Clinical characteristics and thrombolytic outcomes of infective endocarditis-associated stroke.

Objective: Our aim was to describe the clinical features of infective endocarditis (IE) in the acute stroke setting and outcomes following thrombolytic therapy.

Methods: This is a single-center, retrospective, descriptive case series of IE-related stroke (IES). Infective endocarditis diagnosis was based on the modified Duke criteria.

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke.

Objective: To conduct a cost-effectiveness analysis of telestroke--a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients--compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts).

Intrasinus catheter-directed heparin infusion in the treatment of dural venous sinus thrombosis.

Background And Purpose: In this small series, local intrasinus catheter-directed heparin infusion with or without balloon thrombectomy was safe in the treatment of dural venous sinus thrombosis (DVST). Although systemic anticoagulation (SAC) is the treatment of choice, there is a lack of consensus regarding the best treatment should SAC fail or be contraindicated. We present our institutional experience with 16 patients in whom failure of, or contraindication to, SAC occurred and who subsequently underwent intrasinus catheter-directed heparin infusion with or without balloon thrombectomy.

A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association.

The aim of this new statement is to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. The evidence is organized and presented within the context of the American Heart Association's Stroke Systems of Care framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class of evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke; notification and response of emergency medical services; acute stroke treatment, including the hyperacute and emergency department phases; hospital-based subacute stroke treatment and secondary prevention; and rehabilitation.

Targeting the inflammatory response in secondary stroke prevention: a role for combining aspirin and extended-release dipyridamole.

The recognition that stroke and other ischemic events are manifestations of chronic progressive inflammation has had a great impact on the development of prevention strategies. The most recent American Heart Association guidelines recommend combination aspirin and extended-release dipyridamole over aspirin alone for patients with prior ischemic stroke or transient ischemic attack. Although aspirin and extended-release dipyridamole have long been recognized for their antiplatelet activities, there is now evidence that these drugs also have complementary antiinflammatory properties that contribute to improved outcomes when used to prevent secondary stroke.

Sporadic fatal insomnia masquerading as a paraneoplastic cerebellar syndrome.

Background: Sporadic fatal insomnia is a rare prion disease that has recently been recognized.

Objective: To report a unique case of sporadic fatal insomnia in a woman with progressive cerebellar deterioration who was originally thought to have a paraneoplastic cerebellar syndrome.

Design: Case report describing a patient with autopsy-proven sporadic fatal insomnia.

Optimal outcome measures for detecting clinical benefits of early reperfusion: insights from the DEFUSE Study.

Background: There is no consensus regarding which clinical outcome scales are the most sensitive indicators of early reperfusion in patients with acute stroke.

Methods: Patients with acute stroke enrolled in the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study with a perfusion-/diffusion-weighted imaging mismatch at baseline magnetic resonance imaging were studied. Prespecified secondary outcome measures were evaluated at both 30 and 90 days after treatment with intravenous tissue plasminogen activator.

Novel intra-arterial strategies in the treatment of acute ischaemic stroke.

Acute ischaemic stroke is among the leading causes of death and disability in developed societies. I.v.

Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study.

Objective: To determine whether prespecified baseline magnetic resonance imaging (MRI) profiles can identify stroke patients who have a robust clinical response after early reperfusion when treated 3 to 6 hours after symptom onset.

Methods: We conducted a prospective, multicenter study of 74 consecutive stroke patients admitted to academic stroke centers in North America and Europe. An MRI scan was obtained immediately before and 3 to 6 hours after treatment with intravenous tissue plasminogen activator 3 to 6 hours after symptom onset.

Single-gene stroke disorders.

Monogenic causes of stroke are rare but should not be missed by the neurologist. The purpose of this review is to aid the reader in the evaluation of a patient with cryptogenic stroke with or without a family history suspicious for an inherited condition. The clinical findings, diagnosis, and management of monogenic causes of stroke and stroke look-alikes are discussed, including cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry's disease, vascular Ehlers-Danlos, Marfan syndrome, sickle cell disease, the thrombophilias, hereditary hemorrhagic telangiectasia, cerebral cavernous malformations, hereditary cerebral hemorrhage with amyloidosis, and mitochondrial encephalopathy, lactic acidosis, and strokelike episodes.

Prophylaxis for deep venous thrombosis in neurosurgery: a review of the literature.

The incidence of deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) in patients undergoing neurosurgery has been reported to be as high as 25%, with a mortality rate from PE between 9 and 50%. Even with the use of pneumatic compression devices, the incidence of DVT has been reported to be 32% in these patients, making prophylactic heparin therapy desirable. Both unfractionated and low-molecular-weight heparin have been shown to reduce the incidence of DVT consistently by 40 to 50% in neurosurgical patients.

Ischemic stroke during sexual intercourse: a report of 4 cases in persons with patent foramen ovale.

Background: The association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical embolization through a PFO represents a possible mechanism by which PFO might predispose to stroke.

Objective: To describe 4 patients with PFO who experienced the onset of ischemic stroke during sexual intercourse.

Spinal manipulative therapy is an independent risk factor for vertebral artery dissection.

Objective: To determine whether spinal manipulative therapy (SMT) is an independent risk factor for cervical artery dissection.

Methods: Using a nested case-control design, the authors reviewed all patients under age 60 with cervical arterial dissection (n = 151) and ischemic stroke or TIA from between 1995 and 2000 at two academic stroke centers. Controls (n = 306) were selected to match cases by sex and within age strata.

Pallidotomy improves motor responses and widens the levodopa therapeutic window in Parkinson's disease.

Stereotactic posteroventral pallidotomy (PVP) as a treatment for Parkinson's disease (PD) symptoms has been increasingly used in moderate-advanced disease. We examined the pharmacodynamic responses of PD patients to single oral levodopa doses and intravenous levodopa infusions before and after PVP surgery. Nine subjects with advanced PD received a single oral dose and ramped intravenous levodopa infusions before and 3-5 weeks after unilateral PVP.