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Surgical Approaches to Stroke Risk Reduction
This article examines the evidence for using the available options. RECENT FINDINGS Carotid endarterectomy is an effective treatment option for reducing the risk of stroke in appropriately selected patients. Patients should be stratified for future stroke risk based on both the degree of stenosis and the presence of symptoms referable to the culprit lesion. Carotid stenting is also useful in reducing stroke risk, again in carefully selected patients. Because of the publication of significant data regarding both carotid endarterectomy and carotid artery stenting in the last several years, selection can be far more person...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Spatial Neglect and Anosognosia After Right Brain Stroke
This article guides neurologists’ assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
Source: CONTINUUM: Lifelong Learning in Neurology - December 1, 2021 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Treatment of Acute Ischemic Stroke
This article provides an update on the state of the art of the emergency treatment of acute ischemic stroke with particular emphasis on the alternatives for reperfusion therapy. Recent Findings: The results of several randomized controlled trials consistently and conclusively demonstrating that previously functional patients with disabling strokes from a proximal intracranial artery occlusion benefit from prompt recanalization with mechanical thrombectomy using a retrievable stent have changed the landscape of acute stroke therapy. Mechanical thrombectomy within 6 hours of symptom onset should now be considered the prefer...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Remote Evaluation of the Patient With Acute Stroke
This article describes advances related to the successful remote evaluation of the patient with acute stroke. Telestroke is a connected care approach that brings expert stroke care to remote, neurologically underserved urban or rural locations. Recent findings reveal strong evidence showing that telestroke is equivalent to in-person care. Time is critical in treating patients with acute stroke, and telestroke networks must assure that technology improves—not delays—delivery of care. The stroke center and the spoke site must work collaboratively to develop and institute protocols and policies to ensure that eligible pat...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Practice Issues Source Type: research

Update on Treatment of Acute Ischemic Stroke
This article provides an update on the state of the art of the treatment of acute ischemic stroke with particular emphasis on the indications for reperfusion therapy. RECENT FINDINGS In addition to the previously established indications for intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of stroke symptom onset and endovascular therapy with mechanical thrombectomy for patients with large artery occlusion who can be treated within 6 hours of symptom onset, recent randomized controlled trials have now established new indications for emergency reperfusion in patients with ...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Recovery After Stroke
This article describes restorative therapies to improve patient outcomes after stroke. These therapies contrast with acute stroke treatments such as recombinant tissue plasminogen activator (rtPA) and thrombectomy that target clots, aim to salvage threatened brain tissue to limit injury, and have a time window measured in hours. Restorative therapies target the brain, aim to promote plasticity within surviving brain tissue, and have a time window measured in days to weeks or longer. RECENT FINDINGS A number of drugs are under study. Preclinical studies are providing attractive therapeutic candidates for translation, suc...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Maternal Stroke Associated With Pregnancy
This article summarizes current knowledge of the epidemiology, pathophysiology, prevention, and treatment of cerebrovascular disease in pregnant and postpartum women. RECENT FINDINGS Stroke is a leading cause of maternal morbidity and mortality, and most fatal strokes are preventable. Adaptive physiologic changes of pregnancy, including hemodynamic changes, venous stasis, hypercoagulability, and immunomodulation, contribute to increased maternal stroke risk. The highest-risk time period for maternal stroke is the immediate postpartum period. Migraine and hypertensive disorders of pregnancy, including gestational hyp...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Primary Progressive Aphasia and Stroke Aphasia
This article summarizes the clinical and anatomic features of the three named variants of primary progressive aphasia (PPA): semantic variant PPA, nonfluent/agrammatic variant PPA, and logopenic variant PPA. Three stroke aphasia syndromes that resemble the PPA variants (Broca aphasia, Wernicke aphasia, and conduction aphasia) are also presented. RECENT FINDINGS Semantic variant PPA and Wernicke aphasia are characterized by fluent speech with naming and comprehension difficulty; these syndromes are associated with disease in different portions of the left temporal lobe. Patients with nonfluent/agrammatic variant PPA or B...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Innovations in Prehospital Stroke Management Utilizing Mobile Stroke Units
Using a representative case, this article discusses prehospital innovations for patients with acute large vessel occlusion ischemic stroke, including mobile stroke unit care supported by advanced field imaging.
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: PRACTICE ISSUES Source Type: research

Coding in Stroke and Other Cerebrovascular Diseases
This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Practice Issues Source Type: research

Large Artery Atherosclerotic Occlusive Disease
ABSTRACT: Purpose of Review: Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient’s symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Prevention and Management of Poststroke Complications
This article provides a synopsis of the immediate and delayed medical complications of stroke, with an emphasis on prevention and management of these complications. Recent Findings: Meta-analysis of the trials for endovascular treatment of acute stroke shows no significant increase in hemorrhagic events. Rehabilitation guidelines published by the American Heart Association and American Stroke Association in 2016 aid in providing the best clinical practice for patients with stroke, from the time of their initial hospitalization to their return to the community. Summary: Medical complications from stroke are common and are...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Blood Cell Disorders and the Nervous System
This article discusses the epidemiology, diagnosis, treatment, and prevention of neurologic complications of common and rare blood cell disorders. recent findings A growing number of preventive treatment options are available for stroke in sickle cell disease. Paroxysmal nocturnal hemoglobinuria and immune thrombocytopenia can lead to stroke. Thrombotic thrombocytopenic purpura frequently causes neurologic symptoms and should be considered in the differential diagnosis of a patient with neurologic symptoms, thrombocytopenia, and hemolytic anemia. Polycythemia vera and essential thrombocythemia are rare causes of stroke....
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Acute Vestibular Syndrome
This article provides a practical approach to acute vestibular syndrome while highlighting recent research advances. RECENT FINDINGS Acute vestibular syndrome is defined as sudden-onset, continuous vertigo lasting longer than 24 hours with associated nausea and vomiting, all of which are worsened with head movement. Acute vestibular syndrome is provoked by a variety of central and peripheral causes, the most common of which are vestibular neuritis and acute stroke (posterior circulation). A clinical approach focusing on timing, associated history, and ocular motor findings can improve diagnostic accuracy and is more...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2021 Category: Neurology Tags: REVIEW ARTICLES 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

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