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What is Clinical Efficacy of Transesophageal Echocardiography in Patients With Cryptogenic Stroke?: A Critically Appraised Topic
Conclusions: TEE identifies potential causal sources of embolus in patients with cryptogenic stroke that leads to changes in management and outcomes at least 3% of the time. Other findings, particularly aorta atherosclerosis, are identified much more commonly but the causal link to stroke is uncertain, thus changes in management in these cases is variable and data describing resulting outcomes are lacking.
Source: The Neurologist - December 22, 2017 Category: Neurology Tags: Critically Appraised Topics Source Type: research

Thrombolytic Therapy in Acute Ischemic Stroke in Patients Not Fulfilling Conventional Criteria
Conclusions: This study demonstrated that the off-label group had comparable symptomatic intracranial hemorrhagic risk which gave ground for further study into its safety. However, some subgroups had less favorable outcome, including high blood pressure, severe stroke, and old age. This may be due to underlying comorbidities and limited rehabilitation potential rather than thrombolysis per se.
Source: The Neurologist - November 1, 2017 Category: Neurology Tags: Original Articles Source Type: research

Perioperative Stroke and Mortality After Surgical Aortic Valve Replacement: A Meta-Analysis
Objective: Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.4%. The aim of this study was to determine whether perioperative stroke is a risk factor for operative mortality after SAVR by performing a meta-analysis of relevant studies. Materials and Methods: PubMed, EMBASE, and Web of Science databases were searched to retrieve relevant literature. Screening of the articles was done independently on the basis of predetermined criteria. Data from the relevant studies were extracted and a random effects model was us...
Source: The Neurologist - November 1, 2017 Category: Neurology Tags: Review Article Source Type: research

Embolic Stroke of Undetermined Source in Latin America: A Review
Conclusions: Undiagnosed AF is likely to contribute significantly to cryptogenic stroke and ESUS. Research is needed to continue evaluation of the optimum means of identifying clinically relevant occult AF. In view of the thromboembolic mechanism of ESUS, anticoagulant therapy may prove useful in prevention of recurrence. Ongoing trials are evaluating use of dabigatran, rivaroxaban, or apixaban versus aspirin for reducing the risk of recurrent stroke in patients with previous ESUS.
Source: The Neurologist - September 1, 2017 Category: Neurology Tags: Review Article Source Type: research

Reexpression of Prior Stroke Symptoms in Adults: When is a Mimic a Mimic?
A “stroke mimic” refers to any clinical condition that causes neurological symptoms clinically indistinguishable from a cerebral lesion that affects a vascular distribution, but is not caused by ischemia. One subtype of stroke mimic, termed stroke reexpression, is a form of mimicry in which previously recovered or improved stroke symptoms recur in the setting of a neurological disturbance (seizure, hypoperfusion state) or a systemic disturbance (toxic, metabolic, infectious). Many reports of stroke reexpression exist in the literature and are well known to clinicians, but there has been no consensus regarding terminolo...
Source: The Neurologist - September 1, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Cholesterol Levels and Hemorrhagic Stroke Risk in East Asian Versus Non-East Asian Populations: A Systematic Review and Meta-Analysis
Background: The aim of this work was to evaluate the relationships between cholesterol levels and risk of hemorrhagic stroke [including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)] in East Asian versus non-East Asian populations. Materials and Methods: Relevant prospective studies were identified from systematic searches of PubMed and EMBASE. A random-effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) that were used to compare the relationships between cholesterol levels and risk of hemorrhagic stroke in East Asian versus non-East Asian populations. Re...
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Original Articles Source Type: research

Risk Factors, Etiological Classification, Topographical Location, and Outcome in Medullary Infarctions
An understanding of the etiological mechanisms is important for therapeutic decisions and prognostic evaluation of patients with ischemic stroke. The object of this study was to evaluate the risk factors, etiological subtypes, and topography of lesion in patients with medullary infarctions (MIs). Besides, we also investigated early neurological deterioration, new vascular events, and functional outcome of all patients at 3-month follow-up. We analyzed our database consisting of patients who were diagnosed with acute MI and who were admitted within 24 hours of onset. Etiological classification of stroke was made on the basi...
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Original Articles Source Type: research

Antineuroinflammation of Minocycline in Stroke
Accumulating research substantiates the statement that inflammation plays an important role in the development of stroke. Both proinflammatory and anti-inflammatory mediators are involved in the pathogenesis of stroke, an imbalance of which leads to inflammation. Anti-inflammation is a kind of hopeful strategy for the prevention and treatment of stroke. Substantial studies have demonstrated that minocycline, a second-generation semisynthetic antibiotic belonging to the tetracycline family, can inhibit neuroinflammation, inflammatory mediators and microglia activation, and improve neurological outcome. Experimental and clin...
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Review Article Source Type: research

Antiphospholipid Syndrome With a Distinctive Constellation of Neurological Manifestations: Blue Toes, Red Valves, White Retinal Spots
We present a case of APS with uncommon neurological manifestations.
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Intravenous Alteplase for Acute Stroke and Pulmonary Embolism in a Patient With Recent Abdominoplasty
Conclusions: Interdisciplinary collaboration can successfully inform the decision to treat acute ischemic stroke with IV alteplase in the setting of recent major surgery.
Source: The Neurologist - June 24, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Angioinvasive Aspergillus-associated Stroke in an Immunocompetent Host Following Cardiac Surgery and ECMO
Conclusions: Ischemic infarcts in the setting of CABG or ECMO are often presumed to be thromboembolic from the heart or device, related to underlying hemodynamic instability, or due to a clinically apparent systemic infection such as endocarditis. This report suggests that invasive cerebral aspergillosis should be considered in seemingly immunocompetent patients following CABG or ECMO. The mechanism is unclear, but may be related to systemic inflammatory dysregulation resulting in increased susceptibility to uncommon pathogens.
Source: The Neurologist - May 1, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Early Carotid Occlusion After Endarterectomy in a Patient With a Mutation for MTHFR A1298C Polymorphism
Conclusions: Even if the association between homocysteine and carotid restenosis after CEA is unclear, an initial screening before the surgical procedure could be useful to promptly treat this condition and probably reduce the risk of this complication. In the case of homozygous mutation, the selection of patients and the appropriate therapy could reduce the risk of carotid restenosis.
Source: The Neurologist - May 1, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Early Neurological Deterioration During Alteplase Infusion for Acute Ischemic Stroke: An Uncommon Complication of Intravenous Thrombolysis
Conclusions: This case highlights that the use of thrombectomy in clinical practice provides an effective therapeutic option for large vessel occlusion in this setting. However, high clinical suspicion for this rare complication is mandatory to proceed to correct diagnosis and treatment.
Source: The Neurologist - May 1, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

Creutzfeldt-Jakob Disease Presenting as Stroke: A Case Report and Systematic Literature Review
Conclusions: CJD develops primarily within a population in whom stroke risk factors are common and represents a rare but important stroke mimic. Negative vascular imaging in elderly patients with apparent acute stroke syndromes should prompt diagnostic review including consideration of prion diseases.
Source: The Neurologist - March 1, 2017 Category: Neurology Tags: Review Article Source Type: research

“Phacing” a New Cause of Carotid Artery Dissection
Conclusions: Noteworthy, among vascular abnormalities of PHACE, CADs have never been reported before. Our 2 cases suggest that CAD is an underecognized cerebrovascular manifestation of PHACE and it should be searched for in these patients. Ultrasound, being noninvasive and portable, is a useful tool for the assessment and follow-up of these patients.
Source: The Neurologist - March 1, 2017 Category: Neurology Tags: Case Report/Case Series Source Type: research

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