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Latest & greatest articles for stroke
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Meta-Analysis Comparing Patent Foramen Ovale Closure Versus Medical Therapy to Prevent Recurrent Cryptogenic Stroke 29306484 2018 02 08 1879-1913 121 5 2018 Mar 01 The American journal of cardiology Am. J. Cardiol. Meta-Analysis Comparing Patent Foramen Ovale Closure Versus Medical Therapy to Prevent Recurrent Cryptogenic Stroke. 649-655 S0002-9149(17)31862-3 10.1016/j.amjcard.2017.11.037 New evidence suggests that closure of a patent foramen ovale (PFO) plus medical therapy (MT; antiplatelet (...) or anticoagulation) is superior to MT alone to prevent recurrent cryptogenic stroke. We performed a meta-analysis of randomized controlled trials that compared PFO closure plus MT with MT alone in patients with cryptogenic stroke. The efficacy end points were recurrent stroke, transient ischemia attack, and death. The safety end points were major bleeding and newly detected atrial fibrillation. Trials were pooled using random effects and fixed effects models. A trial sequential analysis was performed to assess
Comorbidity and the increased mortality after hospitalization for stroke: a population-based cohort study 29171148 2018 02 12 1538-7836 16 2 2018 Feb Journal of thrombosis and haemostasis : JTH J. Thromb. Haemost. Comorbidity and the increased mortality after hospitalization for stroke: a population-based cohort study. 242-252 10.1111/jth.13908 Essentials Comorbidity is prevalent in the stroke population and affects post-stroke survival. A stroke patient cohort (n = 201 691) and a general (...) population cohort were followed for survival. Cancer and advanced renal/liver disease substantially increased one-year stroke mortality. Tailoring stroke interventions according to comorbidity may reduce excess mortality. Background Comorbidity is prevalent among stroke patients, affecting post-stroke survival. It remains unknown whether comorbidity impacts post-stroke mortality beyond the combined individual effects of stroke and comorbidity. Methods Using nationwide Danish databases, we performed
Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis 29232981 2017 12 13 1477-0873 2017 Dec 01 Clinical rehabilitation Clin Rehabil Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. 269215517745349 10.1177/0269215517745349 To evaluate (1) the effectiveness of transcutaneous electrical nerve (...) stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS. A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery
Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial 29273692 2018 01 12 1468-330X 2017 Dec 22 Journal of neurology, neurosurgery, and psychiatry J. Neurol. Neurosurg. Psychiatry Efficacy of intensive aphasia therapy in patients with chronic stroke: a randomised controlled trial. jnnp-2017-315962 10.1136/jnnp-2017-315962 Recent evidence has fuelled the debate on the role of massed practice in the rehabilitation of chronic post-stroke aphasia. Here (...) , we further determined the optimal daily dosage and total duration of intensive speech-language therapy. Individuals with chronic aphasia more than 1 year post-stroke received Intensive Language-Action Therapy in a randomised, parallel-group, blinded-assessment, controlled trial. Participants were randomly assigned to one of two outpatient groups who engaged in either highly-intensive practice (Group I: 4 hours daily) or moderately-intensive practice (Group II: 2 hours daily). Both groups went
Prediction of Incident Atrial Fibrillation According to Gender in Patients With Ischemic Stroke From a Nationwide Cohort 29307458 2018 01 24 1879-1913 121 4 2018 Feb 15 The American journal of cardiology Am. J. Cardiol. Prediction of Incident Atrial Fibrillation According to Gender in Patients With Ischemic Stroke From a Nationwide Cohort. 437-444 S0002-9149(17)31774-5 10.1016/j.amjcard.2017.11.016 The CHA 2 DS 2 -VASc score may identify patients at higher risk of atrial fibrillation (AF (...) ) following ischemic stroke (IS) in patients without known AF. We compared gender-related differences in items from CHA 2 DS 2 -VASc score and their relation with AF occurrence after IS. This French cohort study was based on the database covering hospital care from 2009 to 2012 for the entire population. Of 336,291 patients with IS, 240,459 (71.5%) had no AF at baseline. Women were older, more frequently had hypertension, heart failure, and had a higher CHA 2 DS 2 -VASc score than men (4.63 vs 4.39, p<2DS
Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials 29229471 2018 02 13 1555-7162 2017 Dec 08 The American journal of medicine Am. J. Med. Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials. S0002-9343(17)31219-6 10.1016/j.amjmed.2017.11.027 Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic (...) stroke, but available trials have varied by size, device studied, and follow-up. We conducted a systematic search of published randomized clinical trials evaluating patent foramen ovale closure versus medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models. Of 480 studies screened, we included 5 randomized clinical trials in the meta-analysis in which 3440 patients were randomized
Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke: Association with mortality and cardioembolic etiology 29321236 2018 02 13 1526-632X 90 6 2018 Feb 06 Neurology Neurology Midregional proatrial natriuretic peptide improves risk stratification after ischemic stroke. e455-e465 10.1212/WNL.0000000000004922 To validate midregional proatrial natriuretic peptide (MR-proANP) for outcome prediction and diagnosis of cardioembolic stroke etiology compared (...) to established clinical variables. In this prospective multicenter cohort study, we quantified MR-proANP levels in ischemic stroke patients within 24 hours of onset. Primary outcome measures were 90-day mortality, unfavorable functional outcome (modified Rankin Scale score >2), and cardioembolic stroke etiology diagnosed during hospitalization. Of 788 included patients, 783 completed their 90-day follow-up, and 118 patients (15%) died. After full adjustment, MR-proANP levels were associated with 90-day
Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study Line Melgaard 1 ,Thure Filskov Overvad 1 , Flemming Skjøth 1 , Jeppe Hagstrup Christensen 2 , Torben Bjerregaard Larsen 1,3 * † and Gregory Y.H. Lip 1,4† 1 Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg (...) without atrial ?brillation. Methods andresults In this observational cohort study, heart failure patients without atrial?brillation were identi?ed using Danish nationwide registries. Risk of stroke, major haemorrhage, and death were calculated after 1 and 5 years to compare patients with and without CKD, ±dialysis [dialysis: CKD with renal replacement therapy (CKD-RRT); no dialysis: CKD-no RRT]. Atotalof 43199 heart failurepatients were included, among which 0.8% had CKD-RRT and 5.9% had CKD-no RRT
Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus RESEARCH ARTICLE Open Access Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus Grace M. Turner 1,2* , Ruth Backman 1 , Christel McMullan 1 , Jonathan Mathers 1 , Tom Marshall 1,2 and Melanie Calvert 1,2 Plain English summary What is the problem and why is this important? Mini-strokes (...) are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. Background Thrombectomy is currently recommended for eligible patients with stroke who are treated within 6 hours after the onset of symptoms. Methods We conducted a multicenter, randomized, open-label trial, with blinded outcome assessment, of thrombectomy in patients 6 to 16 hours after they were last known to be well and who had remaining ischemic brain tissue that was not yet infarcted. Patients with proximal (...) stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted. (Funded by the National Institute of Neurological Disorders and Stroke; DEFUSE 3 ClinicalTrials.gov number, NCT02586415 .).
Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: an updated systematic review 1 Wang X, et al. Stroke and Vascular Neurology 2018;0:e000112. doi:10.1136/svn-2017-000112 Open Access Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: an updated systematic review Xia Wang, 1,2 Shoujiang You, 3 Shoichiro Sato, 4 Jie Yang, 5 Cheryl Carcel, 1,2,6 Danni Zheng, 1,2 Sohei Yoshimura, 1,2,4 Craig S Anderson, 1,2,6,7 (...) Else Charlotte Sandset, 8 Thompson Robinson, 9 John Chalmers, 1,2,3 Vijay K Sharma 10,11 For numbered affiliations see end of article. Correspondence to Dr Jie Yang; y angjie1126@ 163. com To cite: Wang X, You S, Sato S, et al. Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: an updated systematic review. Stroke and Vascular Neurology 2018;0: e000112. doi:10.1136/svn- 2017-000112 ? Additional material is published online only. To view please visit
Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke 1 Etherton MR, et al. Stroke and Vascular Neurology 2018;0:e000119. doi:10.1136/svn-2017-000119 Open Access Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke Mark R Etherton, 1,2 Khawja A Siddiqui, 2 Lee H Schwamm 1,2 1 Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA 2 Department of Neurology, Massachusetts General (...) Hospital, Boston, Massachusetts, USA Correspondence to Dr Mark R Etherton; metherton@ partners. org To cite: Etherton MR, Siddiqui KA, Schwamm LH. Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke. Stroke and Vascular Neurology 2018;0: e000119. doi:10.1136/svn- 2017-000119 ? Additional material is published online only. To view please visit the journal online (http:// dx. doi. org/ 10. 1136/ svn- 2017- 000119). Received 20 October 2017 Revised 1
Diet for stroke prevention 1 Spence JD. Stroke and Vascular Neurology 2018;0:e000130. doi:10.1136/svn-2017-000130 Open Access Diet for stroke prevention J David Spence 1,2 1 Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada 2 Neurology and Clinical Pharmacology, University of Western Ontario, London, Ontario, Canada Correspondence to Professor J David Spence; dspence@ robarts. ca To cite: Spence JD. Diet for stroke prevention. Stroke and (...) decreased. Between 2003 and 2013, coronary mortality in China increased 213%, while stroke mortality increased by 26.6%. Besides a high content of cholesterol, meat (particularly red meat) contains carnitine, while egg yolks contain phosphatidylcholine. Both are converted by the intestinal microbiome to trimethylamine, in turn oxidised in the liver to trimethylamine n-oxide (TMAO). TMAO causes atherosclerosis in animal models, and in patients referred for coronary angiography high levels after a test
Stroke-induced immunosuppression and poststroke infection 1 Shi K, et al. Stroke and Vascular Neurology 2018;0:e000123. doi:10.1136/svn-2017-000123 Open Access Stroke-induced immunosuppression and poststroke infection Kaibin Shi, 1,2 Kristofer Wood, 2 Fu-Dong Shi, 1,2 Xiaoying Wang, 3 Qiang Liu 1,2 1 Departments of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China 2 Departments of Neurology, Barrow Neurological Institute, St. Joseph’s (...) Hospital and Medical Center, Phoenix, Arizona, USA 3 Departments of Neurology and Radiology, Neuroprotection Research Laboratory, Massachusetts General Hospital, Neuroscience Program, Harvard Medical School, Boston, Massachusetts, USA Correspondence to Dr Qiang Liu, Departments of Neurology Tianjin Neurological Institute, Tianjin Medical University General Hospital Tianjin China; qliu. asu@ gmail. com To cite: Shi K, Wood K, Shi F-D, et al. Stroke-induced immunosuppression and poststroke infection
Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis 1 You S, et al. Stroke and Vascular Neurology 2018;0:e000106. doi:10.1136/svn-2017-000106 Open Access Abstr Act The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients (...) with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL) , from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of =6. We included seven studies
Overview of stroke Overview of stroke - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of stroke Last reviewed: August 2018 Last updated: June 2018 Introduction Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is subdivided into ischaemic stroke (caused by vascular occlusion or stenosis) and haemorrhagic stroke (caused by vascular rupture (...) , resulting in intra-parenchymal and/or subarachnoid haemorrhage). Ischaemic stroke accounts for about 85% of cases and haemorrhagic stroke about 15%. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics - 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113:e85-e151. http://circ.ahajournals.org/content/113/6/e85.full http://www.ncbi.nlm.nih.gov/pubmed/16407573?tool=bestpractice.com Related conditions
Haemorrhagic stroke Haemorrhagic stroke - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Haemorrhagic stroke Last reviewed: August 2018 Last updated: August 2018 Summary Approximately 15% of strokes are haemorrhagic. Computed tomography (CT) or magnetic resonance imaging (MRI) scans, with high sensitivity for intracerebral haemorrhage, are essential in diagnosis. Treatments for intracerebral haemorrhage (ICH (...) ) and ischaemic stroke differ radically. The primary treatment of haemorrhagic stroke involves supportive care and optimisation of intracranial haemodynamics. Surgical resection of intracerebral haematomas may be of benefit in select cases, but has yet to be demonstrated as effective in clinical trials. Newer minimally invasive surgical techniques are currently being investigated. Study results show that patients in dedicated stroke units have improved survival and reduced disability at 1 year. Definition
Ischaemic stroke Ischaemic stroke - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Ischaemic stroke Last reviewed: August 2018 Last updated: July 2018 Summary A leading cause of morbidity and mortality. Approximately 85% of strokes are ischaemic, caused by vascular occlusion. A clinical emergency: timely diagnosis, triage, and intervention can improve outcome. Care of patients in dedicated stroke units improves (...) survival and function. Intravenous recombinant tissue plasminogen activator is given within 4.5 hours of stroke onset. Endovascular interventions, such as clot retrieval devices or intra-arterial thrombolysis, can be used in carefully selected patients within 6 hours of ischaemic stroke onset. Definition Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology. It is further subdivided into ischaemic stroke (caused by vascular occlusion
Prevention of Stroke with the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) 28972004 2017 12 26 2017 12 26 1524-4539 136 25 2017 Dec 19 Circulation Circulation Prevention of Stroke with the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial). 2440-2450 10.1161 (...) /CIRCULATIONAHA.117.029095 Patients who experience an acute coronary syndrome are at heightened risk of recurrent ischemic events, including stroke. Ezetimibe improved cardiovascular outcomes when added to statin therapy in patients stabilized after acute coronary syndrome. We investigated the efficacy of the addition of ezetimibe to simvastatin for the prevention of stroke and other adverse cardiovascular events in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial
Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling 28647551 2017 12 12 2017 12 12 1532-821X 98 12 2017 Dec Archives of physical medicine and rehabilitation Arch Phys Med Rehabil Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. 2433-2441 S0003-9993(17)30408-2 10.1016/j.apmr.2017.05.018 To identify factors predicting falls (...) and limited mobility in people with stroke at 12 months after returning home from rehabilitation. Observational cohort study with 12-month follow-up. Community. People with stroke (N=144) and increased falls risk discharged home from rehabilitation. Not applicable. Falls were measured using monthly calendars completed by participants, and mobility was assessed using gait speed over 5m (high mobility: >0.8m/s vs low mobility: ≤0.8m/s). Both measures were assessed at 12 months postdischarge. Demographics