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Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease
Purpose of review Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice. Recent findings The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and...
Source: Current Opinion in Neurology - November 17, 2022 Category: Neurology Tags: TRAUMA AND REHABILITATION: Edited by Stefano Tamburin Source Type: research

Editorial: Advances in stroke management and upcoming challenges
No abstract available
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Shifting acute stroke management to the prehospital setting
Purpose of review The earlier the treatment, the better the outcomes after acute ischemic stroke. Optimizing prehospital care bears potential to shorten treatment times. We here review the recent literature on mothership vs. drip-and-ship as well as mobile stroke unit concepts. Recent findings Mobile stroke units result in the shortest onset-to-treatment times in mostly urban settings. Summary Future research should focus on further streamlining processes around mobile stroke units, especially improving dispatch algorithms and improve referral for endovascular therapy.
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Intravenous thrombolysis for acute ischemic stroke: why not?
Purpose of review The aim of this study was to summarize available evidence regarding the safety and efficacy of intravenous thrombolysis (IVT) using recombinant tissue-plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients with specific comorbidities and potential contraindications to systemic reperfusion therapy. Recent advances in IVT implementation in wake-up stroke and in extended time window using advanced neuroimaging will also be highlighted. Recent findings Despite theoretical concerns of a higher bleeding risk with IVT, there are no data showing increased risk of symptomatic intracerebra...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Persistent challenges in endovascular treatment decision-making for acute ischaemic stroke
Purpose of review Although endovascular treatment (EVT) is the gold standard for treating acute stroke patients with large vessel occlusion (LVO), multiple challenges in decision-making for specific conditions persist. Recent evidence on a selection of patient subgroups will be discussed in this narrative review. Recent findings Two randomized controlled trials (RCTs) have been published in EVT of basilar artery occlusion (BAO). Large single arm studies showed promising results in Patients with low Alberta stroke program early CT score (ASPECTS) and more distal vessel occlusions. Recent data confirm patients wit...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Advanced imaging in acute ischemic stroke: an updated guide to the hub-and-spoke hospitals
Purpose of review The purpose of this review is to summarize the role of the hub-and-spoke system in acute stroke care, highlight the role of advanced imaging and discuss emerging concepts and trials relevant to the hub-and-spoke model. Recent findings The advent of advanced stroke multimodal imaging has provided increased treatment options for patients, particularly in rural and regional areas. When used in the hub-and-spoke model, advanced imaging can help facilitate and triage transfers, appropriately select patients for acute therapy and treat patients who may otherwise be ineligible based on traditional tim...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Cerebrovascular disease in pregnancy and postpartum
Purpose of review Cerebrovascular disorders during pregnancy and puerperium are uncommon but potentially serious entities. This review aims to provide guidance on the diagnosis and management of these diseases, according to the most recent findings. Recent findings Proteinuria is no longer a mandatory criterion for the diagnosis of preeclampsia. Favourable long-term foetal and maternal outcomes are achieved in most patients with ruptured cerebral arterial malformations during pregnancy receiving interventional treatment prior to delivery. Despite the recent recommendations, physicians still hesitate to administe...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa 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

Precision medicine in secondary prevention of ischemic stroke: how may blood-based biomarkers help in clinical routine? An expert opinion
Purpose of review One in eight patients unfortunately suffers a new stroke within 5 years of their first stroke, even today. Research in precision medicine could lead to a more individualized treatment allocation, possibly achieving lower recurrence rates of ischemic stroke. In this narrative review, we aim to discuss potential clinical implementation of several promising candidate blood biomarkers. Recent findings We discuss specifically some promising blood-based biomarkers, which may improve the identification of underlying causes as well as risk stratification of patients according to their specific cerebr...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Anticoagulation after stroke: persistent uncertainties
Purpose of review Direct oral anticoagulants (DOAC) are the mainstay of anticoagulant therapy for stroke prevention in patients with nonvalvular atrial fibrillation. Persistent uncertainties remain in different areas, and this review discusses current dilemmas based on selected studies. Recent findings Optimal timing of DOAC initiation after a recent ischaemic stroke in patients with atrial fibrillation is currently unknown and subject of ongoing randomized controlled trials. Ischaemic stroke despite anticoagulant therapy in patients with atrial fibrillation is frequent, constitutes heterogeneous causes (competi...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Diana Aguiar de Sousa Source Type: research

Vestibular function testing in the 21st century: video head impulse test, vestibular evoked myogenic potential, video nystagmography; which tests will provide answers?
Purpose of review To most neurologists, assessing the patient with vertigo is an unpleasant and worrisome task. A structured history and focused examination can be complemented by carefully selected laboratory tests, to reach an early and accurate diagnosis. We provide evidence-based recommendations for vestibular test selection. Recent findings The video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (VEMP) and home-video nystagmography are four modern, noninvasive methods of assessing vestibular function, which are equally applicable in the hospital and office-practice. Coll...
Source: Current Opinion in Neurology - January 19, 2022 Category: Neurology Tags: NEURO-OTOLOGY: Edited by Kristen K. Steenerson and Terry D. Fife Source Type: research

Editorial: Coronavirus disease 2019 and stroke: how to avoid a new lockdown for stroke patients
No abstract available
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso 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

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

Maintaining high thrombectomy rates during pandemics
Purpose of review The aim of this article is to review the current literature on endovascular treatment of acute ischemic stroke in the aftermath of the coronavirus disease 2019 (COVID-19) lockdown. Recent findings The outbreak of the COVID-19 has had effect of unprecedented magnitude on the social, economic and personal aspects around the globe. Healthcare providers were forced to expand capacity to provide care to the surging number of symptomatic COVID-19 patients, while maintaining a fully operating service for all non-COVID patients. The recent literature suggesting an overall decrease in acute ischemic str...
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso Source Type: research

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