Stroke
08 Dec CT Scan May Predict Risk of Second Stroke
MedicalResearch.com Interview with Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented. Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population. Dr. Perry: Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:- 2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
- 5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
- 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels in addition to acute ischemia;
- 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.
01 Dec Dedicated Neuro Emergency Department Improves Stroke Outcomes
Stroke Wasserman Perry 006768R PDF
MedicalResearch.com Interview with:
Karen Greenberg, DO, FACOEP
Capital Health Center for Neurologic Emergencies
750 Brunswick Ave, NJ 08638
Medical Research: What is the background for this study?
Dr. Greenberg: Capital Health Regional Medical Center in Trenton, NJ opened the first dedicated Neurologic Emergency Department in the country in January of 2011. Dr. Veznedaroglu, our chief neurosurgeon, recognized the importance and emergent nature of patients with neurologic complaints. He recruited dedicated Emergency Medicine Physicians, one of which is myself, who would be assigned to see patients with neurologic complaints during peak hours of 7a-6p daily seven days a week. Having a section of the ED dedicated to identifying, triaging, and treating patients with neurologic emergencies has led to more advanced and efficient care. Due to the initial success of the neuro ED, 5 dedicated physicians became educated and comfortable in administering IV-tPA to acute ischemic stroke patients. This decision was made to eliminate delays associated with teleneurology or neurology consultation prior to administering thrombolytics in order to improve door-to-needle times and outcomes in acute stroke patients. As far as we know, we are still the only dedicated Neuro ED in the country.
25 Nov Stroke: Golden Hour Thrombolysis Improved Discharge To Home
MedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Berlin | Germany Medical Research: What is the background for this study? What are the main findings? Response: Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That's because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial - both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.31 Oct Age-Related Macular Degeneration: Lucentis Raises Stroke Risk
MedicalResearch.com Interview with: Takashi Ueta, M.D., Ph.D. Assistant Professor, Department of Ophthalmology Graduate School and Faculty of Medicine The University of Tokyo Medical Research: What is the background for this study? What are the main findings? Dr. Ueta: In 2009 we had reported an initial systematic review and meta-analysis which include pivotal RCTs but the number of the included studies were only 3 (MARINA, ANCHOR, FOCUS). During the following several years, more trials comparing different dosages and frequencies of ranibizumab treatment were conducted, which made us to update our meta-analysis. Based on our updated meta-analysis, increase in several systemic vascular adverse events was observed: 86% increase in odds ratio (OR) for the risk of cerebrovascular accident (CVA) when 0,5 mg ranibizumab used. 89% increase in OR for the risk of CVA when monthly ranibizumab of any dosage is used. 57% increase in OR for the risk of non-ocular hemorrhage when ranibizumab of any dosage with any frequency is used.25 Oct How Good Is Stroke Care in Canada?
MedicalResearch.com Interview with: Michael Douglas Hill, MD, MSc The Calgary Stroke Program, Department of Clinical Neurosciences Hotchkiss Brain Institute Associate Professor, University of Calgary Calgary, Alta MedicalResearch: What is the background for this study? Dr. Hill: We conducted an audit of stroke admissions to Canadian hospitals in all provinces. We examined key metrics of quality stroke care focusing on the acute treatment. Use of thrombolysis for stroke is a key quality metric in the Accreditation Canada standards for stroke care. We found that the use of thrombolysis, while better than the past review (CMAJ. 2005 May 10;172(10):1307-12) remains low. This is a marker for the overall quality of acute stroke care in Canada. As expected, larger academic hospitals perform at a higher level than smaller community hospitals. Overall, this study serves to quantify the gaps in the delivery of acute stroke care to Canadians.24 Oct Long-Term Costs of Stroke Remain HIgh
MedicalResearch.com Interview with:
A/Prof Dominique Cadilhac, MPH PhD
Head: Translational Public Health Division
Stroke and Ageing Research Centre (STARC)
Department of Medicine,
School of Clinical Sciences at Monash Health, Monash University
Melbourne, Australia
Medical Research: What are the main findings of the study?
Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH).
243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on.
The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]).
The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because
a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and
b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event.
17 Oct Coumarin Users at Higher Risk For Cerebral Microbleeds
MedicalResearch.com: Interview Invitation S. Akoudad, MD Msc PhD candidate Dep. Epidemiology, Radiology, Neurology Erasmus MC, Rotterdam , the Netherlands Medical Research: What are the main findings of the study? Dr. Vernooij: We found that compared to never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and probably also a higher incidence of any microbleeds. A higher maximum international normalized ratio (INR) was associated with deep or infratentorial microbleeds, and among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds.07 Oct Team Management of Stroke Improved Patient Satisfaction, Decreased Hospital Days
Posted at 23:49h
in Stroke
MedicalResearch.com Interview with:
John Falconer MD FRCPC
Neurologist, Kelowna General Hospital;
Clinical Associate Professor of Neurology,
University of British Columbia
Medical Research: What are the main findings of this study?
Dr. Falconer: This study set out to investigate the possible benefits of having a
physician with a proprietorial interest (Pro-MD) in a stroke unit, tightly
combined with a multidisciplinary inter-professional team, and including
the family and the patient in as essential members for the management of a
stroke patient. This also involved the introduction of a geographic
located Acute Stroke Unit. We compared Acute Bed Days used by patients
from the five months before to five months after this system was put in
place. Our main end point was number of days in acute hospital care before
and after, but we also informally tracked patient and caregiver
satisfaction and staff morale.
The Proprietary Physician, or Pro-M Drefers to a physician who has a “proprietorial” interest in a hospital unit or ward. In other words, I was working at this unit in a
wholistic sense, trying not only to manage patients as best they can, but
also interested in the patient flow and family-patient communications.
We found that patient bed days were reduced by approximately 25% overall,
while at the same time, patient and family satisfaction was improved, and
staff morale increased.
Initially, we had supposed that patients and their family would be more
satisfied, but we were surprised at the reduction in Acute Bed Days that
resulted.
07 Oct TIAs, Strokes Decline Over Last Decade
MedicalResearch.com Interview with:
Vijaya Sundararajan, MD, MPH, FACP
Associate Professor
Head, Health Outcomes Group, Head, Biostatistics Hub
Research Advisor, Centre for Palliative Care
Department of Medicine Eastern Hill Academic Centre
Melbourne Medical School
Faculty of Medicine, Dentistry and Health Sciences University of Melbourne
Medical Research: What are the main findings of this study?
Dr. Sundararajan: The main findings of the study are that over the last 10 years, there has been a measurable decline in people having a stroke 3 months after a new mini stroke (TIA); a mini stroke is also known as a ‘warning sign for stroke’. There has also been an overall decline in of the proportion of people having these mini strokes in the Australian State of Victoria (population 5.6million). These trends probably reflect improved primary and secondary prevention efforts for the last decade. These improvements are likely to include increased use of preventive medications and surgery for carotid artery narrowing in people identified as being at high risk of having a stroke, as well as improved behaviors (e.g. reducing smoking, improving diets, uptake of physical activity, among others).
The most important aspect of our results is many fewer strokes occur when people with a TIA are managed in a hospital with a stroke unit (up to 6%). Even when the patient’s TIA is managed in an Emergency Department and the patient released without admission, if the hospital has a stroke unit, these patients appear to have better outcomes. This likely reflects the cohesion and organization of the stroke unit in implementing the necessary tests and treatments promptly, and setting up the infrastructure to follow patients up.
17 Sep Carotid Stenosis: Using Cerebrovascular Reserve To Assess Stroke Risk
MedicalResearch.com Interview with:
Ankur Pandya, PhD
Assistant Professor of Healthcare Policy and Research
Departments of Healthcare Policy and Research
Weill Cornell Medical College
New York, NY 10065.
Medical Research: What are the main findings of the study?
Dr. Pandya: Asymptomatic carotid stenosis is a highly prevalent condition that can lead to ischemic stroke, which is a leading cause of death and healthcare costs in the U.S. Revascularization procedures are often performed on asymptomatic carotid stenosis patients, but experts have questioned whether the stroke prevention benefits outweigh the risks and costs of revascularization in these patients. Imaging-based stroke risk assessment has traditionally focused on the degree of artery narrowing, but there has been growing interest in using cerebrovascular reserve (CVR) assessment to stratify these patients into those that are more likely to have a stroke, and thus better candidates for revascularization, and those that would be better off with less invasive management strategies (such as medical therapy). We therefore developed a simulation model to evaluate whether the CVR-based decision rule could be used efficiently select the right patients for revascularization. We found that the CVR-based strategy represented the best value for money compared to immediate revascularizations or medical therapy-based treatment for all patients.
16 Sep 20 Year Drop In Stroke Incidence
MedicalResearch.com Interview with:
Silvia Koton, PhD, MOccH, RN
Chair, Department of Nursing
The Stanley Steyer School of Health Professions
Tel Aviv University Tel Aviv, Israel
Medical Research: What are the main findings of the study?
Dr. Koton: Based on data on 14,357 participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of stroke when the study began in 1987 and followed until the end of 2011, we found a 24 percent overall decline in first-time strokes in each of the last two decades and a 20 percent overall drop per decade in deaths after stroke. The results were similar across race and gender, but varied by age: the decline in stroke risk was concentrated mainly in the over-65 set, while the decrease in stroke-related deaths was primarily found among those under age 65.
27 Aug Only 4% of US Stroke Patients Receive Approved Medication tPA
MedicalResearch.com Interview with:
Opeolu Adeoye, MD MS FACEP FAHA
Associate Professor, Emergency Medicine and Neurosurgery
Division of Neurocritical Care
University of Cincinnati
Cincinnati, OH 45267
Medical Research: What are the main findings of the study?
Dr. Adeoye : Despite adequate access of the US population to hospitals that can deliver acute stroke care, only 4% of stroke patients in the US received tPA, the only approved medication for treating acute ischemic stroke.
21 Aug Recurrent Hypoglycemia Raises Stroke Risk in Kidney Disease Patients
MedicalResearch.com Interview with: Prof. Chia-Huang Kao From the Graduate Institute of Clinical Medical Science Department of Radiation Oncology and Nuclear Medicine and PET Center Graduate Institute of Clinical Medical Science China Medical University Hospital, Taichung, Taiwan. Medical Research: What are the main findings of the study? Prof. Kao: Patients with chronic kidney disease (CKD) are at high risk for hypoglycemia; several factors are reported to contribute to hypoglycemia in these patients. However, most previous studies were limited by the relatively small number of patients with CKD included in the study by the exclusion of cases with CKD. In the present study, the incidence rate of hypoglycemia in patients with CKD was 4.5%, which is approximately twice the value noted in previous reports and multivariate analysis revealed a 2.53-fold increase in the risk of death for CKD patients with hypoglycemia after adjusting for related confounding factors including hypertension, hyperlipidemia, diabetes, and antidiabetic drugs.15 Aug Smokers With Low Educational Level Have Greater Stroke Risk
MedicalResearch.com Interview with: Helene Nordahl, MS, PhD Department of Public Health, University of Copenhagen Copenhagen, Denmark. Medical Research: What are the main findings of this study? Dr. Nordahl: The combined effect of low educational level and smoking on the risk of stroke is the most surprising finding of our paper. In other words, we found that...
11 Aug Stem Cells May Give Hope To Patients With Severe Stroke Disability
MedicalResearch.com Interview with: Dr Soma Banerjee M.D. Department of Stroke Medicine Imperial College Healthcare National Health Services Trust St. Mary’s Hospital Campus, Praed Street, London Medical Research: What are the main findings of the study? Dr. Banerjee: This stem cell trial is the first of its kind in humans to show that selected bone marrow stem cells (CD34+ cells) from the patients' own bone marrow, can be administered to patients with severe strokes, within an early timescale after their stroke. This pilot study of 5 patients showed that it was both safe and feasible to administer these cells to patients within a week of the event. This was primarily a safety study, but clinical measures of recovery were also assessed, and these showed improvements in disability scores and scores of neurological impairment, in all 5 patients.09 Aug Stroke: Lower Cognitive Function Linked to Increase Risk, Mortality
MedicalResearch.com Interview with:
Kumar Bharat Rajan, PhD
Assistant Professor
Department of Internal Medicine
Section of Population Sciences
Chicago IL 60612
Medical Research: What are the main findings of the paper?
Dr. Rajan: Lower levels of cognitive functioning was associated with incident stroke and the change in cognitive functioning was increased after incident stroke. Cognitive functioning was an independent marker of mortality even after accounting for incident stroke.
23 Jul Moral Judgment Impairment Can Be Seen With Both Dementia and Stroke
MedicalResearch.com Interview with: Agustin Ibanez, PhD Laboratory of Experimental Psychology and Neuroscience Institute of Cognitive Neurology and the National Scientific and Technical Research Council and Sandra Baez, MS; Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina Medical Research: What are the main findings of the study? Answer: Both patients with the behavioral variant of frontotemporal dementia (bvFTD) and patients with frontal strokes presented moral judgment abnormalities. Their deficits were related to impairments in the integration of intentions and outcomes. Specifically, both patient groups judged moral scenarios by focusing on the actions' outcomes instead of the protagonists' intentions.20 Jul Stroke: Homocysteine Associated With Atherosclerosis of Cerebral Vessels
MedicalResearch.com Interview with:
Sang-Beom Jeon, MD, PhD
From the Department of Neurology
Asan Medical Center
University of Ulsan College of Medicine
Seoul, Republic of Korea.
Medical Research: What are the main findings of the study?
Dr. Sang-Beom Jeon: In this MRI study of 825 stroke patients, we demonstrated that high plasma concentrations of homocysteine, also known as hyperhomocysteinemia, were associated with small-vessel disease (lacunar infarcts and leukoaraiosis) and large-vessel atherosclerosis of cerebral arteries.
17 Jul Stroke History Raises Risks of Non-Cardiac Surgery
MedicalResearch.com Interview with:
Mads E. Jørgensen, M.B.
University of Copenhagen, Denmark
Medical Research: What are the main findings of the study?
Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke.
An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE.
When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke.
We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery.
15 Jul Family History Closely Linked To Carotid Artery Stenosis
MedicalResearch.com Interview with:
Iftikhar J. Kullo, MD
Division of Cardiovascular Diseases
Mayo Clinic Rochester, MN
Medical Research: What are the main findings of the study?
Dr. Kullo: The main findings of the study are:
1) Family history of stroke or heart attack is associated with presence of significant narrowing (greater than 70%) of the carotid arteries. These are the arteries that supply blood to the brain and narrowing or blockage of these arteries is associated with increased risk of stroke;
2) Having a sibling history of stroke or heart attack was more strongly associated with narrowing of the carotid artery than having a parent with such history;
3) The greater number of relatives with history of stroke or heart attack, the greater the odds of having narrowing in one of the carotid arteries.
04 Jul Validating Medicare Claims Data For Stroke
MedicalResearch.com Interview with Hiraku Kumamar, MD, MPH Department of Epidemiology Harvard School of Public Health, Boston, MA and Soko Setoguchi-Iwata, M.D. Duke Clinical Research Institute Durham, NC 27715 Medical Research: What are the main findings of the study? Answer: We evaluated the accuracy of discharge diagnosis of stroke in the Medicare claims database by linking it to a nationwide epidemiological study cohort with 30239 participants called REasons for Geographic And Racial Differences in Stroke (REGARDS). We found that among the 282 events captured using a strict claims definition of stroke, 91% were true events. We also found that 12% of the overall strokes had been identified only by Medicare claims, strongly supporting the use of these readily available data for event follow-up in cohort studies.01 Jul Asymptomatic Atrial Fibrillation Relatively Common In Cryptogenic Stroke
MedicalResearch.com Interview with: Dr. Tommaso Sanna MD Institute of Cardiology Catholic University of the Sacred Heart Rome, Italy MedicalResearch: What are the main findings of the study? Dr. Sanna: In patients with cryptogenic stroke, continuous ECG monitoring with an implantable device, called the Reveal XT Insertable Cardiac Monitor (ICM), discovered Atrial Fibrillation in 6.4 times more patients than conventional diagnostic strategies at six months, 7.3 times more patients at 12 months, and 8.8 times more patients at 36 months. In more detail, after 36 months of follow-up, 30% of patients with cryptogenic stroke had at least one episode of atrial fibrillation.25 Jun Overall Hospitalizations for Stroke Decrease, but Racial Disparities Remain
MedicalResearch.com Interview with:
Wuwei (Wayne) Feng MD MS FANA
Assistant Professor, Department of Neuroscience
Department of Health Science & Research
Medical University of South Carolina Stroke Center
The Center of Rehabilitation Research in Neurological Conditions
MedicalResearch: What are the main findings of the study?
Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years).
By way of background:
84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites.
Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001).
This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes.
22 Jun Stroke Patients Have Chronic Disease At High Risk For Readmissions
MedicalResearch.com Interview with:
Cheryl Bushnell, MD, MHS
Associate Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist School of Medicine
Winston Salem, NC 27157
MedicalResearch: What are the main findings of the study?
Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure).
26 May After Intracerebral Bleeds: Risks Remain From Both Recurrent Bleed and Future Ischemic Events
MedicalResearch.com Interview with:
Michael T. C. Poon, MBChB, BMedSci (Hons)
Junior Doctor, Wycombe General Hospital
Buckinghamshire Healthcare NHS Trust, UK
MedicalResearch: What are the main findings of the study?
Dr. Poon: At present, we know that the incidence and one-month case fatality of intracerebral haemorrhage (ICH) have remained static for the past two decades. However, any trend in long-term survival after ICH is less clear. Survivors face the risks of recurrent ICH as well as ischaemic events in the future. The balance between these risks has particular clinical implication on the decision about restarting antiplatelet/anticoagulant therapy after ICH. To address these questions, we undertook a systematic review and meta-analysis to determine whether long-term survival after intracerebral haemorrhage has changed over time, and to re-assess the balance between the risks of recurrent ICH and ischaemic events in studies quantifying both of these risks in the same population.
The survival rates after ICH at 1 year and 5 years do not appear to have changed over time – 1 year survival was 46% and 5 year survival was 29%. The risk of recurrent ICH may be influenced by the ICH location, with lobar ICH having a higher rate of recurrence. In contrast to the previous systematic review, we found the risk of ischaemic stroke to be at least as high as the risk of recurrent ICH over 3 years after ICH. This reinforces the difficulty that clinicians and patients have in deciding about antithrombotic treatment after ICH.
15 May Migraines Associated With Increased Risk of Silent Stroke
MedicalResearch Interview with: Dr. Teshamae Monteith MD Assistant professor of Neurology Chief of the Headache Division University of Miami Miller School of Medicine. MedicalResearch: What are the main findings of the study? Dr. Monteith:- A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
- No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
- Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.
- High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.
14 May Stroke Risk Reduced by Increased Fruit and Vegetable Consumption
MedicalResearch Interview with: Dr. Yan Qu Qingdao Municipal hospital Fruits and Vegetables Consumption and Risk of Stroke A Meta-Analysis of Prospective Cohort Studies MedicalResearch: What are the main findings of the study? Reply: First, both fruits and vegetables were found inversely associated with risk of stroke, and the relationships might be linear. Second, the inverse association of fruits and vegetables consumption with risk of stroke is consistent across subgroup analysis by outcome (stroke incidence and stroke mortality), location where the study was conducted (USA, Europe and Asia), sex (male and female), and stroke subtypes (ischemic and hemorrhagic). Third, citrus fruits, leafy vegetables and apples/pears were found inversely associated with risk of stroke. Fourth, very similar results were found in the subgroup analysis by status [yes: 0.78 (0.71-0.86) or no: 0.79 (0.74-0.85)] of adjusting for 6 or more of the 7 covariates (smoking, alcohol, blood pressure/hypertension, serum cholesterol, physical activity, body mass index, ≥3 dietary variables). These findings generally indicated that the association of fruits and vegetables consumption with the reduced risk of stroke may not be the result of confounding by the known factors.09 May Does Marijuana Increase Stroke Risk in Young Adults?
MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center MedicalResearch: What are the main findings of the study? Dr. Dutta: We analyzed data from the Stroke Prevention in Young Adults Study in order to evaluate for an association between self-reported marijuana use and ischemic stroke. 1,101 cases and 1,154 age, gender, and race-matched controls, aged 15-49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Interviews were conducted to assess for various potential stroke risk factors, including illicit drug, alcohol, and tobacco use. Individuals reporting use of vasoactive illicit drugs, including cocaine and amphetamines, were excluded, yielding 751 cases and 813 controls. Logistic regression analysis was used to determine the association between marijuana use and ischemic stroke, adjusting for age, gender, race, current tobacco use, current alcohol use, hypertension, and diabetes. We did not find a positive association between marijuana use and ischemic stroke risk in our population of young-onset stroke patients compared to matched controls, even after controlling for current tobacco and alcohol use, hypertension, and diabetes. A statistically significant inverse relationship was observed between remote use (defined as any use over one year ago) and stroke risk (adjusted OR 0.77, CI 0.61-0.98, p = 0.03). We also looked to see whether recent use (in the past 30 days), and particularly recent heavy use, was associated with ischemic stroke risk as has been suggested in the medical literature. Though our data did not show this association, the number of patients reporting recent use in our study was very small.06 May MRI Findings as Surrogate Markers for Brain Microinfarcts
MedicalResearch.com Interview with:
Kejal Kantarci, M.D. M.S.
Professor of Radiology
Division of Neuroradiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch: What are the main findings of the study?
Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.