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European Stroke research activity: Annual Stroke Conference 2011

amer — Tue, 19 Jul 2011 13:09:50 +0000

This is the presentation by the Editor, Dr. Amer Jafar, regarding the European stroke research activity based on the papers and posters presented in the European Stroke Conference which was held in Hamburg, Germany in May 2011. ESC 2011 – Copy

Atypical presentations of stroke

amer — Fri, 20 May 2011 19:52:15 +0000

In the daily practice of Stroke physicians, there is always the concern about how accurate is the diagnosis and whether the physicians are going to end up thrombolysing non-stroke patients at the end.

Edlow and Salim wrote in the Lancet Neurology issue of June 2011 an interesting article about the atypical presentations of acute cerebravascualr syndromes.

They suggested three strategies which could help to reduce misdiagnosis of stroke.

First, clinicians should suspect stroke in any patient with abrupt onset of neurological symptoms. Second, clinicians should be aware that some patients will initially present with various uncommon and atypical stroke symptoms. Third, a complete and systematic neurological examination should be routinely done in patients presenting with acute neurological symptoms.

Haemodynamic stroke: Management and Prognosis

amer — Mon, 20 Sep 2010 23:20:04 +0000

Compromising the haemodynamic status due for example to heart failure and hypotension can lead to signs and symptoms of a stroke.
A new review article by the Lancet Neurology was published on line of the October 2010 issue of the Journal (The Lancet Neurology 9;10: 1008-1017). Severe obstruction of the carotid or vertebral arteries was mentioned as a cause of a haemodynamic stroke as well.
It becomes clear from the clinical practice that patients with haemodynamic stroke or transient ischaemic attack might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease. Ancillary investigations of cerebral perfusion can show whether blood flow to the brain is compromised and provide important prognostic information as the review article suggested. Management of patients who have hypoperfusion as the major cause of ischaemic stroke or as a contributing factor is hampered by the lack of clinical trials. The authors mentioned that treatment aimed at increasing cerebral blood flow might be considered in selected patients on the basis of information from case series. The Review article concluded that further research is needed to define criteria for the diagnosis of haemodynamic stroke and to investigate treatment options in controlled studies.

Weekly Stroke Care Videoconference in Wales/UK

amer — Mon, 02 Aug 2010 20:30:12 +0000

This presentation is part of the activity of Gwent Stroke Team to participate in the videoconference weekly stroke care meetings. These meetings were started 6 months ago and aiming to exchange clinical experience in acute stroke management between stroke physicians from all over Wales. In this presentation Dr Amer Jafar, is reviewing the August 2010 issue of the journal ‘Stroke’, the international stroke Journal published by the American Heart Association.

Stroke August 2010 [Compatibility Mode]

Risk factors for ischaemic and haemorrhagic stroke: A global view

amer — Wed, 14 Jul 2010 19:35:07 +0000

On behalf of the Interstroke investigators, Martin J O’Donnell et al have published their results of the study about the risk factors for stroke in 22 countries around the glob (The Lancet, 2010;376,9735:112-123). They aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and myocardial infarction. The case control study was done between March 2007 and April 2010.
It is not surprising as the study reported that history of hypertension was the first risk factor which was mentioned by the first 3000 stroke patients in 22 countries worldwide. The majority of the patients had ischaemic stroke (78%).
Other risk factors were: current smoking, waist-to-hip ratio, diet risk score, lack of regular physical activity, alcohol intake, psychological stress and depression.
In their interpretation the authors of this study concluded that ten risk factors are associated with 90% of the risk of stroke. The reader will conclude that reducing the high blood pressure to the normal level and encouraging smokers to quit in addition to promoting physical activity and healthy diet will reduce the burden of stroke in general.

Intravenous Alteplase in Middle Cerebral Artery Occlusion

amer — Wed, 07 Apr 2010 22:11:19 +0000

Intravenous Alteplase in Middle Cerebral Artery Occlusion:

Japan Alteplase Clinical Trial II (J-ACT II)

A team from Tohoku University in Japan has published recently the result of a study about the effects of 0.6mg/kg intravenous Alteplase on the clinical outcome following an occlusion in the middle cerebral artery (Stroke. 2010; 41:46). This study is part of a postmarketing Phase 4 trial of prospective cohort study design.

It was revelled that a favourable clinical outcome was achieved in46.6%. None had symptomatic intracranial haemorrhage.

The study concluded that early recanalization of an occluded middlecerebral artery can be provoked by 0.6 mg/kg intravenous alteplaseand may induce a favourable clinical outcome. The rates of recanalizationand favourable outcome are comparable to that previously reportedwith the 0.9-mg/kg dose.

The Metabolic Syndrome and thrombolysing stroke patients

amer — Wed, 05 Aug 2009 21:37:55 +0000

In a study from University of Helsinki published recently ( Stroke. 2009;40:337.) the authors concluded that metabolic syndrome as well as its individual components predicted the incidence of the ischaemic stroke and the coronary heart disease equally well and should be treated equally as well.
But what is about the effect of the metabolic syndrome on thrombolysing stroke patients? Arenillas et al tried to answer this question by prospectively studying consecutive ischaemic stroke patients, treated with intravenous tissue-type plasminogen activator according to SITS-MOST criteria, with an MCA occlusion on prebolus transcranial Doppler examination ( Stroke. 2009;40:344).
The assumption is that metabolic syndrome (MetS) might confer a higher resistance to intravenous thrombolysis in acute middle cerebral artery (MCA) ischaemic stroke. MetS increases the risk of stroke in women to a greater extent than in men.

Childhood arterial ischaemic stroke

amer — Sun, 26 Jul 2009 18:53:08 +0000

This review of articles and research papers ( Lancet Neurology 2008; 7:425-435) regarding the subject of childhood stroke is useful to both stroke physicians and pediatricians. Amlie-Lefond C et al, mentioned that stroke is increasingly recognised as a cause of childhood disability and lifelong morbidity.
Diagnosis of stroke in children is often delayed owing to low clinical suspicion and the need to exclude the frequent mimics of stroke in childhood. Outcomes are related to presentation, associated illnesses, the underlying cause, size, and location of the infarct, and stroke subtype, but more than a half of the children who have had a stroke will have long-term neurological sequelae. Furthermore, estimates of recurrence rates range from 6–19% in the first few years. Arteriopathy—including arterial dissection and other progressive and non-progressive arteriopathies—might account for up to 80% of childhood stroke in otherwise healthy children. Because children with cerebrovascular abnormalities are at the highest risk of recurrence (66% at 5 years), understanding of the nature and course of these arteriopathies is crucial to the development of secondary stroke prevention strategies.

Cerebellar infarction: Diagnosis and Management

amer — Sun, 26 Jul 2009 18:50:00 +0000

Early correct diagnosis of cerebellar infarction is crucial to help prevent treatable but potentially fatal complications, such as brainstem compression and obstructive hydrocephalus.

In this review article Edlow JA et al (Lancet Neurology 2008; 7:951-964) discusses the diagnosis and the management plan for patients with signs and symptoms of cerebellar infarction. It focuses on differential diagnosis of the disease which is broad, and includes many common and benign causes. The authors review the clinical presentation of cerebellar infarction, from diagnosis and misdiagnosis to patients’ monitoring, treatment, and potential complications

Cerebral microbleeds: a guide to detection and interpretation

amer — Sun, 26 Jul 2009 18:47:52 +0000

Cerebral microbleeds (CMBs) are increasingly recognised neuroimaging findings in individuals with cerebrovascular disease and dementia, and in normal ageing.
In this Review (The Lancet Neurology, 2009; 8: 165 – 174), the authors focus on the recent developments in cerebral microbleeds and their effects on two main questions: how CMBs are detected, and how CMBs should be interpreted. The number of CMBs detected depends on MRI characteristics, such as pulse sequence, sequence parameters, spatial resolution, magnetic field strength, and image post-processing, emphasising the importance of taking into account MRI technique in the interpretation of study results. Recent investigations with sensitive MRI techniques have indicated a high prevalence of CMBs in community-dwelling elderly people.