Stroke care in Armenia: Recent developments.

Introduction: Armenia is an upper-middle-income country with a population of nearly 3 million. Stroke is one of its major public health problems and ranks as the sixth leading cause of death, with a mortality of 75.5 per 100,000.

Chronic Kidney Disease as Risk Factor for Enlarged Perivascular Spaces in Patients With Stroke and Relation to Racial Group.

Background And Purpose: Enlarged perivascular spaces (EPVS) are considered subclinical markers of small vessel disease, associated with increased risk of stroke and dementia. Increasing evidence links chronic kidney disease (CKD) to small vessel disease. We explored the relationship between CKD and EPVS burden and the influence of racial group in this relation.

Direct Visualization of Arterial Emboli in Moyamoya Syndrome.

Background: Hemodynamic insufficiency is often considered the cause of ischemic stroke in patients with moyamoya syndrome. While high-intensity transient signals (HITS) on transcranial Doppler (TCD) have been reported in this population, the relationship between these signals and ischemic symptoms is not clearly established. Accordingly, current treatment is directed at improving perfusion.

High Prevalence of Cerebral Microbleeds in Inner City Young Stroke Patients.

Background: Data on cerebral microbleeds (CMBs) in younger populations are lacking, particularly in young stroke patients. We sought to characterize CMBs in an inner city cohort of young adults with stroke.

Methods: CMB presence, count, and topography were assessed on magnetic resonance imaging (MRI) scans of 104 young stroke patients (≤49 years) presenting to Boston Medical Center between January 2006 and February 2010.

Larger A1/M1 diameter ratio predicts embolic anterior cerebral artery territorial stroke.

Background And Purpose: In contrast to middle cerebral artery territory strokes, anterior cerebral artery strokes (ACAS) occur rarely. The low frequency of ACAS, in relation to middle cerebral artery territory strokes, may be explained by differences in ACA and middle cerebral artery anatomy influencing their respective flow-directed embolism rates. We aimed to determine whether variability in ACA anatomy, and in particular A1 segment diameter, is associated with embolic ACAS.

Intra-arterial treatment methods in acute stroke therapy.

Acute revascularization is associated with improved outcomes in ischemic stroke patients. It is unclear which method of intra-arterial intervention, if any, is ideal. Promising approaches in acute stroke treatment are likely a combination of intravenous and endovascular revascularization efforts, combining early treatment initiation with direct clot manipulation and/or PTA/stenting.

Acute stroke, catheter related venous thrombosis, and paradoxical cerebral embolism: report of two cases.

Background: Patent foramen ovale (PFO) has been associated with cryptogenic stroke, particularly in young adults. However, the source of particles leading to cerebral embolism remains frequently unknown despite comprehensive evaluation.

Objective: To report and comment on therapeutic options for 2 patients with acute ischemic strokes, PFO, and venous access related thrombosis, sources of paradoxical embolism, from Boston Medical Center stroke database.

Cerebral collateral circulation in carotid artery disease.

Carotid artery disease is common and increases the risk of stroke. However, there is wide variability on the severity of clinical manifestations of carotid disease, ranging from asymptomatic to fatal stroke. The collateral circulation has been recognized as an important aspect of cerebral circulation affecting the risk of stroke as well as other features of stroke presentation, such as stroke patterns in patients with carotid artery disease.

Microemboli are not associated with delirium after coronary artery bypass graft surgery.

Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery.

Balloon angioplasty of the A2 segment of the anterior cerebral artery for recurrent, symptomatic atherosclerotic disease.

Intracranial atherosclerotic disease accounts for 5-10% of ischemic strokes in the US. Lesions located in the anterior cerebral artery territory are infrequently reported. Patients in whom medical therapy fails are at a high risk for recurrent ischemic events, in which case intracranial angioplasty or stenting may be a reasonable therapy.

Cerebral hemodynamics during coronary artery bypass graft surgery: the effect of carotid stenosis.

Carotid stenosis is a frequent coexisting condition in patients undergoing coronary artery bypass graft (CABG) surgery. The impact of carotid stenosis on cerebral perfusion is not fully understood. The purpose of this study was to determine the impact of carotid stenosis on cerebral blood flow velocity in patients undergoing CABG.

Cerebral ischemic events associated with 'bubble study' for identification of right to left shunts.

Background And Purpose: Detection of an intracardiac shunt is frequently sought during the evaluation of patients with cryptogenic ischemic stroke and agitated saline intravenous injection, or "bubble study" (BS), is performed in most cases. We present the first attempt to identify the clinical features in patients who had cerebral ischemic events with BS.

Methods: Using a list serve established by the American Academy of Neurology, a member posted a question regarding the safety of BS in patients with patent foramen ovale.

Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review.

Background: Much attention in the literature has focused on the relationship between perioperative microemboli during cardiac and vascular surgery and postoperative cognitive decline. Transcranial Doppler ultrasonography (TCD) has been used to measure high-intensity transient signals (HITS), which represent microemboli during cardiac, vascular, and orthopedic surgery. The purpose of this study was to systematically examine the literature with respect to HITS and postoperative cognitive function.

Intracranial hemorrhage sparing meningioma in an anticoagulated patient.

Background And Purpose: The risk of intracerebral hemorrhage (ICH) in patients receiving antithrombotic therapy is well known. However, there is sparse literature regarding the risk of intracerebral hemorrhage in patients receiving warfarin, who have an intracranial meningioma.

Methods And Results: We report a case of a 66-year-old man who developed multifocal ICHs in the context of supratherapeutic anticoagulation.

Neuroprotection and stroke rehabilitation: modulation and enhancement of recovery.

Recent advances in research are modifying our view of recovery after nervous system damage. New findings are changing previously held concepts and providing promising avenues for treatment of patients after stroke. This review discusses mechanisms of neuronal injury after brain ischemia and the attempts to study neuroprotection options based on such mechanisms.

Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe.

Introduction: High intensity transient signals (HITS) have been reported to occur following perfusionist intervention during cardiac surgery. This study investigates the relationship of the syringe bore, injection rate, and HITS created.

Methods: Syringes (10 mL) with a male luer-lock connection (Large Bore) and Abboject 'jet syringes' with a 20 GA needle and male luer-lock connector (Small Bore) were filled with 10 mL of 0.

Atherosclerosis is associated with delirium after coronary artery bypass graft surgery.

Objectives: To investigate whether atherosclerosis of the ascending aorta, internal carotid arteries, and coronary arteries is predictive of postoperative delirium in subjects undergoing coronary artery bypass graft (CABG) surgery.

Design: Prospective cohort study.

Setting: Boston Veterans Affairs Healthcare System.

Influence of 17-beta-estradiol on cerebrovascular impedance during menstrual cycle in women.

Numerous experimental studies showed that estrogen alters diameters of cerebral arteries by modifying production of vasoactive substances. In this study, we address a question whether increased concentration of 17-beta-estradiol (E2) during a typical menstrual cycle of young, healthy women influences cerebrovascular impedance, as measured with Doppler pulsatility index (PI) in the common (CCA), internal (ICA), and external (ECA) carotid arteries using duplex Doppler sonography. PI was determined and correlated with plasma E2 concentration in 14 women (ages 23-25) throughout their menstrual cycle.

Symptomatic and asymptomatic retinal embolism have different mechanisms.

Purpose: To investigate differences between symptomatic and asymptomatic retinal embolism regarding the frequency and source of cerebral microemboli.

Methods: Thirty-seven patients with transient monocular blindness or retinal infarction and 27 patients (29 eyes) with asymptomatic retinal embolism were prospectively enrolled. Patients underwent a transcranial Doppler study and noninvasive imaging of the cervical internal carotid arteries (ICA).

Brain Embolism Monitoring with Transcranial Doppler Ultrasound.

Embolism is considered to be the main mechanism leading to brain infarction today; with the introduction of sophisticated neuroimaging tools, its impact is increasingly appreciated. Transcranial Doppler ultrasound allows noninvasive monitoring of in vivo embolism. Acute stroke, internal carotid artery stenosis, several cardiac conditions, internal carotid endarterectomy, and coronary artery bypass graft surgery have been extensively monitored.

Brain microembolism.

Purpose: To alert clinicians about the occurrence of a subtype of brain infarction, its suspected etiology, and its detection by specific neuroimaging techniques.

Methods: The article presents 5 nonconsecutive patients admitted to the stroke services of 2 tertiary care hospitals, who presented with acute or subacute symptoms suspicious, but at times atypical, of brain ischemia.

Findings: Each patient had evidence of 3 to > 20 small areas of recent brain infarction detected by diffusion-weighted imaging (DWI).

Echocardiographic findings of patients with retinal ischemia or embolism.

Background And Purpose: A potential source of emboli is not detected in more than 50% of patients with retinal arterial occlusive events. Echocardiographic studies are not always included in the diagnostic workup of these patients. The authors studied the diagnostic yield of transthoracic (TTE) and/or transesophageal (TEE) echocardiography in identifying potential sources of emboli in patients with retinal ischemia or embolism.