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Sleep apnea and stroke
Purpose of review Stroke and sleep apnea are highly prevalent conditions with a physiologically plausible bidirectional relationship. This review addresses prestroke sleep apnea, wake-up stroke and sleep apnea, and poststroke sleep apnea, with an attempt to highlight research published in the last 18 months. Recent findings Sleep apnea is highly prevalent poststroke. Poststroke sleep apnea is associated with worse poststroke functional and cognitive outcomes and a higher risk of recurrent stroke. Physiologic tests are needed to diagnose sleep apnea in poststroke patients as sleep apnea questionnaires do not perform we...
Source: Current Opinion in Neurology - January 17, 2020 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind Source Type: research

Digital health in stroke medicine: what are the opportunities for stroke patients?
Purpose of review The European Stroke Organisation published a European Stroke Action Plan (SAP-E) for the years 2018–2030. The SAP-E addresses the entire chain of care from primary prevention through to life after stroke. Within this document digital health tools are suggested for their potential to facilitate greater access to stroke care. In this review, we searched for digital health solutions for every domain of the SAP-E. Recent findings Currently available digital health solutions for the cerebrovascular disease have been designed to support professionals and patients in healthcare settings at all stage...
Source: Current Opinion in Neurology - January 21, 2021 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Valeria Caso Source Type: research

Spatial cognitive rehabilitation and motor recovery after stroke
Purpose of review: Stroke rehabilitation needs to take major steps forward to reduce functional disability for survivors. In this article, we suggest that spatial retraining might greatly increase the efficiency and efficacy of motor rehabilitation, directly addressing the burden and cost of paralysis after stroke. Recent findings: Combining motor and cognitive treatment may be practical, as well as addressing the needs after moderate-to-severe stroke. Spatial neglect could suppress motor recovery and reduce motor learning, even when patients receive appropriate rehabilitation to build strength, dexterity, and endurance. S...
Source: Current Opinion in Neurology - November 7, 2014 Category: Neurology Tags: DEGENERATIVE AND COGNITIVE DISEASES: Edited by Gabriella Bottini Source Type: research

Recent advances in mesoscopic-scale imaging in animal models of ischemic stroke
This article provides an overview of the recent literature regarding the application of in-vivo brain imaging techniques to animal models of ischemic stroke. Recent findings: Major breakthroughs concerned the effects of sensory stimulation on neuronal function, local hemodynamics, and tissue outcome in the hyperacute phase of stroke; the novel application to stroke of hybrid scanners allowing simultaneous PET and magnetic resonance; the refinements of magnetic resonance-based oxygen imaging, allowing to map the ischemic penumbra in a completely noninvasive way; the implementation of new PET ligands to selectively map post...
Source: Current Opinion in Neurology - January 12, 2016 Category: Neurology Tags: Special Commentary Source Type: research

Managing high blood pressure during acute ischemic stroke and intracerebral hemorrhage
Purpose of review Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines. Recent findings Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and...
Source: Current Opinion in Neurology - December 20, 2017 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Hugh S. Markus Source Type: research

Pregnancy and ischemic stroke: a practical guide to management
Purpose of review Ischemic stroke during pregnancy or the puerperium is a devastating disease during a crucial period in life and warrants a specific approach. To date, current practice is mainly based on expert opinion because of a lack of randomized controlled trials and high-quality observational studies. The present review is intended as a practical guide to (acute) management of ischemic stroke during pregnancy and puerperium. Recent findings Recent findings showed that the incidence of stroke during pregnancy is rising. In 2014, the first guideline for the prevention of stroke in women was released, however on m...
Source: Current Opinion in Neurology - December 20, 2017 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Hugh S. Markus Source Type: research

Managing high blood pressure during acute ischemic stroke and intracerebral hemorrhage
Purpose of review Blood pressure (BP) elevations above premorbid levels are observed in at least 60% of acute ischemic and hemorrhagic stroke patients, within the first 24 h of symptom onset. A number of potential causes have been hypothesized, and high BP may be associated with poor stroke outcome. This review discusses management strategies of high BP in acute stroke, in the context of current guidelines. Recent findings Excessive BP elevation can impact acute stroke therapeutic strategies, particularly in modifying intervention safety and efficacy. Currently, guidance on BP management in acute ischemic stroke and...
Source: Current Opinion in Neurology - January 17, 2018 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Hugh S. Markus Source Type: research

Pregnancy and ischemic stroke: a practical guide to management
Purpose of review Ischemic stroke during pregnancy or the puerperium is a devastating disease during a crucial period in life and warrants a specific approach. To date, current practice is mainly based on expert opinion because of a lack of randomized controlled trials and high-quality observational studies. The present review is intended as a practical guide to (acute) management of ischemic stroke during pregnancy and puerperium. Recent findings Recent findings showed that the incidence of stroke during pregnancy is rising. In 2014, the first guideline for the prevention of stroke in women was released, however on m...
Source: Current Opinion in Neurology - January 17, 2018 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Hugh S. Markus Source Type: research

Acute imaging for evidence-based treatment of ischemic stroke
Purpose of review Until recently, intravenous thrombolysis and mechanical thrombectomy for acute stroke treatment relied on reported information on the known time of symptom onset and was limited to treatment within a narrow time window. New trials have provided evidence for imaging-based effective reperfusion treatment in an extended time window and unknown-onset stroke. This review summarizes evidence from recent clinical trials and suggests a simple algorithm for the choice of imaging modalities to guide evidence-based reperfusion treatment of acute stroke. Recent findings Two trials have provided evidence for bene...
Source: Current Opinion in Neurology - June 27, 2019 Category: Neurology Tags: NEUROIMAGING: Edited by Stefan Klöppel Source Type: research

Atrial fibrillation and stroke: how much atrial fibrillation is enough to cause a stroke?
Purpose of review The association between atrial fibrillation and stroke is firmly established, and anticoagulation reduces stroke risk in patients with atrial fibrillation. However, the role of anticoagulation in very brief durations of atrial fibrillation (subclinical atrial fibrillation) is an area of controversy. Recent findings Stroke risk increases alongside burden of atrial fibrillation. Ongoing trials will clarify if 24 h or less of atrial fibrillation on extended monitoring necessitates lifelong anticoagulation. Trials examining empiric anticoagulation for individuals with ESUS did not demonstrate benefit o...
Source: Current Opinion in Neurology - January 17, 2020 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Mitchell S.V. Elkind 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

Blood−brain barrier breakdown and neovascularization processes after stroke and traumatic brain injury
Purpose of review: Angiogenesis or vascular reorganization plays a role in recovery after stroke and traumatic brain injury (TBI). In this review, we have focused on two major events that occur during stroke and TBI from a vascular perspective − what is the process and time course of blood−brain barrier (BBB) breakdown? and how does the surrounding vasculature recover and facilitate repair? Recent findings: Despite differences in the primary injury, the BBB changes overlap between stroke and TBI. Disruption of BBB involves a series of events: formation of caveolae, trans and paracellular disruption, tight junction brea...
Source: Current Opinion in Neurology - November 11, 2015 Category: Neurology Tags: TRAUMA AND REHABILITATION: Edited by S. Thomas Carmichael Source Type: research

Pre and intrahospital workflow for acute stroke treatment
Purpose of review: With the recent demonstration of the effectiveness of rapid recanalization of large vessel occlusions in acute ischemic stroke, it is important to assess the current status of pre and intrahospital workflow for acute stroke. Recent findings: We will review trends in the evaluation and treatment of acute stroke and offer suggestions for how best to advance the workflow for acute stroke care in the coming years. Summary: Future research is needed for: field use of clinical scores for predicting large vessel occlusions, telemedicine to facilitate prehospital triage, and pre and intrahospital processes for...
Source: Current Opinion in Neurology - January 12, 2016 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Patrik Michel Source Type: research

Imaging-based selection for revascularization in acute ischemic stroke
Purpose of review: With the positive results of recent endovascular thrombectomy (EVT) trials, intravenous thrombolysis (IVT) and EVT provide physicians with two majorly effective acute treatment options for patients with acute ischemic stroke. IVT and EVT can be used as a single treatment or as a combined IVT/EVT treatment approach. This review summarizes how imaging findings can help in selecting stroke patients who are likely to benefit from these revascularization therapies. Recent findings: IVT applied within 4.5 h from symptom onset remains the mainstay of acute stroke therapy and was also applied to most patients...
Source: Current Opinion in Neurology - January 12, 2016 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Patrik Michel Source Type: research

Management of acute stroke in patients on oral anticoagulants
Purpose of review: An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs. Recent findings: Testing coagulation in patients with acute ischemic stroke and receiving NOACs is complex, and observational data challen...
Source: Current Opinion in Neurology - February 1, 2017 Category: Neurology Tags: CEREBROVASCULAR DISEASE: Edited by Jean-Louis Mas and David Calvet Source Type: research

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