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Is there Still a Time Window in the Treatment of Acute Stroke?
AbstractPurpose of reviewIt has become evident that strict time-based criteria are not optimal in selecting patients for acute stroke intervention, leaving the majority of patients untreated due to missing universal time-based criteria. We discuss the pathophysiologic basis for a shift of focus from time to the imaging evidence of salvageable tissue, as well as clinical and imaging tools.Recent findingsThere is strong evidence for the benefit of thrombectomy in patients with a sustained salvageable tissue presenting within 24  h. Although evidence of benefit is limited in patients presenting longer than 24 h, those patie...
Source: Current Treatment Options in Neurology - June 2, 2020 Category: Neurology Source Type: research

A Review of the Current Literature and Updates on Embolic Stroke of Undetermined Source (ESUS)
AbstractPurpose of ReviewThe initial ESUS construct presumed that atrial fibrillation (AF) would be detected in a substantial percentage of patients, but subsequent studies have determined that the rate of AF detection is much lower than anticipated, thereby highlighting other potential causes of ESUS. To date, there is no clear consensus supporting PFO closure or anticoagulation in ESUS patients. In this review, we discuss the recent studies on potential causes of ESUS and related work-up as well as report the recent trials on the treatment of ESUS.Recent FindingsSome of the potential causes of ESUS are undetected AF, pat...
Source: Current Treatment Options in Neurology - August 6, 2022 Category: Neurology Source Type: research

Treatment of Malignant Brain Edema and Increased Intracranial Pressure After Stroke
Opinion statement The management of patients with large territory ischemic strokes and the subsequent development of malignant brain edema and increased intracranial pressure is a significant challenge in modern neurology and neurocritical care. These patients are at high risk of subsequent neurologic decline and are best cared for in an intensive care unit or a comprehensive stroke center with access to neurosurgical support. Risks include hemorrhagic conversion, herniation, poor functional outcome, and death. This review discusses recent advances in understanding the pathophysiology of edema formation, identify...
Source: Current Treatment Options in Neurology - November 9, 2014 Category: Neurology Source Type: research

Prevention of Stroke in Rheumatoid Arthritis
Opinion statement Recognizing that systemic inflammation is a major contributor to the increased risk of cardiovascular disease (CVD), including stroke, in rheumatoid arthritis (RA) serves as the basis for prevention strategies for cerebrovascular disease in RA. In addition to traditional cardiovascular risk factors, recognize that RA may be an independent risk factor for cerebrovascular accident (CVA). The risk of CVD should be assessed in each patient with RA, utilizing modified risk score calculators. Careful monitoring and control of systemic inflammation should be undertaken in conjunction with assessing eac...
Source: Current Treatment Options in Neurology - May 18, 2015 Category: Neurology Source Type: research

Therapies for Hemorrhagic Transformation in Acute Ischemic Stroke
Opinion statementHemorrhagic transformation occurs in about 10 –15% of patients with acute ischemic stroke. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure. Future research should be directed on identifying indications to treat and use of appropriate homeostatic regimens to effectively reverse the different anticoagulants and thrombolytic agents in an attempt to improve outcomes of patients with hemorrhagic transformation.
Source: Current Treatment Options in Neurology - January 26, 2017 Category: Neurology Source Type: research

Management of Cognitive Impairment After Stroke
AbstractPurpose of ReviewIn this review, we present the reader with the latest diagnostic and therapeutic approaches in the management of patients with post-stroke cognitive impairment (PSCI). We discuss the most commonly utilized and validated neuropsychological assessments and neuroimaging diagnostic assessment tools. We also provide a critical appraisal of the pharmacological treatment approaches of  PSCI, in addition to highlighting the latest emerging non-pharmacological and technological advances in cognitive rehabilitation techniques.Recent FindingsAdvanced MRI techniques and newer PET tracers are being utilized h...
Source: Current Treatment Options in Neurology - June 15, 2020 Category: Neurology Source Type: research

Update on Large-Vessel Revascularization in Acute Ischemic Stroke
AbstractPurpose of reviewThis review presents the critical appraisal of current therapeutic strategies for patients with large-vessel occlusion (LVO) acute ischemic stroke (AIS). We provide the reader with most recent evidence supporting endovascular thrombectomy (EVT), different techniques used for thrombectomy, and highlight knowledge gaps regarding therapeutic efficacy of this intervention in respective subgroup of these patients based on site of occlusion, size of ischemic core, time from symptom onset, utility of concurrent intravenous thrombolysis (IVT), mild strokes, or tandem occlusions.Recent findingsEVT is the es...
Source: Current Treatment Options in Neurology - July 1, 2023 Category: Neurology Source Type: research

Treatment of Extracranial Arterial Dissection: the Roles of Antiplatelet Agents, Anticoagulants, and Stenting
AbstractPurpose of reviewCervicocephalic arterial dissection (CeAD) is the most commonly identified cause of stroke in young healthy individuals. The management of acute ischemic stroke due to the diagnosed or suspected CeAD is well established and is appropriate for thrombolysis. There is a substantial risk of stroke recurrence in the early post-stroke period. The optimum method of stroke prevention in the subacute period remains debatable. In our review, we focused on the management of recurrent stroke in CeAD, the choice of various antithrombotic agents for stroke risk reduction with regard to specific pathogenetic mech...
Source: Current Treatment Options in Neurology - September 25, 2019 Category: Neurology Source Type: research

Management of Neurologic Manifestations in Patients with Liver Disease
Opinion statement Liver disease, both in its acute and chronic forms, can be associated with a wide spectrum of neurologic manifestations, both central and peripheral, ranging in severity from subclinical changes to neurocritical conditions. Neurologists are frequently consulted to participate in their management. In this review, we present an overview of management strategies for patients with hepatic disease whose clinical course is complicated by neurologic manifestations. Type A hepatic encephalopathy (HE), which occurs in acute liver failure, is a neurologic emergency, and multiple measures should be taken t...
Source: Current Treatment Options in Neurology - June 16, 2016 Category: Neurology Source Type: research

Tenecteplase or Alteplase: What Is the Thrombolytic Agent of the Future?
AbstractPurpose of reviewAlteplase has been the thrombolytic of choice for acute ischaemic stroke for more than two decades. A thrombolytic which is easier to administer and with improved or comparable safety and efficacy is desirable. Tenecteplase has emerged as a potential successor, and its off-license use in acute ischaemic stroke has increased in recent years. We aimed to examine the evidence base for each drug and discuss their use in varying patient populations in acute ischaemic stroke.Recent findingsSeveral trials comparing tenecteplase and alteplase have reported very recently with the results of the ACT trial st...
Source: Current Treatment Options in Neurology - July 30, 2022 Category: Neurology Source Type: research

Telestroke ’s Role Through the COVID-19 Pandemic and Beyond
AbstractPurpose of reviewThe goal of this paper is to discuss the role and utilization of telestroke services through the COVID-19 pandemic and to suggest future directions to sustain and increase patients ’ access to stroke expertise.Recent findingsTelestroke is an innovative and effective tool that has been shown to improve access, quality of care, and outcomes of patients with acute stroke syndromes in resource-limited areas for the last two decades. The COVID-19 pandemic posed a significant challenge and strained healthcare systems worldwide, but it created novel and unique opportunities to expand and increase the ut...
Source: Current Treatment Options in Neurology - August 19, 2022 Category: Neurology Source Type: research

Diagnosis and Treatment of Poststroke Epilepsy: Where Do We Stand?
AbstractPurpose of ReviewStroke is the most common cause of seizures and epilepsy in older adults. This educational paper aims to give an update on current clinical aspects of diagnosis and treatment of poststroke epilepsy.Recent FindingsRegarding epileptic seizures related to stroke, it is important to distinguish between acute symptomatic seizures and unprovoked seizures as they differ in their risk for seizure recurrence. In fact, after a single unprovoked poststroke seizure, a diagnosis of epilepsy can be made because there is a greater than 60% risk for further seizures. Clinical models that can predict the developmen...
Source: Current Treatment Options in Neurology - December 1, 2022 Category: Neurology Source Type: research

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review
AbstractPurpose of reviewThe risks of cerebrovascular manifestations due to SARS-CoV-2 infection are significantly increased within the first 6 months of the infection. Our work aims to give an update on current clinical aspects of diagnosis and treatment of cerebrovascular manifestations during acute and long-term SARS-CoV-2 infection.Recent findingsThe incidence of acute ischemic stroke and haemorrhagic stroke during acute SARS-CoV-2 patients is estimated at 0.9 to 4.6% and 0.5 –0.9%, respectively, and were associated with increased mortality. The majority presented with hemiparesis, dysarthria, sensory deficits, and a...
Source: Current Treatment Options in Neurology - March 4, 2023 Category: Neurology Source Type: research

Neurological Deficits in Obstructive Sleep Apnea
Opinion statementObstructive sleep apnea (OSA) is the most common sleep-related breathing disorder characterized by repetitive episodes of complete or partial obstruction of the upper airway. The prevalence of this disorder is strictly dependent on its gravity. At ≥15 events/h apnea–hypopnea index (AHI), it ranges from 6 to 17% in the general population, with higher rates in men and increasing with age. The hypoxia induced by OSA severely affects the structure and function of blood vessels, culminating in mortality and morbidity. Its negative impact influ ences also cognitive functioning. Recent papers showed the relat...
Source: Current Treatment Options in Neurology - April 3, 2017 Category: Neurology Source Type: research

Anticoagulation for Noncardiac Indications in Neurologic Patients: Comparative Use of Non-Vitamin K Oral Anticoagulants, Low-Molecular-Weight Heparins, and Warfarin
Opinion statement Patients with neurologic disorders may develop a wide variety of thromboembolic events, both as a primary manifestation and as a consequence of their underlying neurologic condition. There are many available options for anticoagulation, ranging from warfarin to the parenteral subcutaneously administered anticoagulants to the non-vitamin K oral anticoagulants (NOACs). Warfarin is orally available, well-studied, and easily reversible in the setting of bleeding, but has a prolonged onset of action, measured in days, and equally slow offset; requires frequent monitoring for dose titration; and has m...
Source: Current Treatment Options in Neurology - July 19, 2014 Category: Neurology Source Type: research

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