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RNA expression studies in stroke: what can they tell us about stroke mechanism?
Purpose of review Diagnosis of stroke and understanding the mechanism of stroke is critical to implement optimal treatment. RNA expressed in peripheral blood cells is emerging as a precision biomarker to aid in stroke diagnosis and prediction of stroke cause. In this review, we summarize available data regarding the role of RNA to predict stroke, the rationale for these changes, and a discussion of novel mechanistic insight and clinical applications. Recent findings Differences in RNA gene expression in blood have been identified in patients with stroke, including differences to distinguish ischemic from hemorrhagic s...
Source: Current Opinion in Neurology - January 17, 2020 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research

Acute stroke treatment during coronavirus disease 2019 pandemic
Purpose of review The coronavirus disease 2019 (COVID-19) pandemic has caused a major impact on stroke care. This review synthesizes the available data and provides a framework for optimal management of stroke patients with confirmed or suspected COVID-19 infection and eligible to reperfusion treatments. Recent findings Reorganization of health services has led to the conversion of stroke units and relocation of stroke staff to COVID units. During the pandemic surge, there has been a general decline of stroke presentations, increased time delays, and reduced activity across all areas of stroke care, specifically...
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso Source Type: research

Antiplatelet therapy after stroke: should it differ in the acute and chronic phase after stroke
Purpose of review Reviewing existing evidence regarding well tolerated and effective antiplatelet treatment in patients with acute or chronic, noncardioembolic ischemic stroke and transient ischemic attack (TIA). Recent findings For patients with high-risk stroke or TIA, for instance, minor stroke or high-risk TIA, or stroke of atherosclerotic origin with evidence suggesting risk of artery-to-artery embolism or with high-grade, symptomatic arterial stenosis, early initiated, short-term dual antiplatelet (e.g. aspirin and clopidogrel) is effective in reducing the risk of recurrent stroke and other vascular events which...
Source: Current Opinion in Neurology - December 20, 2017 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Hugh S. Markus Source Type: research

Stroke mimics and chameleons
The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient. Recent findings The safety profile of intravenous thrombolysis (IVT) in patients who have stroke mimics is excellent, and intracranial hemorrhages are rare. Modern neuroimaging techniques help identifying most mimics. For stroke chameleons the role of imaging may be less important, especially when the clinical presentation is not suggestive of a brain disorder that request immediate neuroimaging. Education of health providers to identify such situations...
Source: Current Opinion in Neurology - January 13, 2019 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Didier Leys Source Type: research

Implementation of the Stroke Action Plan for Europe 2018--2030 during coronavirus disease-2019
Purpose of review To describe the background, principles and implementation of the Stroke Action Plan for Europe 2018--2030 (SAP-E) in the perspective of the current COVID-19 pandemic. Recent findings SAP-E sets targets for the implementation of evidence-based preventive actions and stroke services to 2030. A recent mapping of stroke care in Europe has documented massive inequalities and even in high-income European countries access to reperfusion therapy and mortality after ischaemic stroke varies significantly. Organized stroke care providing stroke unit care and access to reperfusion therapies reduces mortali...
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso Source Type: research

The back and forth of axonal injury and repair after stroke
Purpose of review: The axon plays a central role in both the injury and repair phases after stroke. This review highlights emerging principles in the study of axonal injury in stroke and the role of the axon in neural repair after stroke. Recent findings: Ischemic stroke produces a rapid and significant loss of axons in the acute phase. This early loss of axons results from a primary ischemic injury that triggers a wave of calcium signaling, activating proteolytic mechanisms and downstream signaling cascades. A second progressive phase of axonal injury occurs during the subacute period and damages axons that survive the in...
Source: Current Opinion in Neurology - November 7, 2014 Category: Neurology Tags: TRAUMA AND REHABILITATION: Edited by S. Thomas Carmichael Source Type: research

The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties
Purpose of review: Atrial fibrillation is being increasingly diagnosed after ischemic stroke and transient ischemic attack (TIA). Patient characteristics, frequency and duration of paroxysms, and the risk of recurrent ischemic stroke associated with atrial fibrillation detected after stroke and TIA (AFDAS) may differ from atrial fibrillation already known before stroke occurrence. We aim to summarize major recent advances in the field, in the context of prior evidence, and to identify areas of uncertainty to be addressed in future research. Recent findings: Half of all atrial fibrillations in ischemic stroke and TIA patie...
Source: Current Opinion in Neurology - February 1, 2017 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Jean-Louis Mas and David Calvet Source Type: research

Lifestyle modification for stroke prevention: facts and fiction
Purpose of review: The purpose is to summarize recent evidence on lifestyle modifications and first or recurrent stroke risk. Recent findings: Weight reduction, low-risk diet, regular physical activity, smoking cessation, and low-to-moderate alcohol consumption may reduce stroke risk up to 50% or more, but level one evidence is still lacking for several interventions. Appropriate food ingredients can significantly decrease stroke risk as recently confirmed for Mediterranean diet. The optimal intensity and amount of physical exercise is still not well established before and after stroke, although modest levels of activity ...
Source: Current Opinion in Neurology - January 12, 2016 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Patrik Michel Source Type: research

Improving cognitive outcomes for pediatric stroke
Purpose of review: The past 20 years have seen a 35% increase in prevalence of pediatric stroke. Contrary to widely held views, children do not recover better than adults. This review explores the impact of pediatric stroke on cognitive domains, including intellectual and executive functions, memory and behavior, and the influence of age, lesion characteristics, and comorbidities on outcome. Recent findings: Cognitive problems occur in up to half of ischemic and hemorrhagic stroke survivors. Single-center studies have shown intelligence quotient scores skewed to the lower end of the average range, with greater impairment ...
Source: Current Opinion in Neurology - March 2, 2017 Category: Neurology Tags: DEVELOPMENTAL DISORDERS: Edited by Fenella Kirkham Source Type: research

Ischemic stroke and infectious diseases in low-income and middle-income countries
Purpose of review To address the important relationships between stroke and infection, focusing on the most frequent infections found in low-income and middle-income countries. Recent findings Stroke is one of the leading causes of mortality and disability worldwide, with a great proportion of the stroke burden occurring in low-income and middle-income countries. Infectious diseases are still a great health problem in developing countries and it is possible that the proportion of infection-related strokes is greater in these nations. Infectious diseases and stroke have a bidirectional relationship. Common infections m...
Source: Current Opinion in Neurology - January 13, 2019 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Didier Leys Source Type: research

Patent foramen ovale and stroke: current evidence and treatment options
Purpose of review Recent data have changed the landscape of patent foramen ovale (PFO) closure for secondary stroke prevention. This review synthesizes the data and provides a framework for optimal management of stroke patients with PFO. Recent findings The cumulative evidence indicates that PFO closure reduces the risk of recurrent stroke in carefully selected young cryptogenic stroke patients, with an annualized risk reduction of ∼0.6%. The benefit of PFO closure is particularly evident in patients with embolic appearing strokes, large right-to-left shunt, or an associated atrial septal aneurysm. There may be litt...
Source: Current Opinion in Neurology - January 17, 2020 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research

Stroke epidemiology and COVID-19 pandemic
Purpose of review The aim of this study was to describe the impact of the COVID-19 outbreak on the epidemiology, cause and clinical characteristics of incident stroke in different settings and populations. Recent findings Several studies have shown that there are three main themes in the epidemiology of stroke during the COVID-19 pandemic: COVID-19 seems to be associated with stroke in a significant number of patients. This association has been reported in several clinical series, mainly from China. There is a consistent trend towards a decreased number of hospital admissions of stroke patients during the pandem...
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso Source Type: research

Insights into a personalized management of blood pressure in acute stroke
Purpose of review Blood pressure management in acute stroke has long been a matter of debate. Epidemiological data show that high blood pressure is associated with death, disability and early stroke recurrence, whereas the pathophysiological rationale for ensuring elevated blood pressure in order maintain adequate cerebral perfusion remains a pertinent argument, especially in ischaemic stroke. Recent findings The European Stroke Organisation Guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage provide recommendations for the appropriate management of blood pressure in v...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Difficult situations in anticoagulation after stroke: between Scylla and Charybdis
This article focuses on three common anticoagulant-related situations, where the stroke physician needs to find the delicate balance between the two risks. Recent findings: Three typical case vignettes are presented and the associated dilemmas are discussed: a patient with an anticoagulant-related intracranial hemorrhage: would you restart anticoagulation?, an anticoagulated patient with a previous stroke because of atrial fibrillation is scheduled for an elective polyp removal: how would you handle anticoagulation perioperatively?, and a patient presents with an ischemic stroke because of atrial fibrillation: how soon wo...
Source: Current Opinion in Neurology - January 12, 2016 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Patrik Michel Source Type: research

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