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41. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

or calcified vessels along the margin of the hemorrhage or regions of increased density corresponding to the vascular nidus, suggestive of an underlying vascular anomaly. The clinical scenario and location of intraparenchymal hemorrhage can also be helpful in differentiating a primary from secondary pathogenesis of the hemorrhage in which the deep cerebral and brainstem regions are more related to primary hypertensive causes. , Delgado Almandoz et al studied 623 patients presenting with intraparenchymal (...) informed decision in terms of both the feasibility of and the need for endovascular treatment. The immediate risks of DSA relate primarily to neurological complications such as thromboembolic stroke. These risks are low, likely related to the relatively young age and good health of patients with bAVMs compared with patients presenting with ischemic stroke. In addition to stroke risk, DSA entails radiation exposure with potential long-term consequences. bAVM DSA studies often require high frame rates

2017 American Heart Association

42. The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association

of a phenotype because it is observable. In clinical use, phenotyping refers to the trait that is being studied such as myocardial infarction (MI) or stroke. A phenotype such as MI may have numerous subphenotypes such as hypertension, hyperlipidemia, or sensitivity to tobacco use, each of which may also have its own subphenotypes such as salt sensitivity, lipid plaque stability, or nicotine addiction. The harmonization of phenotypes refers to having a common definition of the phenotype being studied (...) The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association | Circulation: Cardiovascular Genetics Search Hello Guest! Login to your account Email Password Keep me logged in Search February 2019 January 2019 This site uses cookies

2017 American Heart Association

43. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke

After Thrombolysis; MSS, Multicenter Stroke Survey; NIHSS, National Institutes of Health Stroke Scale; SEDAN, blood sugar, early infarct signs, hyperdense cerebral artery sign, age, NIHSS; SITS-ICH, Safe Implementation of Thrombolysis in Stroke–Intracranial Hemorrhage; SPAN, Stroke Prognostication Using Age and NIH Stroke Scale; and THRIVE, Totaled Health Risks in Vascular Events. Risk scores for sICH can be helpful for guiding patients’ and their families’ expectations and perhaps to inform (...) Institutes of Health Stroke Scale; NINDS, National Institute of Neurological Diseases and Stroke; PH, parenchymal hematoma; PROACT, Prolyse in Acute Cerebral Thromboembolism; and SITS-MOST, Safe Implementation of Thrombolysis in Stroke: Monitoring Study. Figure 1. Radiographic classification of hemorrhagic transformation with the blue arrow in each figure showing the hemorrhage. Top left , Hemorrhagic infarction type 1. Top right , Hemorrhagic infarction type 2. Bottom left , Parenchymal hematoma type 1

2017 American Academy of Neurology

44. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

preeclampsia 1.66 (1.29–2.14) CI indicates confidence interval; HR, hazard ratio; OR, odds ratio; SGA, small for gestational age; and TIA, transient ischemic attack. * Defined as preeclampsia between 16 and 36 weeks. The basis of the association between preeclampsia and future stroke is not entirely known but is hypothesized to be possibly related to genetic factors; shared risk factors (hypertension, dyslipidemia, endothelial dysfunction) between preeclampsia/eclampsia or other pregnancy complications (...) study Preterm birth; SGA Cerebrovascular events (infarction, hemorrhage, subarachnoid hemorrhage, TIA, other stroke) Preterm birth 2.41 (1.4–4.17); SGA birth 1.68 (1.46–2.06); preterm and SGA birth 3.11 (1.91–5.09) Irgens et al, 2001 626 272 Retrospective cohort study Preeclampsia Stroke mortality Term preeclampsia 0.98 (0.5–1.91); preterm preeclampsia 5.08 (2.09–12.35) Wilson et al, 2003 1312 Retrospective cohort study Preeclampsia Stroke mortality 32 3.59 (1.04–12.4) Ray et al, 2005 1 026 265

2014 American Heart Association

45. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack Full Text available with Trip Pro

cholesterol; LMWH, low-molecular-weight heparin; LV, left ventricular; LVAD, left ventricular assist device; MI, myocardial infarction; PFO, patent foramen ovale; SAMMPRIS, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis; STEMI, ST-elevation myocardial infarction; TIA, transient ischemic attack; UFH, unfractionated heparin; and VKA, vitamin K antagonist. * Includes recommendations for which the class was changed from one whole number to another (...) on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease Originally published 1 May 2014 Stroke. 2014;45:2160–2236 You are viewing the most recent version of this article. Previous versions: Abstract The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage

2014 American Heart Association

46. Development and validation of a score to detect paroxysmal atrial fibrillation after stroke (Abstract)

with variable selection, age and the qualifying stroke event (categorized as stroke severity with NIH Stroke Scale [NIHSS] score ≤5 [odds ratio 2.4 vs TIA; 95% confidence interval 0.8-6.9, p = 0.112] or stroke with NIHSS score >5 [odds ratio 7.2 vs TIA; 95% confidence interval 2.4-21.8, p < 0.001]) were found to be predictive for the detection of pAF within 72 hours of Holter monitoring and included in the final score (Age: 0.76 points/year, Stroke Severity NIHSS ≤5 = 9 points, NIHSS >5 = 21 points; to Find (...) Development and validation of a score to detect paroxysmal atrial fibrillation after stroke Prolonged monitoring times (72 hours) are recommended to detect paroxysmal atrial fibrillation (pAF) after ischemic stroke but this is not yet clinical practice; therefore, an individual patient selection for prolonged ECG monitoring might increase the diagnostic yield of pAF in a resource-saving manner.We used individual patient data from 3 prospective studies (ntotal = 1,556) performing prolonged

2019 EvidenceUpdates

47. Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke (Abstract)

Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.A total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06-1.29) for the primary outcome, 1.13 (1.02-1.25) for major disability, 1.49 (...) Tissue inhibitor metalloproteinase-1 and clinical outcomes after acute ischemic stroke To prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin

2019 EvidenceUpdates

48. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke (Abstract)

group, phenylephrine was administered intravenously to increase systolic blood pressure (SBP) up to 200 mm Hg. The primary efficacy endpoint was early neurologic improvement (reduction in NIH Stroke Scale [NIHSS] score of ≥2 points during the first 7 days). The secondary efficacy endpoint was a modified Rankin Scale score of 0 to 2 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage/edema, myocardial infarction, and death.In the modified intention-to-treat analyses, 76 and 77 (...) Therapeutic-induced hypertension in patients with noncardioembolic acute stroke To evaluate the safety and efficacy of induced hypertension in patients with acute ischemic stroke.In this multicenter randomized clinical trial, patients with acute noncardioembolic ischemic stroke within 24 hours of onset who were ineligible for revascularization therapy and those with progressive stroke during hospitalization were randomly assigned (1:1) to the control and intervention groups. In the intervention

2019 EvidenceUpdates

49. A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score (Abstract)

, Switzerland, as well as Frankfurt a.M., Germany. The score components were copeptin levels, age, NIH Stroke Scale, and recanalization therapy (CoRisk score). Copeptin levels were measured in plasma drawn within 24 hours of AIS and before any recanalization therapy. The primary outcome of disability and death at 3 months was defined as modified Rankin Scale score of 3 to 6.Overall, 1,102 patients were included in the analysis; the derivation cohort contributed 319 patients, and the validation cohort (...) A novel biomarker-based prognostic score in acute ischemic stroke: The CoRisk score To derive and externally validate a copeptin-based parsimonious score to predict unfavorable outcome 3 months after an acute ischemic stroke (AIS).The derivation cohort consisted of patients with AIS enrolled prospectively at the University Hospital Basel, Switzerland. The validation cohort was prospectively enrolled after the derivation cohort at the University Hospital of Bern and University Hospital Basel

2019 EvidenceUpdates

50. Endovascular Stroke Treatment

Endovascular Stroke Treatment Emergency Medicine > Journal Club > Archive > May 2015 Toggle navigation May 2015 Endovascular Stroke Treatment Vignette A 67 year old white female presents to a moderate sized community hospital (also a Primary Stroke Center) 90 minutes after the onset of right-arm and leg hemiplegia as well as aphasia. The initial NIH Stroke Scale (NIHSS) is 13. A non-contrast head CT is negative, though there is a possible hyperdense "MCA sign" per the preliminary read. All labs (...) to a larger center? How much better are these new therapies compared with standard IV therapy? PICO Question #1 Population: Adult patients with acute ischemic stroke Intervention: Intra­‐arterial clot retrieval or intra­‐arterial thrombolysis Comparison: Standard of care Outcome: Functional status, mortality, quality of life Search Strategy No formal search was conducted. Three recent positive articles and one negative article from 2013 were selected by Dr. Peter Panagos, an expert in neurologic

2015 Washington University Emergency Medicine Journal Club

51. Is Alteplase Beneficial for Treating Ischemic Stroke?

to reduce harm and costs with same efficacy Febuxostat (brand name: Febric): Inferior to allopurinol Too frequent cardiovascular events, gouty attacks, serious allergy Review Is Alteplase Beneficial for Treating Ischemic Stroke? No proven efficacy if it is given 1.5 hours after onset CONTENTS (December 2015,Vol. 1, No. 3) 34 35 38 40Page 34 · MED CHECK - TIP DECEMBER 2015 / Vol.1 No.3 “Surrogate endpoint” qualify “real advance”? Surrogate endpoints are overused. The case of febuxostat (brand name (...) raised the age for “administer carefully” from 75-year and older to 81-year and older, and the NIHSS scores for “administer carefully” from 23 and above to 26 and above [6]. In any case, the revised guidelines allow wider use by listing many “contraindications” in the package insert under “administer carefully” and raising the upper age limit for the administration. Note: The NIHSS is a scale to assess severity of stroke developed by National Institute of Health (NIH) in the US. Scores are given

2015 Med Check - The Informed Prescriber

52. Quality of life in patients with TIA and minor ischemic stroke. Full Text available with Trip Pro

Quality of life in patients with TIA and minor ischemic stroke. We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system.Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke (...) ) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months.Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL

2015 Neurology

53. Prognostic Value of Inflammatory and Cardiovascular Biomarkers for Prediction of 90-Day All-Cause Mortality after Acute Ischemic Stroke-Results from the Linz Stroke Unit Study. Full Text available with Trip Pro

and the NIH Stroke Scale (NIHSS), only NIHSS >3 [risk ratio (RR) 7.87, 95% CI, 3.61-17.16; P < 0.001], IL-6 > 7 pg/mL (RR 4.09, 95% CI, 2.02-8.29; P < 0.001), and NT-proBNP >447 ng/L (RR 4.88, 95% CI, 2.41-9.88; P < 0.001) remained independent predictors. Using a simple multimarker approach combining these 3 complementary markers, we demonstrated that patients with increased NIHSS, IL-6, and NT-proBNP had the poorest outcome with a mortality rate of 38%, whereas no patient with negative readings for all 3 (...) Prognostic Value of Inflammatory and Cardiovascular Biomarkers for Prediction of 90-Day All-Cause Mortality after Acute Ischemic Stroke-Results from the Linz Stroke Unit Study. Early outcome prediction after acute ischemic stroke is of great interest. The aim of our study was to evaluate the prognostic value of blood biomarkers in patients with acute ischemic stroke.We measured interleukin-6 (IL-6), d-dimer, amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac

2017 Clinical Chemistry

54. NIH Stroke Scale

Scale II. Precautions NIH Stroke Scale has imperfect interrater reliability (i.e. different scores by different providers) NIH Stroke Scale may be low despite severe, disabling symptoms and signs (e.g. in posterior CVA) Facial droop may be subtle Consider counting visible teeth on each side for comparison When a patient is too weak overall to perform a particular exam element Default to a lower score (as if patient could perform that element) Obviously this does not apply to a focal weakness (...) window. Related Studies (from Trip Database) Ontology: NIH stroke scale (C1697238) Concepts Diagnostic Procedure ( T060 ) LNC LP145895-1, MTHU043309 Dutch NIH stroke scale French Échelle NIH d'accident vasculaire cérébral German NIH-Stroke-Skala Italian Scala per l'ictus dell'NIH Portuguese Escala NIH de AVC Spanish Escala de accidente cerebrovascular de NIH Japanese NIH脳卒中スケール , NIHノウソッチュウスケール Czech Stupnice mrtvice NIH English NIH stroke scale (physical finding) , NIH stroke scale Hungarian NIH

2015 FP Notebook

55. Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke (Abstract)

neuropsychological testing, the Clinical Dementia Rating (CDR) scale, the modified Rankin Scale (mRS), and Instrumental Activities of Daily Living (IADL) and analyzed with generalized estimating equations. All-cause mortality was investigated by Cox proportional hazard models. Analyses were adjusted for demographic variables, education, vascular risk factors, premorbid cognitive status, and NIH Stroke Scale scores. The additive predictive value of MoCA was examined with receiver operating characteristic (...) Early MoCA predicts long-term cognitive and functional outcome and mortality after stroke To examine whether the Montreal Cognitive Assessment (MoCA) administered within 7 days after stroke predicts long-term cognitive impairment, functional impairment, and mortality.MoCA was administered to 274 patients from 2 prospective hospital-based cohort studies in Germany (n = 125) and France (n = 149). Cognitive and functional outcomes were assessed at 6, 12, and 36 months after stroke by comprehensive

2018 EvidenceUpdates

56. Return to work after ischemic stroke in young adults: A registry-based follow-up study Full Text available with Trip Pro

Return to work after ischemic stroke in young adults: A registry-based follow-up study We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were (...) Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.NRTW is a frequent adverse outcome after IS in young adults with mild to moderate

2018 EvidenceUpdates

57. NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic stroke (Abstract)

NIHSS cut-point for predicting outcome in supra- vs infratentorial acute ischemic stroke To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS).Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics (...) of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3-6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point.Patients with infratentorial AIS (n = 289) had lower baseline NIHSS scores than those with supratentorial AIS (n = 2,613) (median 7 vs 9; p < 0.001). NIHSS cut points for poor outcome were 10 (AUC 76

2018 EvidenceUpdates

58. Endostatin as a novel prognostic biomarker in acute ischemic stroke. (Abstract)

Stroke were included in this study. The primary outcome was death or severe disability (modified Rankin scale score of 4-6), and secondary outcomes included death and vascular events.After 3-month follow-up, 402 (11.61%) participants experienced severe disability or died. Compared with the lowest quartile of endostatin, odds ratios or hazard ratios (95% confidence intervals) for the highest quartile were 1.47 (1.04-2.09) for the primary outcome, and 2.36 (1.23-4.54) for death after adjustment (...) for multiple covariates, including age, sex, admission NIH Stroke Scale score and systolic blood pressure. Each 1-SD higher log-transformed endostatin was associated with a 20% (6%-36%) increased risk for primary outcome. Adding plasma endostatin to the basic model constructed with conventional factors significantly improved risk stratification of primary outcome, as observed by the category-free net reclassification index of 20.5% (95% CI 10.1%-30.8%; p < 0.001) and integrated discrimination improvement

2020 Atherosclerosis

59. Safety of intravenous alteplase within 4.5 hours for patients awakening with stroke symptoms. Full Text available with Trip Pro

trial of standard dose IV tPA in patients who presented with stroke symptoms within 0-4.5 hours of awakening. From January 30, 2013, to September 1, 2015, twenty consecutive wakeup stroke patients selected by NCHCT were enrolled. The primary outcome was symptomatic intracerebral hemorrhage (sICH) in the first 36 hours. Secondary outcomes included NIH stroke scale (NIHSS) at 24 hours; and modified Rankin Score (mRS), NIHSS, and Barthel index at 90 days.The average age was 65 years (range 47-83); 40 (...) Safety of intravenous alteplase within 4.5 hours for patients awakening with stroke symptoms. Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria.The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety

2018 PLoS ONE

60. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

, and many of them remain with residual functional deficits. Thus, the need for effective stroke rehabilitation is likely to remain an essential part of the continuum of stroke care for the foreseeable future. Despite the extensive resources devoted to stroke rehabilitation and aftercare, large-scale, rigorous, clinical trials in this field have been few and have been conducted only in the past decade or so. Thus, many gaps continue to be seen in the evidence base for stroke rehabilitation, for which (...) to span the entire course of rehabilitation, from the early actions taken in the acute care hospital through reintegration into the community. The end of formal rehabilitation (commonly by 3–4 months after stroke) should not mean the end of the restorative process. In many respects, stroke has been managed medically as a temporary or transient condition instead of a chronic condition that warrants monitoring after the acute event. Currently, unmet needs persist in many domains, including social

2016 American Heart Association

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