infarction EDITORIALS Source Type: research

A Rare Neurological Complication of Waldenstroms Macroglobulinemia (P5.183)
Conclusions:Diagnostic approach to bilateral FNP should evaluate for: traumatic (skull fractures), infectious (classically Lyme disease), metabolic (diabetes), autoimmune (sarcoidosis, Guillain-Barré syndrome), congenital (Moebius syndrome) and neoplastic (brainstem tumors) entities. WM is a rare cause, a condition due to low-grade B cell lymphoma where lymphoplasmacytoid cells infiltrate different tissues and secrete monoclonal IgM. Peripheral neuropathy develops in 15–30% of the cases, usually a chronic, progressive, symmetric, predominantly distal polyneuropathy. Facial nerve impairment is unusual, caused b...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Acosta, G. T., Gadhia, R., Leslie-Mazwi, T. Tags: Neuro-oncology: Brain and CNS Metastases Source Type: research

Telestroke: Solid support for virtual acute stroke care
IV recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset has been established as an effective therapy for acute ischemic stroke.1 Over the past 2 decades, systems of care and quality assurance teams have developed to ensure that all potentially eligible patients receive IV rtPA in a timely and effective manner.2 Many neurologists cannot arrive rapidly to the emergency department for in-person acute stroke assessment, and many rural areas lack 24/7 coverage by neurologists. Telemedicine has brought neurologic expertise through real-time audiovisual technical link to the emergency department for a...
Source: Neurology - September 25, 2016 Category: Neurology Authors: Demaerschalk, B. M., Levine, S. R. Tags: Outcome research, All Cerebrovascular disease/Stroke, Clinical trials Systematic review/meta analysis EDITORIALS Source Type: research

And why not thrombolysis in the ambulance (at least for some)?
The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental. Moreover, at least some of the pati...
Source: Neurology - July 10, 2016 Category: Neurology Authors: Rosenberg, G., Steiner, I. Tags: CT, All Clinical trials, All Cerebrovascular disease/Stroke, Intracerebral hemorrhage VIEWS & amp;amp; REVIEWS Source Type: research

Acute Stroke Due to High Voltage Electrocution (P4.347)
We present a case of acute stroke due to high voltage electrocution. Case presentation 38 year old white male accidently grabbed a live wire in the field and got electrocuted. He sustained 2nd degree electric burns at the entry wound in his right palm with a small exist wound in the right foot. On admission, he was stable with total amnesia of the incident event. He had no major medical, psychiatric or substance abuse problems. He remained confused in the hospital with expressive aphasia. Repeat CT scan of the head showed multiple hypo density in both frontal and left partial region. MRI confirmed the presence of acute isc...
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kokatnur, L., Khan, I., Chernyshev, O., Rudrappa, M. Tags: Cerebrovascular Case Reports Source Type: research

Transient ischemic attack service provision: A review of available service models
This article reviews recommended interventions and then discusses the inpatient and 6 alternative TIA service models to help modern stroke services determine the model best suited to their local health service environment.
Source: Neurology - March 7, 2016 Category: Neurology Authors: Ranta, A., Barber, P. A. Tags: All Health Services Research, Cost effectiveness/economic, Stroke prevention, All Cerebrovascular disease/Stroke VIEWS & amp;amp; REVIEWS Source Type: research

Hemorrhagic stroke following use of the synthetic marijuana "spice"
The association between the street drug spice (K-2 or herbal incense), a synthetic marijuana, and intracranial hemorrhage (ICH) has not yet been described, but it has with acute ischemic stroke (AIS),1 seizure, and myocardial infarction.2 Two young patients (31 and 25 years old) independently presented to our hospital with subarachnoid hemorrhage (SAH) after spice inhalation. The first also had 2 large intraparenchymal hemorrhages (IPH); the other also had AIS. Both were previously healthy without hypertension, coagulopathy, bleeding diathesis, thrombocytopenia, intracranial aneurysm, arteriovenous malformation, connective...
Source: Neurology - September 28, 2015 Category: Neurology Authors: Rose, D. Z., Guerrero, W. R., Mokin, M. V., Gooch, C. L., Bozeman, A. C., Pearson, J. M., Burgin, W. S. Tags: Stroke in young adults, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke, Other toxicology, Intracerebral hemorrhage CLINICAL/SCIENTIFIC NOTES Source Type: research

Infantile basal ganglia stroke after mild head trauma
A 13-month-old boy presented to our hospital with a history of right hemiparesis and right facial paresis for 2 days. These symptoms occurred several hours after a fall from a bed to the ground. An MRI of the brain showed an ischemic lesion and cerebral ultrasound examinations demonstrated bilaterally hyperechogenic lenticulostriate arteries (figure).
Source: Neurology - June 8, 2015 Category: Neurology Authors: Yang, S.-T., Lee, W.-T., Hung, K.-L., Chang, C.-L. Tags: Childhood stroke, Ultrasound, Brain trauma, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke NEUROIMAGES Source Type: research

Enhancement of TIA management in primary care with a novel electronic tool
Cerebrovascular disease causes a heavy burden for society.1 To avoid disability and reduce costs, stroke prevention is essential. The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) and Transient Ischemic Attack Clinic with Round-the-Clock Access (SOS-TIA) studies in Oxfordshire and Paris suggested that rapid investigation and treatment can prevent early stroke in TIA patients.2,3 Neurologist-led rapid access clinics are not available to all, however, and it is general practitioners (GPs) who most commonly play the crucial role in early management, making the diagnosis and urgent transfer to hospital, or i...
Source: Neurology - April 13, 2015 Category: Neurology Authors: Canavero, I., Gerraty, R. P. Tags: Cost effectiveness/economic, Stroke prevention, All Clinical trials, All Cerebrovascular disease/Stroke, All Practice Management EDITORIALS Source Type: research

CARES (Changing and Advancing Risk factor control through Educations after Stroke): A Pilot Trial of a Transitions in Care Post-discharge Telephone Intervention for Stroke Patients (S13.006)
OBJECTIVE: The purpose of study is to test the feasibility and effectiveness of a telephonic post-discharge intervention designed to improve access to care, reinforce self-management skills, improve health literacy, and screen for complications in a government-run safety net system. BACKGROUND: In the United States, risk factor control after stroke is poor, particularly among socio-economically disadvantaged populations with poor access to care. The immediate post-discharge period is a vulnerable time for stroke patients, given their risk of recurrent stroke, worsening symptoms, complications, and need for medication titra...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Hudson, L., Corrales, M., Moreno, L., Valle, N., Razmara, A., Dutta, T., Ramirez-Gomez, L., Towfighi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Epidemiology and Risk Factors Source Type: research

Influence of hospital-level practices on readmission after ischemic stroke
Source: Neurology - January 19, 2015 Category: Neurology Tags: CORRECTIONS Source Type: research

International Issues: Acute ischemic stroke: An international experience
Mr. Q, a 72-year-old right-handed man with hypertension, hyperlipidemia, recurrent angina, and a 30 pack-year smoking history is a retired scientist living in the United States with his wife. He recently visited his native country, Ukraine, for the first time in almost 30 years. After an emotional day with family members, he returned home and suddenly became diaphoretic and weak, and ultimately lost consciousness. His wife drove him to the nearest open medical clinic. Because it was severely underresourced, he was then emergently taken by ambulance to a larger hospital 6 hours away. He regained consciousness by the time he...
Source: Neurology - November 3, 2014 Category: Neurology Authors: Colling, M., Lioutas, V.-A., Krishnan, V. Tags: Cost effectiveness/economic, Outcome research, Quality of life, Stroke prevention, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Feeding tube placement in stroke patients: Urgent need for health services and outcomes research
Up to 70% of acute stroke patients demonstrate dysphagia. Approximately half of these patients recover sufficient swallowing ability to meet their caloric needs, while the other half will have long-term swallowing dysfunction.1,2 Surgical feeding tubes can provide nutritional support in patients with severe dysphagia, but the decision of if and when to place a feeding tube poses a substantial challenge because of an inability to predict long-term recovery accurately. In this issue of Neurology®, George et al.3 examined feeding tube placement in the United States in adults with acute ischemic stroke. The authors used th...
Source: Neurology - September 1, 2014 Category: Neurology Authors: Willis, A. W., Williams, L., Mullen, M. T. Tags: All Health Services Research, Medical care, All Cerebrovascular disease/Stroke, All Sleep Disorders EDITORIALS Source Type: research

Are prehospital stroke scales better than a coin toss at predicting acute stroke?
Acute therapy for ischemic stroke is exquisitely time sensitive.1 Patients treated within 90 minutes of symptom onset fare far better than patients treated beyond 90 minutes,2 with a 1.5 greater likelihood of ambulating independently at discharge, a 1.3 greater likelihood of discharge to home, and a 0.74 lower likelihood of dying in hospital. Yet only 1%–8% of all ischemic stroke patients are currently treated within the "golden hour" after the onset of stroke symptoms.3 This persists even in urban settings, where the majority of patients live within 60 minutes of an acute stroke center.4 As a community of neurologis...
Source: Neurology - June 16, 2014 Category: Neurology Authors: Gordon-Perue, G., Rundek, T. Tags: EDITORIALS Source Type: research

Rare Presentation of Churg-Strauss Syndrome: Intracerebral Hemorrhage, Subdural Hemorrhage and an Intracranial Aneurysm (P2.103)
DISCUSSION:CSS can present with rare neurologic complications namely peripheral neuropathy, ischemic and hemorrhagic stroke and much less commonly - intracranial aneurysms. Our patient also had cardiac masses that resolved after treatment with high dose steroids. Subdural hemorrhage along with a left MCA aneurysm related to CSS has not been previously reported in literature.Disclosure: Dr. Chahil has nothing to disclose. Dr. Morgan has nothing to disclose. Dr. Gonzales has nothing to disclose. Dr. Wu has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Chahil, M., Morgan, J., Gonzales, N., Wu, T.-C. Tags: Cerebrovascular Disease and Interventional Neurology: Acquired and Congenital Vascular Malformations Source Type: research

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