Clinical Usefulness of Serial Duplex Ultrasound in Cervical Artery Dissection Patients.

Purpose: To study the clinical usefulness of serial color-coded duplex ultrasound (DUS) examinations in cervical artery dissection (CeAD) patients.

Methods: Single-center, CeAD registry-based re-review of serial, routine DUS exams in consecutive CeAD patients treated at the Stroke Center Basel, Switzerland (2009-2015). Two experienced raters reassessed all DUS for the occurrence of new arterial findings during follow-up, that is.

Impact of previous stroke on outcome after thrombectomy in patients with large vessel occlusion.

Background: Many patients with large vessel occlusion (LVO) who are otherwise candidates for endovascular treatment (EVT) have had previous strokes. We aimed to examine the effect of previous stroke on outcome after EVT.

Methods: Consecutive patients with LVO were prospectively entered into a National Acute Stroke registry of patients undergoing EVT.

Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions.

Background And Aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown.

Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization.

Declining Rate and Severity of Hospitalized Stroke From 2004 to 2013: The National Acute Stroke Israeli Registry.

Background And Purpose: Stroke is a leading cause of morbidity and disability. We assessed trends in rates of hospitalized stroke and stroke severity on admission in a prospective national registry of stroke from 2004 to 2013.

Methods: All 6693 acute ischemic strokes and intracerebral hemorrhage in the National Acute Stroke Israeli participants ≥20 years old were included.

Is CT perfusion helpful in the treatment allocation of patients with acute ischemic stroke? An expert-opinion analysis.

Background: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT).

Ten-year risk of stroke in patients with previous cerebral infarction and the impact of carotid surgery in the Asymptomatic Carotid Surgery Trial.

Background: Silent brain infarcts are common in patients at increased risk of stroke and are associated with a poor prognosis. In patients with asymptomatic carotid stenosis, similar adverse associations were claimed, but the impact of previous infarction or symptoms on the beneficial effects of carotid endarterectomy is not clear. Our aim was to evaluate the impact of prior cerebral infarction in patients enrolled in the Asymptomatic Carotid Surgery Trial, a large trial with 10-year follow-up in which participants whose carotid stenosis had not caused symptoms for at least six months were randomly allocated either immediate or deferred carotid endarterectomy.

Serum uric acid and subsequent cognitive performance in patients with pre-existing cardiovascular disease.

High serum uric acid (UA) levels are associated with numerous vascular risk factors, and vascular disease, that predispose patients to cognitive impairment, yet UA is also a major natural antioxidant and higher levels have been linked to slower progression of several neurodegenerative disease. In-order to test the association between UA and subsequent cognitive performance among patients that carry a high vascular burden, UA levels were determined by calorimetric enzymatic tests in a sub-cohort of patients with chronic cardiovascular disease who previously participating in a secondary prevention trial. After an average of 9.

Connective tissue disorders: systemic lupus erythematosus, Sjögren's syndrome, and scleroderma.

Connective tissue disorders are systemic, autoimmune, multiorgan diseases in which the central and peripheral nervous systems are frequently involved. The objective of this chapter is to describe the neurological manifestations of three of the most common systemic autoimmune disorders: systemic lupus erythematosus (SLE), scleroderma, and Sjögren's syndrome (SS). In SLE the neuropsychiatric manifestations involve mainly the central nervous system (CNS), including cognitive dysfunction, headache, psychosis and mood changes, seizures, cerebrovascular disease, and myelopathy.

Is the evaluation and treatment of transient ischemic attack performed according to current knowledge? A nationwide Israeli registry.

Background: Patients with transient ischemic attack (TIA) at a high risk of stroke can be identified and should be managed urgently.

Objectives: To investigate whether recognized recommendations are being implemented in Israel.

Methods: An Israeli nationwide registry (NASIS) on patients admitted with stroke and TIA was conducted in all acute care hospitals within 2 successive months during 2004, 2007 and 2010.

[Approach to the diagnosis and management of transient ischemic attack in Israel].

Transient ischemic attack (TIA) is associated with early stroke risk and thus should be considered as an emergency. Early diagnosis and prompt evaluation and treatment are the key in reducing the stroke risk. Recently, with the recognition of several clinical scores as well as a few imaging modalities that identify those with higher risks, it is likely to be easier to reduce risks.

Off-hours admission for acute stroke is not associated with worse outcome--a nationwide Israeli stroke project.

Background And Purpose: Several studies reported worse outcome for stroke patients arriving on weekends. We compared working hours to off-work hours throughout the week as there is lack of experienced staff and special services during off-hours.

Methods: A nationwide stroke survey project on acute stroke was carried out in all acute care hospitals in Israel during 2004, 2007 and 2010 (2-month each).

Asymptomatic carotid stenosis: intervention or just stick to medical therapy--the case for medical therapy.

Asymptomatic significant (≥50%) carotid stenosis (ASCS) is a frequent finding in the aging population. The prevalence of moderate stenosis (50-70%) increases from 3.6% for those <70 years to 9.

10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial.

Background: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA.

Methods: Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3-2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6-11).

[Guideliness for the management of stroke--2008 invasive measures for prevention of ischemic stroke].

Stroke is a major cause of morbidity and mortality in Israel and the main cause for neurological disability among adults. Continued efforts for its prevention and treatment began a long time ago and currently persist. During the last decade, these efforts have resulted in a number of significant breakthroughs.

[Guidelines for the management of stroke--2007 prevention of ischemic stroke--general approach and medical treatment].

Stroke is a major cause of morbidity and mortality in Israel, the third most common cause of death and the main cause for neurological disability among adults. During the last decade several significant breakthroughs have occurred in the management of stroke and consequently several new guidelines and consensus statements from Europe and North America have been published. The new data necessitate a reappraisal of our approach to the management of stroke as well as to its primary prevention.

Stroke in congenital heart disease and patent foramen ovale.

Congenital heart disease is usually regarded as an esoteric field of medicine, dealt with primarily by dedicated specialists. However, over the last two decades, increased attention has been given by the medical profession, the media and the general public to the possible association between a minor and common congenital heart defect, namely patent foramen ovale, and stroke. In recent months, unusual and unfortunate circumstances have made this topic one of the most fiercely debated medical issues in Israel.

[Guidelines for the management of acute stroke--2005].

Stroke is a major cause for morbidity and mortality in Israel, the third most common cause of death and the main cause for neurological disability among adults. Several significant breakthroughs occurred over recent years in the management of stroke, and acute stroke has increasingly been recognized as a medical emergency--a "brain attack" comparable to a "heart attack". Several new scientific publications, guidelines and consensus statements from Europe and North America necessitate a paradigm shift in the management of acute stroke.

The relationship between mean flow velocity and functional and neurologic parameters of ischemic stroke patients undergoing rehabilitation.

Objective: To investigate the correlation between mean flow velocity (MFV) as measured by transcranial Doppler ultrasonography (TCD) and functional and neurologic impairment during inpatient rehabilitation after acute stroke.

Design: Prospective study comparing results of rehabilitation in patients with different TCD findings.

Setting: Acute neurologic rehabilitation department.

[Hyperperfusion syndrome].

Hyperperfusion syndrome (HPS) is a neurological syndrome, which consists of a triad of unilateral headache, seizures and focal neurological deficits. In its extreme form it can present as an intracerebral hemorrhage. Originally HPS was described in patients undergoing carotid endarterectomies for severe carotid stenosis but, more recently, it was also described following other means of cerebral revascularization such as stent-assisted angioplasty.

PET-CT imaging of combined brachial and lumbosacral neurolymphomatosis.

Neurolymphomatosis is a rare manifestation of progressive non-Hodgkin's lymphoma. A 44-yr-old man with diffuse large B-cell lymphoma presented with unilateral progressive peripheral sensorimotor neuropathy after the 7th cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. No pathology in the nervous system was evident by computerized tomography (CT), magnetic resonance imaging (MRI) of the head, spinal axis and plexuses and by repeated analysis of cerebrospinal fluid.

Development and progression of leukoaraiosis in patients with brain ischemia and carotid artery disease.

Background And Purpose: Leukoaraiosis (LA) or the presence of white matter changes, a frequent finding on brain CT scans of elderly individuals, is a risk factor for stroke and vascular death. The aim of the study was to seek development and progression of LA and associated risk factors in patients with symptomatic carotid artery disease.

Methods: Presence and extent of LA were determined on entry and follow-up CT scans from 685 patients in the North American Symptomatic Carotid Endarterectomy Trial.