Vascular Disorders

Stroke current issue

Recombinant Human Erythropoietin in the Treatment of Acute Ischemic Stroke [Original Contributions]
Ehrenreich, H., Weissenborn, K., Prange, H., Schneider, D., Weimar, C., Wartenberg, K., Schellinger, P. D., Bohn, M., Becker, H., Wegrzyn, M., Jahnig, P., Herrmann, M., Knauth, M., Bahr, M., Heide, W., Wagner, A., Schwab, S., Reichmann, H., Schwendemann, G., Dengler, R., Kastrup, A., Bartels, C., for the EPO Stroke Trial Group Background and Purpose— Numerous preclinical findings and a clinical pilot study suggest that recombinant human erythropoietin (EPO) provides neuroprotection that may be beneficial for the treatment of patients with ischemic stroke. Although EPO has been considered to be a safe and well-tolerated drug over 2 decades, recent studies have identified increased thromboembolic complications and/or mortality risks on EPO administration to patients with cancer or chronic kidney disease. Accordingly, the double-blind, placebo-controlled, randomized German Multicenter EPO Stroke Trial (Phase II/III; ClinicalTrials.gov Identifier: NCT00604630) was designed to evaluate efficacy and safety of EPO in stroke. Methods— This clinical trial enrolled 522 patients with acute ischemic stroke in the middle cerebral artery territory (intent-to-treat population) with 460 patients treated as planned (per-protocol population). Within 6 hours of symptom onset, at 24 and 48 hours, EPO was infused intravenously (40 000 IU each). Systemic thrombolysis with recombinant tissue plasminogen activator was allowed and stratified for. Results— Unexpectedly, a very high number of patients received recombinant tissue plasminogen activator (63.4%). On analysis of total intent-to-treat and per-protocol populations, neither primary outcome Barthel Index on Day 90 (P=0.45) nor any of the other outcome parameters showed favorable effects of EPO. There was an overall death rate of 16.4% (n=42 of 256) in the EPO and 9.0% (n=24 of 266) in the placebo group (OR, 1.98; 95% CI, 1.16 to 3.38; P=0.01) without any particular mechanism of death unexpected after stroke. Conclusions— Based on analysis of total intent-to-treat and per-protocol populations only, this is a negative trial that also raises safety concerns, particularly in patients receiving systemic thrombolysis.
Prophylactic, Endovascularly Based, Long-Term Normothermia in ICU Patients With Severe Cerebrovascular Disease: Bicenter Prospective, Randomized Trial [Original Contributions]
Broessner, G., Beer, R., Lackner, P., Helbok, R., Fischer, M., Pfausler, B., Rhorer, J., Kuppers-Tiedt, L., Schneider, D., Schmutzhard, E. Background and Purpose— We sought to study the effectiveness and safety of endovascular cooling to maintain prophylactic normothermia in comparison with standardized, stepwise, escalating fever management to reduce fever burden in patients with severe cerebrovascular disease. Methods— This study was a prospective, randomized, controlled trial with a blinded neurologic outcome evaluation comparison between prophylactic, catheter-based normothermia (CoolGard; ie, body core temperature 36.5°C) and conventional, stepwise fever management with anti-inflammatory drugs and surface cooling. Patients admitted to 1 of the 2 neurointensive care units were eligible for study inclusion when they had a (1) spontaneous subarachnoid hemorrhage with Hunt & Hess grade between 3 and 5, (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score ≤10, or (3) complicated cerebral infarction requiring intensive care unit treatment with a National Institutes of Health Stroke Scale score ≥15. Results— A total of 102 patients (56 female) were enrolled during a 3.5-year period. Fifty percent had a spontaneous subarachnoid hemorrhage, 40% had a spontaneous intracerebral hemorrhage, and 10% had a complicated cerebral infarction. Overall median total fever burden during the course of treatment was 0.0°C hour and 4.3°C hours in the catheter and conventional groups, respectively (P<0.0001). Prophylactic normothermia did not lead to an increase in the number of patients who experienced a major adverse event. No significant difference was found in mortality and neurologic long-term follow-up. Conclusions— Long-term, catheter-based, prophylactic normothermia significantly reduces fever burden in neurointensive care unit patients with severe cerebrovascular disease and is not associated with increased major adverse events.
Severe Blood-Brain Barrier Disruption and Surrounding Tissue Injury [Original Contributions]
Chen, B., Friedman, B., Cheng, Q., Tsai, P., Schim, E., Kleinfeld, D., Lyden, P. D. Background and Purpose— Blood–brain barrier opening during ischemia follows a biphasic time course, may be partially reversible, and allows plasma constituents to enter brain and possibly damage cells. In contrast, severe vascular disruption after ischemia is unlikely to be reversible and allows even further extravasation of potentially harmful plasma constituents. We sought to use simple fluorescent tracers to allow wide-scale visualization of severely damaged vessels and determine whether such vascular disruption colocalized with regions of severe parenchymal injury. Methods— Severe vascular disruption and ischemic injury was produced in adult Sprague Dawley rats by transient occlusion of the middle cerebral artery for 1, 2, 4, or 8 hours, followed by 30 minutes of reperfusion. Fluorescein isothiocyanate-dextran (2 MDa) was injected intravenously before occlusion. After perfusion-fixation, brain sections were processed for ultrastructure or fluorescence imaging. We identified early evidence of tissue damage with Fluoro-Jade staining of dying cells. Results— With increasing ischemia duration, greater quantities of high molecular weight dextran-fluorescein isothiocyanate invaded and marked ischemic regions in a characteristic pattern, appearing first in the medial striatum, spreading to the lateral striatum, and finally involving cortex; maximal injury was seen in the mid-parietal areas, consistent with the known ischemic zone in this model. The regional distribution of the severe vascular disruption correlated with the distribution of 24-hour 2,3,5-triphenyltetrazolium chloride pallor (r=0.75; P<0.05) and the cell death marker Fluoro-Jade (r=0.86; P<0.05). Ultrastructural examination showed significantly increased areas of swollen astrocytic foot process and swollen mitochondria in regions of high compared to low leakage, and compared to contralateral homologous regions (ANOVA P<0.01). Dextran extravasation into the basement membrane and surrounding tissue increased significantly from 2 to 8 hours of occlusion duration (Independent samples t test, P<0.05). Conclusion— Severe vascular disruption, as labeled with high-molecular-weight dextran-fluorescein isothiocyanate leakage, is associated with severe tissue injury. This marker of severe vascular disruption may be useful in further studies of the pathoanatomic mechanisms of vascular disruption-mediated tissue injury.
Neuroimaging Demonstration of Evolving Small Vessel Ischemic Injury in Cerebral Amyloid Angiopathy [Case Reports]
Menon, R. S., Kidwell, C. S. Background and Purpose— Cerebral amyloid angiopathy is a small to medium vasculopathy most commonly associated with symptomatic intracerebral hemorrhage and microbleeds. Summary of Case— We present a patient with cerebral microbleeds and likely amyloid angiopathy with evolving ischemic lesions visualized on diffusion-weighted imaging. Conclusions— This case captures with serial MRI the evolving and dynamic nature of cerebral amyloid angiopathy and particularly illustrates the subclinical, yet progressive, ischemic aspects of this vasculopathic process.
Baroreflex: A New Therapeutic Target in Human Stroke? [Comments, Opinions, and Reviews]
Sykora, M., Diedler, J., Turcani, P., Hacke, W., Steiner, T. Background and Purpose— Autonomic dysfunction, including increased sympathetic drive and blunted baroreflex, has repeatedly been observed in acute stroke. Of clinical importance is that the stroke-related autonomic imbalance seems to be linked to worse outcome after stroke. Here, we discuss the role of baroreflex impairment in acute stroke and its possible pathophysiological and therapeutic relevance. Summary of Review— Possible mechanisms linking baroreflex impairment with unfavorable outcome in stroke may include increased cardiovascular morbidity and mortality, promotion of secondary brain injury due to local inflammation, hyperglycemia, or altered cerebral perfusion. Conclusions— We suggest therefore that the modifying of autonomic functions may have important therapeutic implications in acute ischemic as well as in hemorrhagic stroke.
Systematic Review of the Perioperative Risks of Stroke or Death After Carotid Angioplasty and Stenting [Comments, Opinions, and Reviews]
Touze, E., Trinquart, L., Chatellier, G., Mas, J.-L. Background and Purpose— Carotid angioplasty and stenting (CAS) has not been shown to be as safe as carotid endarterectomy (CEA) with regard to the risks of periprocedural complications, but beyond the perioperative period, the risks are comparable, suggesting that CAS may be an acceptable option in selected patients. However, risk factors for perioperative stroke and death have not been clearly established. We aimed to estimate the 30-day absolute risks of stroke or death after CAS and investigate sources of heterogeneity. Methods— We sought articles published between January 1990 and June 2008 by using MEDLINE, EMBASE, the COCHRANE databases, hand-searching, abstract books from conferences, and official websites. Two reviewers independently and in duplicate selected articles on the risks of CAS, irrespective of the type of treatment, study design, setting, or language. The 2 reviewers abstracted data and assessed the quality of the studies. Results— Two hundred six independent studies (with 54 713 patients) were included. The overall 30-day risk of stroke or death was 4.7% (95% CI, 4.1 to 5.2) with substantial heterogeneity across studies. Symptomatic patients were about twice as likely as those with asymptomatic stenoses to have complications. The 30-day risk of stroke or death was 7.6% (3.6 to 9.1) in symptomatic and 3.3% (2.6 to 4.1) in asymptomatic patients. Risks increased with age, hypertension, and history of coronary artery disease; were unrelated to sex and the presence of contralateral carotid occlusion; and were lower in patients who had carotid restenosis after CEA and in those treated with the use of a cerebral protection device. Risks have also decreased over time. Conclusions— Risks of CAS vary substantially across studies. Risks are overall higher than those of CEA in symptomatic patients. Some factors are likely to help select good candidates for CAS.

 

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Acute Stroke Toolbox - Guidelines, pathways, sample admission orders, and complementary tools, courtesy of the Brain Attack Coalition--a nonprofit alliance whose mission is to reduce the occurrence and impact of stroke.

Ahealthyme.com: Stroke: An Animated Guide - Visual introduction to ischemic and hemorrhagic strokes, revealing the fundamental processes involved in each type of brain attack.
Meta Description: [ aHealthyme.com provides information on health and wellness, along with daily health news, full-text journal and magazine articles, personalized newsletters and e-mail reminders, shopping, and more. ]

Artists Recovering from Stroke - Submit your artwork for inclusion in an online gallery, view samples from an Australian exhibition, and learn more about post-stroke conditions that may influence works of art.

Ask the Doctor - The Stroke Rehab Forum - Interactive medical question-and-answer board covering all aspects of stroke rehabilitation. Responses are provided by medical professionals from The Comprehensive Pain and Rehabilitation Center.
Meta Description: [ Interactive medical question and answer format about all aspects of stroke rehabilitation. Extensive library and archive of articles. ]

Believe In Miracles - Online home of James Bradley, stroke survivor and author of Elvis Was My Speech Therapist.
Meta Description: [ Stroke rehabilitation and recovery secrets revealed by stroke survivor James Bradley. Elvis Was My Speech Therapist is James Bradley's inspiring story of determination and hope. After a near-fatal accident, he suffered a stroke and became paralysed throughout his body. Through some simple strateg... ]

Brain Stem Stroke: Joe and Jackie - Reaching out to other families who have been affected by brain stem stroke, with a personal story of survival and links to helpful resources.
Meta Description: [ A couple's story of survival and life after a massive brain stem stroke resulting in a rare condition called 'locked in syndrome' ]

Caregiver-Information.com - Fact sheets, adapted leisure ideas, relaxation tips, news, and other resources for those who are caring for loved ones with stroke or another neurological condition.
Meta Description: [ Domain name renewal and affordable web hosting packages from Network Solutions ]

Constraint-Induced Movement Therapy: Online Publications - Reading list featuring reports on CIMT--a massed practice approach to limb weakness. Intended as a research aid for stroke survivors, medical professionals, and others who wish to investigate the therapy online.
Meta Description: [ Listings for online Constraint-Induced Movement Therapy publications, provided by the Stroke Information Directory. ]

Depression and Stroke - National Institute of Mental Health fact sheet relating the symptoms of post-stroke depression and the importance of obtaining treatment.

eMedicine Health: Stroke - Consumer health resource center, providing information on the causes, symptoms, and urgent treatment of stroke.
Meta Description: [ Stroke is a brain attack. It is much like a heart attack, only it occurs in the brain. Like a heart attack, stroke is a medical emergency. Do not wait ... ]

Family Centered Community Stroke Program - An Ottawa-based study that is designed to gather information about needed community services for stroke survivors and their families.
Meta Description: [ The purpose of the study is to gather information from the participants in the study with regards to what services they need in the community, the strengthening of supportive relationships within the family and community. ]

General Practice Notebook: Stroke - Clinical reference on ischemic and hemorrhagic strokes. Covered topics include differential diagnosis, etiological determination, radiologic investigations, and management of patients within the National Service Framework.

HealthAtoZ: Stroke - Learn how to decrease your stroke risk, and look into available treatments and questions that you should ask your physician if you've just had a stroke.
Meta Description: [ Understand how to decrease your risk of a stroke and the signs of stroke. Also find out what types of questions you should ask your doctor. ]

Hobbies After a Stroke - Created by a brain-stem-stroke survivor who hopes to encourage others to get involved in recreational activities. Her post-stroke hobbies include embroidery and outings on a motorized scooter.
Meta Description: [ This website shows just what an invalid can achieve after suffering a stroke - celebro vascular accident - and after a period of rehabilitation. The hobbies since disability are embroidery and cycling ]

Interact Reading Service - Providing a professional, live, interactive reading service for stroke patients in hospitals and stroke clubs in the London area.

Internet Stroke Center at Washington University in St. Louis - A stroke resource for medical professionals and consumers, alike. Educational information, directories of clinical trials and stroke centers, and a calendar of major stroke conferences are among the site's many offerings.
Meta Description: [ The leading university-based site for information on stroke care and research. ]

Interventional Radiology Procedures for Treatment and Prevention of Stroke - Educational resource from the Society of Interventional Radiology. Covered procedures include intra-arterial thrombolysis, aneurysm embolization, and carotid stenting.
Meta Description: [ The Society of Interventional Radiology (SIR) is a professional society for physicians who specialize in interventional or minimally invasive procedures, SIR is a non-profit, national scientific organization deeply committed to its mission to improve health and the quality of life through the pra... ]

JennyStroke.com - Online home of Jenny Broome, a young brain-stem-stroke survivor sharing perspectives on recovery.
Meta Description: [ Site dedicated to young stroke victim Jenny Broome ]

Lou's Stroke - Link collection and personal story of Louis Albert, a survivor with diabetes and aphasia who has used assistive technology to create his site.
Meta Description: [ In 1983 I began using insulin for my Type-2 DIABETES. In May of 1995 I had a severe stroke. Because of the stroke and the resulting aphasia, I am totally disabled. ]

MerckSource: Stroke - Find background information about stroke--and quick links to online versions of The Merck Manual - Home Edition and Dorland's Medical Encyclopedia--through MerckSource.
Meta Description: [ Find information on Stroke at MerckSource. Learn more about Stroke, A stroke is an interruption of the blood supply to any part of the brain. ]

Neurotransplantation for Patients with Paralysis After Stroke - Overview of the University of Pittsburgh's study of neuronal cell transplantation for the treatment of stroke. Updates on the research program are provided.
Meta Description: [ Study to evaluate neuron cell transplantation for patients who have suffered a stroke. ]

NHS Direct Online Health Encyclopaedia: Stroke - Fundamental stroke information, provided at the companion site to the National Health Service's advice hotline.

NINDS Stroke Information Page - Introduction to stroke, with pointers to related fact sheets concerning symptoms, prevention, and rehabilitation. Presented by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.
Meta Description: [ Stroke information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS). ]

Physiotherapy for Strokes - An overview of the role of physical therapy in stroke rehabilitation, provided by Heads Up!--a specialist neurological physiotherapy practice based in Surrey, England.
Meta Description: [ An information and resource guide for people recovering from strokes. ]

Post Stroke Help - Articles and webcasts concerning post-stroke spasticity, uncontrollable muscle tightness or cramps that cause pain and affect movement. Created in cooperation with Healthology and supported by unrestricted educational grants from Allergan and Medtronic.
Meta Description: [ Stroke recovery information. Learn about leg cramps, muscle cramps, muscle spasms, post stroke rehabilitation and Baclofen or Botox treatments. ]

Separating Myth and Fact: Women and Stroke - Article exploring women's special stroke risks.
Meta Description: [ You probably don't worry too much about it. But maybe you should. Find out why and what you can do. ]

Stroke - From the staff of the Mayo Clinic, a nine-page, consumer-oriented guide to stroke. Topics include risk factors and prevention, screening and diagnosis, treatment, and coping skills.
Meta Description: [ Stroke — Comprehensive overview covers symptoms, causes, treatment of interruption of brain's blood supply. ]

Stroke and Aphasia Information - Resources for stroke recovery, including home therapy tips and survivors' stories. Presented by Bungalow Software, a provider of rehabilitation programs.
Meta Description: [ Stroke information in PLAIN-ENGLISH ]

Stroke and Cerebrovascular Diseases: A Guide for Patients and Their Families - From the stroke specialists at Stanford University's School of Medicine, a nine-part guide featuring information about stroke types, prevention, emergency treatment, and rehabilitation.

Stroke Recovery: Regaining Quality of Life - Discusses the goals of stroke recovery and rehabilitation: to improve quality of life and counteract morbidity
Meta Description: [ Discusses the goals of stroke recovery and rehabilitation: to improve quality of life and counteract morbidity. ]

Stroke Survivors - Maintained by and for stroke survivors and their families to provide information about rehabilitation options, sources of support, and new equipment.

Stroke Survivors Canada Ottawa - Supporting affected families with information about stroke causes, acute care, rehabilitation, financial issues, local services, and Web-based resources.

Stroke Survivors: The Site for Cerebellar Stroke Victims - Developed and maintained by survivor John d'Arcy to support individuals who are dealing with cerebellar stroke. Resources include his personal story, a fact sheet on the condition, a message board, and contact details for related organizations in the United Kingdom.
Meta Description: [ Stroke Survivors is a website for stroke victims, particularly Cerebellar stroke victims who are in a minority. However any stroke victim should find some useful information, at least that is my intention. The site was developed and is maintained by myself; John D'Arcy ]

Stroke-TIA.org - An educational resource focusing on the prevention and treatment of stroke and transient ischemic attacks. Features articles and webcasts of interviews with medical professionals.
Meta Description: [ An educational resource for information on stroke and TIA. Included in this website is information on the treatment, risk factors, symptoms, and prevention of stroke and transient ischemic attack ]

StrokeGene - An international research programme, aiming to discover new treatments for stroke through a genomic approach. Funded by the European Commission.
Meta Description: [ StrokeGene : An international research programme, funded by the European Commission, aiming to discover new treatments for stroke through a genomic approach. ]

StrokeHelp.com - Workshops and video-based courses focusing on stroke rehabilitation. Presented by International Clinical Educators.
Meta Description: [ Continuing education home study DVD & Video programs (CEUs), plus Workshops with Jan Davis for Physical Therapists and Occupational Therapists. Functional treatment and NDT training to improve the quality of care for stroke survivors. ]

StrokeMatters.com - Multi-lingual stroke survey, seeking respondents from Canada, Europe, and the United States. The results will be used to help advance stroke education and care internationally.
Meta Description: [ Thank you for taking the time to complete our multi-lingual Stroke survey. It will be used to assess levels of disease awareness. The information gathered from your responses will help to benefit the advancement of stroke prevention and treatment in the future. Stroke is the leading cause of disa... ]

StrokePage/Slagsiden - Home to the StrokePost news pages and numerous other resources for stroke survivors and their loved ones. Content is presented in both English and Norwegian.
Meta Description: [ Slag, Slaganfall,cerebral infarkt, Hjärnskada, Hjerneskade, Hjerneslag, Stroke, apopleksi, Brain stroke, Traumatic Brain Injury, Neurologisk sjukdom ]

Terri's Stroke Recovery - Story of stroke and continuing recovery, from the rehab unit to independent living. Written in support of other survivors who are on the long journey back from stroke.
Meta Description: [ My 5 years of recovery from a stroke ]

The New England Journal of Medicine: Stroke Collection - From the archives of the journal, literature covering topics such as antithrombotic therapy, cerebral thrombosis, and carotid stenosis.
Meta Description: [ The Stroke collection covers topics such as antithrombotic therapy, cerebral thrombosis, and carotid stenosis and includes research articles, case reports, reviews, and editorial commentary. ]

Transient Ischemic Attack - Information sheet on TIAs (which are also known as mini strokes). Published by National Institute of Neurological Disorders and Stroke.
Meta Description: [ Transient Ischemic Attack (TIA) information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS). ]

Veritas Medicine: Stroke - Personalized trial listings, fundamental information, and treatment reviews pertaining to stroke.
Meta Description: [ Clinical trial listings and in-depth treatment information for serious illnesses. Perform a personalized search to find ongoing clinical trials that match your needs. Research treatments using high-quality original content written by top doctors. ]

Stroke current issue - Stroke RSS feed -- current issue

Stroke current issue - Stroke RSS feed -- current issue