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Stroke-Associated Pneumonia: A Retrospective Study of Risk Factors and Outcomes
Introduction: Pneumonia is the most common complication after stroke, but our knowledge on risk factors and predictors of stroke-associated pneumonia (SAP) is limited. We sought to evaluate the predictors and outcomes of SAP among acute ischemic stroke (AIS) hospitalizations. Methods: This is a cross-sectional study of the Nationwide Inpatient Sample database from the year 2003 to 2014. We identified adult hospitalizations with AIS using International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The SAP was identified by the presence of a secondary diagnosis of hospital-acquired ...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Heart Rate Variability Analysis: A Useful Tool to Assess Poststroke Cardiac Dysautonomia
Background: Neurogenic heart syndrome represents a phenomenon often encountered in clinical practice after ischemic stroke. Further poststroke cardiovascular complications are possibly related to cardiac autonomic dysregulation. Multiple Trigonometric Regressive Spectral (MTRS) analysis of the heart rate variability (HRV) allows a precise evaluation of cardiovascular modulation under different conditions. Objectives: This research aims to evaluate the impact of the middle cerebral artery (MCA) ischemic stroke on cardiac autonomic function, using the MTRS analysis of HRV, during sympathetic and parasympathetic activati...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Effects of Baseline Systolic Blood Pressure on Outcome in Ischemic Stroke Patients With Intravenous Thrombolysis Therapy: A Systematic Review and Meta-Analysis
This study aimed to assess the relationship between baseline SBP and outcome. Materials and Methods: Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. Data were extracted according to a predefined data extraction form and then analyzed by STATA 12.0 software. The primary endpoint was the occurrence of good outcomes measured by a modified Rankin Scale score at 3 months, while the secondary endpoint was the occurrence of intracranial hemorrhage and death. Results: Eleven studies involving a total of 33,263 patients were included. Poo...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke: Case Report and Literature Review
Conclusion: Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case.
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Thrombolysis for Acute Ischemic Stroke Following Transcatheter Aortic Valve Replacement: Case Report and Literature Review
Conclusion: Previously undescribed, we suggest that tPA should be considered for post-TAVR AIS patients who otherwise satisfy inclusion and exclusion criteria.
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke
Background: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient. Objective: To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset. Methods: Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and Au...
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Original Article Source Type: research

Clinical Usefulness of Cell-Free DNA as a Prognostic Marker in Acute Ischemic Stroke
Objective: Stroke has become the second most common cause of death. Several biomarkers have been detected in the peripheral blood from stroke patients, but none has found a place in clinical practice. Cell-free DNA (cf-DNA) liberated into the blood soon after the onset of stroke might be useful for assessing disease severity and prognosis. Study Design and Methods: A total of 54 patients presenting with ischemic stroke were recruited consecutively with the exclusion of patients having trauma, tumor, infections, and organ failure. The cf-DNA was extracted by circulating nucleic acid kit from Qiagen and measured by real...
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Original Article Source Type: research

Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion
Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Successful Thrombolysis in the Setting of Marfan Syndrome and Chronic Aortic Dissection
Conclusion: To our knowledge, this is the first case of Marfan syndrome with chronic aortic dissection undergoing thrombolysis for acute ischemic stroke with a near-complete recovery of neurological deficit and favorable long-term outcome.
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Safety of Early Repeated Thrombolysis: A Case Report
Conclusion: This case report suggests that further randomized studies may evaluate whether repeated IVtPA may be safe and effective in ERS occurring shortly after a previous stroke when patients experience a period of complete neurological regression, minor disability, and a small infarct volume. Should the hypothesis be confirmed, small volume core and wide volume penumbra at perfusion CT may support the decision of adopting IVtPA repetition.
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Intravenous Thrombolysis For Acute Ischemic Stroke in Fabry Disease
Conclusion: The present case supports the scarce data underscoring the safety of intravenous thrombolysis for acute ischemic stroke in Fabry disease patients even when cerebral microbleeds are present.
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Etiological Classification of Cerebral Ischemic Stroke by the TOAST, SSS-TOAST, and ASCOD Systems: The Impact of Observer’s Experience on Reliability
Conclusions: Observer’s experience may affect the reliability of etiological classification systems in patients with ischemic stroke.
Source: The Neurologist - June 28, 2019 Category: Neurology Tags: Original Articles Source Type: research

Serum Uric Acid Level and Outcome of Patients With Ischemic Stroke: A Systematic Review and Meta-Analysis
This study aimed to evaluate the correlation between the SUA level and outcome of patients with ischemic stroke by performing a meta-analysis. Materials and Methods: Studies were included by a systematic search of several databases through December 01, 2018, followed by reviewing reference lists of obtained articles. Studies that included odds ratios (ORs) for ischemic stroke outcome per unit SUA level with 95% confidence intervals (95% CIs) were eligible for the meta-analysis. A random-effects model was used to calculate the pooled risk estimate. Publication bias was detected by Begg’s test. Results: Fifteen studi...
Source: The Neurologist - June 28, 2019 Category: Neurology Tags: Original Articles Source Type: research

Recurrent Stroke in Giant Cell Arteritis Despite Immunotherapy
Conclusions: This case highlights several important features of strokes in GCA: the predilection for the dural entry point of cerebral blood vessels, the progression of disease despite steroids, and the need to quickly escalate treatment in these cases. As seen in our patient, however, this disease carries high morbidity and mortality and patients often have poor outcomes despite aggressive immunosuppression.
Source: The Neurologist - June 28, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Late-onset Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes Presenting With Auditory Agnosia
Conclusions: MELAS is a disorder with clinical variability. Neuroimaging studies during stroke-like episodes in MELAS can provide significant clues to the underlying disorder. Although patients typically present in childhood, the first stroke-like episode can occur later in life in some patients, potentially related to a lower heteroplasmy level.
Source: The Neurologist - May 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

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