The Massachusetts General Hospital acute stroke imaging algorithm: an experience and evidence based approach.
The Massachusetts General Hospital Neuroradiology Division employed an experience and evidence based approach to develop a neuroimaging algorithm to best select patients with severe ischemic strokes caused by anterior circulation occlusions (ACOs) for intravenous tissue plasminogen activator and endovascular treatment.
PRADAXA 150 mg twice daily provided an additional 35% risk reduction of stroke/systemic embolism vs warfarin
Additional 35% risk reduction of stroke/systemic embolism vs warfarin. Protect the brain by reducing the risk of ischemic stroke.
Learn more at pradaxapro.com
Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone.
In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-totreat analysis. Treatment differences were assessed with the use of a Cox proportional- hazards model, with study center as a random effect.
Stroke is a common, potentially devastating disease with potential high morbidity and mortality. Recognition at the onset of acute ischemic stroke is pivotal to changing outcomes such as intravenous thrombolysis. Stroke monitoring is a burgeoning field with various methods described and newer devices that aid in detecting acute or worsening ischemia that can lead to improved bedside and intensive care unit management. This article describes various methods of bedside stroke monitoring including newer techniques of intracranial pressure monitoring using the pressure reactivity index and compensatory reserve index to detect changes in autoregulatory states, noninvasive intracranial pressure monitoring, quantitative EEG with alpha–delta ratio, transcranial Doppler, methods of arteriovenous brain oxygen monitoring such as jugular venous oxygen and near-infrared spectroscopy, invasive brain oxygen probes such as LicoxTM (brain tissue O2), cerebral blood flow probe (CBF HemedexTM) and cerebral microdialysis.
Ischemic Stroke Guidelines released at the end of January 2013.
These guidelines were put together by an expert panel and touch on many aspects of acute stroke care, with a focus on ischemic stroke. The guidelines include dozens of recommendations. I am not going to talk about all of them today, but I would like to highlight some that are particularly important to treating clinicians.
First, the guidelines come out very strongly in favor of transporting patients with acute stroke to the nearest primary or comprehensive stroke center. This is a great idea because we know from numerous studies and analyses that care at these certified stroke centers really does make a difference in terms of improving outcomes and reducing complications. That is a very strong positive recommendation. In addition, the guidelines now say that these stroke centers should be certified by an independent body or agency, so we are moving away from the paradigm of self-certification [toward independent, objective certification], which is also a positive move.
The blood pressure–lowering and lipid effects of dark chocolate could be an effective — and money-saving — strategy for preventing cardiovascular events in high-risk patients, a new study suggests.
“The findings of this study suggest that the blood pressure lowering and lipid effects of plain dark chocolate could represent an effective and cost effective strategy for the prevention of cardiovascular disease in people with metabolic syndrome (and no diabetes),” the researchers, with senior author Christopher M. Reid, PhD, CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia, conclude. [Read more…]
