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Etiology and Treatment of Arterial Ischemic Stroke in Children and Young Adults
Opinion statement Stroke is the second leading cause of death worldwide (Go et al. Circulation 129:e28–292, 2014) and is a major cause of morbidity and mortality. Compared with older adults, arterial ischemic stroke (AIS) is relatively uncommon in children and young adults, comprising 5-10 % of all stroke (Biller Nat Rev Cardiol 6:395–97, 2009), but is associated with significant cost. In contrast to the declining overall incidence of stroke, some early studies suggest that the rate of stroke hospitalizations in children and young adults is rising (George et al. Ann Neurol 70:713–21, 2011; Kissela et al. S...
Source: Current Treatment Options in Neurology - September 18, 2014 Category: Neurology Source Type: research

Sleep Disorders and Stroke: Does Treatment of Obstructive Sleep Apnea Decrease Risk of Ischemic Stroke?
AbstractPurpose of reviewThis review aims to support obstructive sleep apnea (OSA) as a risk factor for ischemic stroke, review treatment strategies for OSA, provide a comprehensive review of clinical data on OSA treatment and ischemic stroke risk, and to critically assess if treatment of OSA decreases the risk of ischemic stroke and if treatment improves outcomes and subsequent ischemic stroke risk in post-stroke patients.Recent findingsSeveral observational studies, randomized controlled trials (RCTs), and meta-analyses have examined the risk of ischemic stroke and cardiovascular events in patients with OSA and have also...
Source: Current Treatment Options in Neurology - June 23, 2019 Category: Neurology Source Type: research

Race/Ethnicity Considerations in the Prevention and Treatment of Stroke
AbstractPurpose of reviewTo describe racial and ethnic considerations that exist for the prevention and treatment of ischemic and hemorrhagic stroke.Recent findingsMultiple studies have characterized stroke disparities. The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) found that Black individuals have nearly twice the rates of stroke compared to White individuals. Differences in the incidence of stroke risk factors, both inherited and acquired, contribute to these disparities. Black individuals have an earlier age of onset, a longer duration, and greater severity of hypertension compared to White individuals....
Source: Current Treatment Options in Neurology - September 27, 2021 Category: Neurology Source Type: research

Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?
We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.Recent findingsRecently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lower...
Source: Current Treatment Options in Neurology - April 7, 2019 Category: Neurology Source Type: research

Stroke Treatment in the Setting of Systemic Disease
AbstractWhile the possible stroke risks for more prevalent conditions, such as cardiac disease or cancer, are important to recognize, there are other equally devastating systemic diseases that can affect younger adults and, if not cautious, may be misdiagnosed if stroke is the initial presentation.Purpose of reviewWe aim to discuss treatments of three rarer, but important systemic diseases associated with an increased incidence of ischemic stroke, specifically sickle cell anemia, human immunodeficiency virus (HIV), and Takayasu ’s arteritis.Recent findingsGiven that individuals with these diseases are now living longer, ...
Source: Current Treatment Options in Neurology - November 13, 2020 Category: Neurology Source Type: research

Causes and Treatment of Acute Ischemic Stroke During Pregnancy
AbstractPurpose of reviewTreatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state.Recent findingsIntravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been use...
Source: Current Treatment Options in Neurology - May 21, 2018 Category: Neurology Source Type: research

Role of Occlusive Devices to Prevent Thromboembolism Among Persons With a Patent Foramen Ovale and Prior Stroke
Opinion statement Patent foramen ovale (PFO) has been linked to stroke, presumably through the mechanism of paradoxical embolism; however, data is confusing regarding the causal relationship between PFO and embolic stroke. What has come to light in the past decade of research is that PFO closure with devices that achieve a high rate of closure may reduce the risk of recurrent stroke compared with medical therapy, but this benefit has not been shown in the general population with a PFO and cryptogenic stroke. The important question now is which patient will benefit from PFO closure for stroke risk reduction. A val...
Source: Current Treatment Options in Neurology - March 7, 2015 Category: Neurology Source Type: research

Dual Antiplatelet Therapy in Ischemic Stroke Prevention: Which Two Could Be Better than One?
AbstractPurpose of reviewRecurrent stroke after ischemic stroke (IS) or high-risk transient ischemic attack (TIA) increases morbidity and mortality. Secondary stroke prevention strategies include modification of behavioral and vascular risk factors and antithrombotic use, including single or dual antiplatelet therapy (DAPT). In this review, we focus on DAPT indications, combinations, and treatment duration.Recent findingsStudies showed that for patients with mild to moderate non-cardioembolic strokes or those with symptomatic intracranial or mild extracranial stenosis ( ≤ 30% diameter reduction), short-term DAPT (21–...
Source: Current Treatment Options in Neurology - November 5, 2021 Category: Neurology Source Type: research

Acute Stroke Treatment in Children: Are Adult Guidelines Applicable?
This article provides an overview of acute treatments in stroke which are widely studied and available for adults and their applicability in the pediatric population.Recent FindingsArterial ischemic stroke is an important cause of morbidity and mortality in the pediatric population. Neurological deficits and etiologies are age-dependent and more challenging to diagnose than in the adult population. Advancements in imaging and treatment modalities including increased treatment windows in acute stroke have led to improvement in the diagnosis and management of pediatric arterial ischemic disease. Accordingly, hyperacute treat...
Source: Current Treatment Options in Neurology - February 19, 2022 Category: Neurology Source Type: research

Selection of Warfarin or One of the New Oral Antithrombotic Agents for Long-Term Prevention of Stroke among Persons with Atrial Fibrillation
Opinion statement Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, which can potentially increases the risk of stroke by five-fold, thus, resulting in high public healthcare burden. Stroke prevention is vital in the management of AF patients. Vitamin K antagonists (VKA, eg, warfarin) have been the mainstay treatment to prevent ischemic stroke and systemic thromboembolism in AF patients for several decades. Despite the efficacy of warfarin, its limitations have recently driven the advent of some new antithrombotic agents, the non-VKA oral anticoagulant (NOACs, including dabigatran, ri...
Source: Current Treatment Options in Neurology - February 11, 2015 Category: Neurology Source Type: research

Antiplatelet Agents in Secondary Stroke Prevention: Selection, Timing, and Dose
AbstractPurpose of reviewThis narrative review critically evaluated the published studies regarding the systematic use of antiplatelet agents for secondary stroke prevention.Recent findingsStroke is a leading cause of morbidity and mortality around the world. Multimodal prevention is the most viable strategy for reducing the societal burden of stroke recurrence. For secondary stroke prevention, antiplatelet therapy is at the core of effective long-term vascular risk reduction among survivors of an ischemic stroke or transient ischemic attack (TIA). In addition to aspirin, there are several antiplatelet agents proven to be ...
Source: Current Treatment Options in Neurology - June 23, 2018 Category: Neurology Source Type: research

Stroke Treatment in the Era of COVID-19: a Review
AbstractPurpose of ReviewTo describe a comprehensive review of the epidemiology, pathophysiology, and treatment of stroke in the era of COVID-19.Recent FindingsCOVID-19 is associated with myriad neurological disorders, including cerebrovascular disease. While ischemic stroke is the most common, COVID-19 is associated with an increased risk of intracranial hemorrhage, arterial dissection, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. In this review, we discuss the epidemiology, pathophysiology, and treatment of stroke due to COVID-19. In addition, we describe how COVID-19 has changed th...
Source: Current Treatment Options in Neurology - April 25, 2022 Category: Neurology Source Type: research

The Evolution and Application of Cardiac Monitoring for Occult Atrial Fibrillation in Cryptogenic Stroke and TIA
Opinion statement The evaluation of the stroke and transient ischemic attack (TIA) patient has been historically predominated by the initial evaluation in the hospital setting. As the etiology of stroke has eluded us in approximately one third of all acute events, the medical community has been eager to seek the answer to this mystery. In recent years, we have seen an explosion of innovations and trends allowing for a more detailed post stroke assessment strategy aimed at the identification of occult atrial fibrillation as the etiologic cause for the cryptogenic event. This has been achieved through the evolution...
Source: Current Treatment Options in Neurology - February 29, 2016 Category: Neurology Source Type: research

Changing Management of Acute Ischaemic Stroke: the New Treatments and Emerging Role of Endovascular Therapy
Opinion statement Urgent reperfusion of the ischaemic brain is the aim of stroke treatment, and the last two decades have seen a rapid advancement in the medical and endovascular treatment of acute ischaemic stroke. Intravenous tissue plasminogen activator (tPA) was first introduced as a safe and effective thrombolytic agent followed by the introduction of newer thrombolytic agents as well as anticoagulant and antiplatelet agents, proposed as potentially safer drugs with more favourable interaction profiles. In addition to chemo-thrombolysis, other techniques including transcranial sonothrombolysis and microbubbl...
Source: Current Treatment Options in Neurology - March 27, 2016 Category: Neurology Source Type: research

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