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The Evolving Concept of Cryptogenic Stroke
This article discusses cryptogenic stroke and the results of recent randomized trials that can inform its evaluation and management. RECENT FINDINGS Most cryptogenic strokes appear embolic, leading to the term embolic stroke of undetermined source. It was previously thought that embolic stroke of undetermined source was a single, therapeutically relevant entity, the underlying sources of which would respond to anticoagulant therapy; however, two large randomized trials found no benefit with anticoagulation compared to antiplatelet therapy for secondary stroke prevention after embolic stroke of undetermined source. A sin...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Aura and Stroke: relationship and what we have learnt from preclinical models
ConclusionPreclinical models suggest a key role for enhanced SD susceptibility and microembolization to explain both the occurrence of migraine attacks and the increased stroke risk in migraineurs. Therapeutic targeting of SD and microembolic events, or potential causes thereof, will be promising for treatment of aura and may also prevent ischemic infarction in vulnerable brains.
Source: The Journal of Headache and Pain - May 28, 2019 Category: Neurology Source Type: research

Application of Machine Learning Techniques to Identify Data Reliability and Factors Affecting Outcome After Stroke Using Electronic Administrative Records
Conclusion: Electronic administrative records from this cohort produced reliable outcome prediction and identified clinically appropriate factors negatively impacting most outcome variables following hospital admission with stroke. This presents a means of future identification of modifiable factors associated with patient discharge destination. This may potentially aid in patient selection for certain interventions and aid in better patient and clinician education regarding expected discharge outcomes.
Source: Frontiers in Neurology - September 27, 2021 Category: Neurology Source Type: research

Cardioembolic Stroke
This article summarizes the different causes of cardioembolism and outlines current management guidelines. Recent Findings: Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including ECG, echocardiography, brain imaging, and cardiac monitoring. Atrial fibrillation is the most common cause of cardioembolic stroke, and anticoagulation is usually recommended. This article reviews risk stratification models to assist in the decision-making process and highlights the increased use of novel oral anticoagulants for stroke prevention in at...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Epidemiology and Primary Prevention of Stroke
This article provides an update on the epidemiology and prevention of a first stroke. Risk factor modification plays a large role in stroke prevention. Strategies for early intervention, particularly for hypertension, are critical for reducing stroke morbidity and mortality. RECENT FINDINGS Because of the new criteria for hypertension, more people are now classified as hypertensive and can benefit from lifestyle or medical management. Direct oral anticoagulants have made it easier to safely treat patients with atrial fibrillation and are now considered first-line therapy for patients with an additional stroke risk facto...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Stroke in Women
This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan. RECENT FINDINGS Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Medical Management for Secondary Stroke Prevention
This article reviews the evidence base and recommendations for medical management for secondary stroke prevention. RECENT FINDINGS Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant–associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source. SUMMARY Most strokes are preventable. The mainstays ...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neuropsychological and neuroimaging evidences of cerebral dysfunction in stroke-free patients with atrial fibrillation: A review
Atrial fibrillation (AF) is the most common heart arrhythmia, with the highest prevalence in the elderly. AF has been correlated with silent lesions and cognitive impairment, even in the absence of stroke. The cognitive impairment in AF represents a risk of functional decline, morbidity, mortality and high costs, constituting a public health problem due to the increasing prevalence of this arrhythmia. Cognitive analysis of patients with AF without stroke has shown poor performance in executive, memory and learning functions.
Source: Journal of the Neurological Sciences - February 18, 2019 Category: Neurology Authors: D.S. Silva, A.C. Coan, W.M. Avelar Tags: Review Article Source Type: research

Diagnosis and Management of Transient Ischemic Attack
This article reviews the diagnosis, investigation, and recommended management after a transient ischemic attack (TIA) and discusses how to make an accurate diagnosis, including the diagnosis of mimics of TIAs. Recent Findings: Up to a 10% risk of recurrent stroke exists after a TIA, and up to 80% of this risk is preventable with urgent assessment and treatment. Imaging of the brain and intracranial and extracranial blood vessels using CT, CT angiography, carotid Doppler ultrasound, and MRI is an important part of the diagnostic assessment. Treatment options include anticoagulation for atrial fibrillation, carotid revascul...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Neurologic Complications of Cardiac and Aortic Disease
This article discusses neurologic complications that can arise from cardiac and aortic disease and dysfunction. Recent Findings: Advances in the care of patients with cardiac or aortic disease include the use of prolonged cardiac monitoring in cryptogenic stroke and the approval of the use of left atrial appendage closure devices for stroke prevention in patients with atrial fibrillation who are not candidates for anticoagulation. Continuing controversy surrounds patent foramen ovale closure, and new evidence indicates that cognitive impairment following coronary artery bypass grafting surgery may be less common than prev...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2017 Category: Neurology Tags: Review Articles Source Type: research