Inhibition of glycogen synthase kinase-3β enhances cognitive recovery after stroke: the role of TAK1.

Memory deficits are common among stroke survivors. Identifying neuroprotective agents that can prevent memory impairment or improve memory recovery is a vital area of research. Glycogen synthase kinase-3β (GSK-3β) is involved in several essential intracellular signaling pathways.

Amphetamine and other pharmacological agents in human and animal studies of recovery from stroke.

Neuromodulation with pharmacological agents, including drugs of abuse such as amphetamine, when paired with behavioral experience, has been shown to positively modify outcomes in animal models of stroke. A number of clinical studies have tested the efficacy of a variety of drugs to enhance recovery of language deficit post-stroke. The purpose of this paper is to: (1) present pertinent animal studies supporting the use of dextro-amphetamine sulfate (AMPH) to enhance recovery after experimental lesions with emphasis on the importance of learning dependent activity for lasting recovery; (2) briefly review neuropharmacological explorations in the treatment of aphasia; (3) present a pilot study in aphasia exploring a drug combination of AMPH and donepezil hydrochloride paired with behavioral treatment to facilitate recovery; and (4) conclude with comments regarding the role of adjunctive pharmacotherapy in the rehabilitation of aphasia, particularly AMPH.

Etiologic stroke subtypes: updated definition and efficient workup strategies.

Stroke affects approximately 16.9 million individuals per year worldwide and is the second leading cause of death. Stroke represents a family of related, but distinct subtypes.

Grading and interpretation of white matter hyperintensities using statistical maps.

Background And Purpose: We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke.

Methods: We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.

Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system.

Background And Purpose: Pathogenetic classification of intracerebral hemorrhage (ICH), using systems such as SMASH-U (structural vascular lesions, medication, cerebral amyloid angiopathy [CAA], systemic disease, hypertension, or undetermined), is important in predicting functional outcomes and mortality in patients with ICH. This study aimed to compare pathogenetic subtypes between the first and recurrent ICH.

Methods: This study obtained data related to 4578 consecutive acute patients with ICH from the National Taiwan University Hospital Stroke Registry during January 1995 to December 2013.

Sex differences in stroke: the contribution of coagulation.

Stroke is now the leading cause of adult disability in the United States. Women are disproportionately affected by stroke. Women increasingly outnumber men in the elderly population, the period of highest risk for stroke.

Social interaction plays a critical role in neurogenesis and recovery after stroke.

Stroke survivors often experience social isolation. Social interaction improves quality of life and decreases mortality after stroke. Male mice (20-25 g; C57BL/6N), all initially pair housed, were subjected to middle cerebral artery occlusion (MCAO).

Stroke treatment academic industry roundtable: research priorities in the assessment of neurothrombectomy devices.

Background And Purpose: The goal of the Stroke Treatment Academic Industry Roundtable (STAIR) meetings is to advance the development of stroke therapies. At STAIR VIII, consensus recommendations were developed for clinical trial strategies to demonstrate the benefit of endovascular reperfusion therapies for acute ischemic stroke.

Summary Of Review: Prospects for success with forthcoming endovascular trials are robust, because new neurothrombectomy devices have superior reperfusion efficacy compared with earlier-generation interventions.

β-Blockers associated with no class-specific survival benefit in acute intracerebral hemorrhage.

Objectives: Despite the high mortality, there is currently no specific treatment for intracerebral hemorrhage (ICH). Research investigating optimum degree of blood pressure control in patients presenting with ICH and hypertension is ongoing. However, there is limited understanding of the potential benefits of specific classes of antihypertensive therapy.

Dysphagia as a predictor of outcome and transition to palliative care among middle cerebral artery ischemic stroke patients.

Background: Middle Cerebral Artery (MCA) territory strokes can be disabling and may leave patients unable to swallow safely. Decisions regarding artificial nutrition and goals of care often arise in patients with severe strokes leading to dysphagia. This study determined some predictors of early transition to palliative level of care among patients with acute ischemic MCA stroke with dysphagia.

Amphetamine and post-stroke rehabilitation: indications and controversies.

There is robust evidence for amphetamine (AMPH) facilitated recovery from behavioral deficits in animal models of stroke. Following experimental lesions, numerous studies of motor, somatosensory and vision recovery show AMPH accelerates the rate of recovery when paired with relevant behavioral experience. While the experimental literature continues to mount for an AMPH effect, the translation to clinical studies has been far less clear.

A trial of imaging selection and endovascular treatment for ischemic stroke.

Background: Whether brain imaging can identify patients who are most likely to benefit from therapies for acute ischemic stroke and whether endovascular thrombectomy improves clinical outcomes in such patients remains unclear.

Methods: In this study, we randomly assigned patients within 8 hours after the onset of large-vessel, anterior-circulation strokes to undergo mechanical embolectomy (Merci Retriever or Penumbra System) or receive standard care. All patients underwent pretreatment computed tomography or magnetic resonance imaging of the brain.

An unusual case of stroke.

New imaging techniques have allowed for the rapid and accurate diagnosis of stroke. In this case, we present a 58-year-old woman with multiple large vessel strokes on magnetic resonance imaging. The initial diagnostic workup centered on a rapidly progressive central nervous system vasculitis.

Early experience with community implementation of thrombolysis three to 4.5 hours after acute ischemic stroke.

Background: The therapeutic time window for IV thrombolytic treatment was recently extended at Hartford Hospital to 4.5-hours. We assessed the safety and efficacy of delayed thrombolysis.

Interventional stroke therapies in the elderly: are we helping?

Background And Purpose: It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed.

Materials And Methods: A retrospective review of patients with AIS 75 years or older (n = 37/1064) was compared with a younger cohort (n = 70/1190) by using an established data base.

Time is brain--quantified.

Background And Purpose: The phrase "time is brain" emphasizes that human nervous tissue is rapidly lost as stroke progresses and emergent evaluation and therapy are required. Recent advances in quantitative neurostereology and stroke neuroimaging permit calculation of just how much brain is lost per unit time in acute ischemic stroke.

Methods: Systematic literature-review identified consensus estimates of number of neurons, synapses, and myelinated fibers in the human forebrain; volume of large vessel, supratentorial ischemic stroke; and interval from onset to completion of large vessel, supratentorial ischemic stroke.

Adequacy of simple measures for characterizing impairment in upper limb strength following stroke.

Simple measures are sometimes used to characterize weakness in the upper limb after stroke, but their reliability and validity remain uncertain. Here, we examined the adequacy of three measures relative to dynamometer measurements of 26 patients (15 women and 11 men, M age=70.1 +/- 11.

Neuromodulation paired with learning dependent practice to enhance post stroke recovery?

Over the past two decades, experimental studies following brain injury have shown that the central nervous system is dynamic and malleable to internal and external inputs. Neuromodulation and/or direct manipulation of motor and sensory experience can modify brain plasticity and functional outcome after experimental lesions. Specifically, pharmacologic modulation has been found to facilitate recovery of various behavioral deficits following occlusive injury.

Expanding the range of therapies for acute ischemic stroke: the early experience of the Regional Stroke Center at Hartford Hospital.

Purpose: Three to four percent of all patients with acute ischemic stroke (AIS) receive the only FDA-approved therapy, intravenous tissue plasminogen activator. We sought to assess the impact of a regional stroke program, the Stroke Center at Hartford Hospital, in facilitating various therapies for patients with AIS, and their early outcomes.

Methods: For a 34-month period (May 2001 to February, 2004), 113 patients received either i.

Poststroke seizures.

Stroke is the most common cause of seizures in the elderly, and seizures are among the most common neurologic sequelae of stroke. About 10% of all stroke patients experience seizures, from stroke onset until several years later. This review discusses current understanding of the epidemiology, pathogenesis, classification, clinical manifestations, diagnostic studies, differential diagnosis, and management issues of seizures associated with various cerebrovascular lesions, with a focus on anticonvulsant use in the elderly.