scholarly journals Brain Functional Reserve in the Context of Neuroplasticity after Stroke

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jan Dąbrowski ◽  
Anna Czajka ◽  
Justyna Zielińska-Turek ◽  
Janusz Jaroszyński ◽  
Marzena Furtak-Niczyporuk ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Management ◽  
Functional Reserve ◽  
Stroke Units ◽  
Prognostic Assessment ◽  
Speech Rehabilitation ◽  
Neuronal Processes ◽  
Successful Design ◽  
Ischemic Episode ◽  
Over 40 Years

Stroke is the second cause of death and more importantly first cause of disability in people over 40 years of age. Current therapeutic management of ischemic stroke does not provide fully satisfactory outcomes. Stroke management has significantly changed since the time when there were opened modern stroke units with early motor and speech rehabilitation in hospitals. In recent decades, researchers searched for biomarkers of ischemic stroke and neuroplasticity in order to determine effective diagnostics, prognostic assessment, and therapy. Complex background of events following ischemic episode hinders successful design of effective therapeutic strategies. So far, studies have proven that regeneration after stroke and recovery of lost functions may be assigned to neuronal plasticity understood as ability of brain to reorganize and rebuild as an effect of changed environmental conditions. As many neuronal processes influencing neuroplasticity depend on expression of particular genes and genetic diversity possibly influencing its effectiveness, knowledge on their mechanisms is necessary to understand this process. Epigenetic mechanisms occurring after stroke was briefly discussed in this paper including several mechanisms such as synaptic plasticity; neuro-, glio-, and angiogenesis processes; and growth of axon.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

Intravenous flat-detector CT angiography in acute ischemic stroke management

2011 ◽  
Vol 54 (4) ◽  
pp. 383-391 ◽  
Author(s):  
Raphaël Blanc ◽  
Silvia Pistocchi ◽  
Drazenko Babic ◽  
Bruno Bartolini ◽  
Michaël Obadia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Stroke Management ◽  
Flat Detector

scholarly journals Establishment of Government-Initiated Comprehensive Stroke Centers for Acute Ischemic Stroke Management in South Korea

Stroke ◽  
2014 ◽  
Vol 45 (8) ◽  
pp. 2391-2396 ◽  
Author(s):  
Jei Kim ◽  
Yang-Ha Hwang ◽  
Joon-Tae Kim ◽  
Nack-Cheon Choi ◽  
Sa-Yoon Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
South Korea ◽  
Acute Ischemic Stroke ◽  
Stroke Management

Simulation-Based Assessment of Graduate Neurology Trainees’ Performance Managing Acute Ischemic Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012972
Author(s):  
Melissa B Pergakis ◽  
Wan-Tsu W Chang ◽  
Ali Tabatabai ◽  
Michael S. Phipps ◽  
Benjamin Neustein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Management ◽  
Delphi Approach ◽  
Cerebral Herniation ◽  
Sum Score ◽  
Simulation Based ◽  
Critical Action ◽  
Attending Physicians

Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees’ education which in turn may contribute to poorer outcomes in community hospitals upon graduation. Our goal was to assess graduate neurology trainee performance independent of a multi-disciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (sub-interns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was graduate neurology trainees’ critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and five attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15/22 (68%). Ninety percent of graduate neurology trainees properly administered tPA, 84% immediately stopped tPA infusion following patient deterioration, but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean score [standard deviation (SD)] = 7.2 (2.8) vs. level 2 mean score (SD) = 12.3 (2.6) vs. level 3 mean score (SD) = 13.3 (2.2) vs. level 4 mean score (SD) = 16.3 (2.4), p < .001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke, but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

General Stroke Management and Stroke Units

Stroke ◽  
2004 ◽  
pp. 971-985 ◽  
Author(s):  
Markku Kaste ◽  
Risto O. Roine
Keyword(s):  
Stroke Management ◽  
Stroke Units

Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region—Results from the Safe Implementation of Treatments in Stroke (SITS)–Middle-East and North African (MENA)

2019 ◽  
Vol 14 (7) ◽  
pp. 715-722 ◽  
Author(s):  
Suhail Al Rukn ◽  
Michael V Mazya ◽  
Faycal Hentati ◽  
Samia Ben Sassi ◽  
Fatma Nabli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle East ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Large Artery ◽  
North African ◽  
Stroke Incidence ◽  
Stroke Units ◽  
Mena Countries ◽  
Incidence And Mortality

Background and methods Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00–18:45), a median of NIHSS 6 (3–14), and a median age of 66 (56–76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. Conclusions MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.

scholarly journals Severely Disturbed Sleep in Patients With Acute Ischemic Stroke on Stroke Units: A Pilot Study

2019 ◽  
Vol 10 ◽  
Author(s):  
Jeannette Hofmeijer ◽  
Ruud van Kaam ◽  
Sarah E. Vermeer ◽  
Michel J. A. M. van Putten
Keyword(s):  
Ischemic Stroke ◽  
Pilot Study ◽  
Acute Ischemic Stroke ◽  
Stroke Units ◽  
Disturbed Sleep

scholarly journals Interventional stroke management in a COVID-19 patient

2020 ◽  
pp. 10.1212/CPJ.0000000000000884 ◽  
Author(s):  
Kevin Yeboah ◽  
Randal Edgell ◽  
Joseph Conway ◽  
Amer Alshekhlee
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Health Care Workers ◽  
Acute Coronary Syndromes ◽  
Acute Treatment ◽  
Mechanical Thrombectomy ◽  
Virus Disease ◽  
Stroke Management ◽  
Care Workers ◽  
Coronary Syndromes

There are now over a million cases of corona virus disease 2019 (Covid-19) worldwide with thousands of reported deaths.1 Based on anecdotal evidence,2 it has been hypothesized that Covid-19 patients are at risk of thromboembolism causing acute coronary syndromes and ischemic stroke. Acute treatment outside the designated quarantine units poses a threat of spreading the illness to health care workers. We report a SARS-CoV-2 positive patient who developed acute ischemic stroke during the hospital course treated with mechanical thrombectomy. We emphasize the importance of adhering to institutional protocols to protect health care workers during the interventional management of acute stroke.

scholarly journals Lessons from Recent Advances in Ischemic Stroke Management and Targeting Kv2.1 for Neuroprotection

2020 ◽  
Vol 21 (17) ◽  
pp. 6107 ◽  
Author(s):  
Chung-Yang Yeh ◽  
Anthony J. Schulien ◽  
Bradley J. Molyneaux ◽  
Elias Aizenman
Keyword(s):  
Ischemic Stroke ◽  
Time Window ◽  
Stroke Therapy ◽  
Stroke Management ◽  
Preclinical Research ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Cell Death Pathway ◽  
To Receive ◽  
Neuroprotective Therapies

Achieving neuroprotection in ischemic stroke patients has been a multidecade medical challenge. Numerous clinical trials were discontinued in futility and many were terminated in response to deleterious treatment effects. Recently, however, several positive reports have generated the much-needed excitement surrounding stroke therapy. In this review, we describe the clinical studies that significantly expanded the time window of eligibility for patients to receive mechanical endovascular thrombectomy. We further summarize the results available thus far for nerinetide, a promising neuroprotective agent for stroke treatment. Lastly, we reflect upon aspects of these impactful trials in our own studies targeting the Kv2.1-mediated cell death pathway in neurons for neuroprotection. We argue that recent changes in the clinical landscape should be adapted by preclinical research in order to continue progressing toward the development of efficacious neuroprotective therapies for ischemic stroke.

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