Stroke

• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Rehabilitation
• Risk Factors
• Risk Reduction
• Treatment - Daily Report

Treatment is updated daily with the most recent articles listed on top.
To view only the last month's articles for the other sub-topics, go to our Monthly Online Newsletters page

If you have any questions regarding our Search Reports, please contact us at info@infomedsearch.com.

REVIEW our Selected Stroke Articles in 2006. Stay informed and updated!

Stroke

NIH - Medical Encyclopedia: Stroke

"The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began."

Highlighted Article

Transient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005)

"Transient ischemic attack (TIA) and ischemic stroke are both characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but they are distinguished by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours and stroke reserved for symptoms of longer duration. ... The short-term risk of ischemic stroke after TIA is very high ..."

Visit InfoMedSearch's Home Page for all InfoMedLinks Cardiovascular Topics: Atherosclerosis, Atrial Fibrillation, Coronary Artery Disease, Cholesterol - Lipids, General Cardiovascular, Heart Failure, Hypertension, Myocardial Infarction (Heart Attack), Peripheral Artery Disease, and Stroke.

Continue your InfoMedSearch research with our previous InfoMedLinks. Start with InfoMedLinks 2006.

Searching for more specific information related to your condition? InfoMedSearch researchers can search and provide you with a custom report. We can also keep you updated. Great Price! Check out our Search Services page. Use our experience to find the important medical information you need. Help protect you and your family's health.

Stroke

General Information

NEWS:

Heavily calcified carotid plaque reduces stroke risk "In current clinical practice, physicians look at the percent blockage in the carotid artery to identify candidates for plaque clearing surgery to prevent stroke. The new findings suggest that calcification percentages should also be considered, Kramer said. The study has potential implications for the management of asymptomatic carotid stenosis. Given the serious risks of surgical and endovascular intervention, a noninvasive method of determining which patients are at decreased risk and potentially amenable to medical therapy is critical. The degree of calcification within the plaque causing stenosis may be an important marker for patients who could potentially be treated less aggressively. "

Lost Chances for Survival, Before and After Stroke "Many patients with stroke symptoms are examined by emergency room doctors who are uncomfortable deciding whether the patient is really having a stroke — a blockage or rupture of a blood vessel in the brain that injures or kills brain cells — or is suffering from another condition. Doctors are therefore reluctant to give the only drug shown to make a real difference, tPA, or tissue plasminogen activator. Many hospitals say they cannot afford to have neurologists on call to diagnose strokes, and cannot afford to have M.R.I. scanners, the most accurate way to diagnose strokes, for the emergency room. Although tPA was shown in 1996 to save lives and prevent brain damage, and although the drug could help half of all stroke patients, only 3 percent to 4 percent receive it. Most patients, denying or failing to appreciate their symptoms, wait too long to seek help — tPA must be given within three hours. And even when patients call 911 promptly, most hospitals, often uncertain about stroke diagnoses, do not provide the drug. "

Pneumonia Most Common Reason for Readmission After Stroke "A retrospective study shows that fewer than 15% of stroke patients survive without hospital readmission during the next 5 years; pneumonia and respiratory illness were the top reasons for readmission, followed by myocardial infarction and recurrent stroke."

Should Stroke Be Considered Both a Brain Attack and a Heart Attack?

Stroke risk high for siblings of stroke patients "Brothers and sisters of people who have had a stroke are nearly twice as likely as the average American to experience a stroke themselves, according to observational data reported at the American Academy of Neurology's annual meeting in Boston on Wednesday. … Among Mexican Americans as a group, the stroke risk ratio was 2-fold higher than expected. This was due to a 2.6-fold higher risk in siblings of Mexican-American men."

Stroke: Where Does Your State Rank?

TIA Linked to Substantial Risk for Major Stroke Within a Week "New research suggests that patients who experience a transient ischemic attack (TIA) are at a substantially increased risk of having a major stroke within 1 week — a finding that, researchers say, warrants treating TIA as a medical emergency."

'Whispering Stroke' Can Cause Lasting Damage "A surprisingly high number of Americans may suffer "whispering" strokes -- attacks whose symptoms are so mild that they often go ignored but can nevertheless cause physical and mental harm, a new study finds. … 'Clearly, the reason they are emphasizing this finding is to get the word out that if people have symptoms like these, they just shouldn't ignore it,' Roach said. 'The first big message here is for individual people to seek treatment. The second message is for all of us as physicians to pay attention and not dismiss it when people come in to report these symptoms.' "

ARTICLES:

From Sea to Shining Sea: What Is It About Where You Live and Your Stroke Risk? "Despite clear documentation that the "Stroke Belt" has existed for more than 60 years, we know remarkably little regarding the underlying causes. … mortality data that document the existence of the Stroke Belt, traditionally defined as the 8-state region (North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, and Louisiana) within the Southeast that has stroke mortality approximately 30% to 40% higher than the rest of the United States.8"

Let's Talk About Stroke

NIH - Stroke Fact Sheet

Transient Neurological Attacks

JOURNAL ARTICLES:

A midlife stroke surge among women in the United States. (Neurology. 2007)

Autopsy Prevalence of Coronary Atherosclerosis in Patients With Fatal Stroke. (Stroke. 2007) "CONCLUSIONS: Coronary atherosclerosis and MI are highly prevalent in patients who died from a stroke regardless of the etiology. They are more frequent when atherosclerosis is present in the carotid and cerebral arteries. They are also common in stroke patients with no evidence of carotid or cerebral atherosclerosis."

Cognitive Disorders in Acute Stroke: Prevalence and Clinical Determinants (Cerebrovascular Diseases 2007) "Conclusions:Cognitive impairment is common in the first weeks after stroke, with executive and perceptual disorders being the most frequent. Intracerebral haemorrhage, cortical involvement of the lesion and premorbid moderate alcohol consumption are independently associated with acute cognitive impairment."

Does sleep protect against ischemic stroke? less frequent ischemic strokes but more severe ones. (J Neurol. 2007) "BACKGROUND AND OBJECTIVE: Stroke occurrence follows a circadian curve, with a higher frequency in the morning. This curve changes if the hours of sleep also change. Our aim was to evaluate the characteristics, risk factors, and prognosis associated with sleep stroke. … CONCLUSIONS: Whilst sleep could be associated with a lesser stroke occurrence, it could also be associated with a higher severity. Obesity appears as a factor related to SS whilst AF appears related to WS."

Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. (J Clin Neurosci. 2007)

Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. (Vasc Health Risk Manag. 2007) "Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD."

Geographic Patterns in Overall and Specific Cardiovascular Disease Incidence in Apparently Healthy Men in the United States (Stroke 2007) "Conclusions— In this homogenous and well-characterized cohort of US male physicians, we found greater incidence of ischemic stroke, but not other vascular events among those living in the Southeastern US, compared with other regions."

Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality. Ten-Year Follow-Up of Ischemic Strokes in the Copenhagen Stroke Study. (Stroke. 2007) "BACKGROUND AND PURPOSE: Evidence of a causal relation between serum cholesterol and stroke is inconsistent. We investigated the relation between total serum cholesterol and both stroke severity and poststroke mortality to test the hypothesis that hypercholesterolemia is primarily associated with minor stroke. … CONCLUSIONS: The results of our study support the hypothesis that a higher cholesterol level favors development of minor strokes. Because of selection, therefore, major strokes are more often seen in patients with lower cholesterol levels. Poststroke mortality, therefore, is inversely related to cholesterol."

High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: A systematic review. (Atherosclerosis. 2007) "BACKGROUND AND PURPOSE: Epidemiological studies have found no relationship between total cholesterol and stroke risk, but little attention has been paid to high-density lipoprotein-cholesterol (HDL-C). … CONCLUSIONS: The weight of evidence in the literature supports an inverse association between HDL-C level and stroke or carotid atherosclerosis, but more data are needed to firmly establish this protective effect."

Improved Survival after Stroke: Is Admission to Hospital the Major Explanation? Trend Analyses of the Auckland Regional Community Stroke Studies (Cerebrovascular Diseases 2007) "Conclusions: These data show significant downwards trends in case fatality after stroke in Auckland over 20 years, which can largely be attributed to improved stroke care associated with increases in hospital admission and brain imaging during the acute phase of the illness."

Incidence and Prognosis of Transient Neurological Attacks (JAMA. 2007) “Context Transient neurological attacks (TNAs) are attacks with temporary (<24 hours) neurological symptoms. These symptoms can be focal, nonfocal, or a mixture of both. The prognostic significance of TNAs with focal symptoms (better known as transient ischemic attacks [TIAs]) is well understood. Conversely, hardly anything is known about the prognostic significance of TNAs with nonfocal or mixed symptoms. … Conclusion Patients who experience nonfocal TNAs, and especially those with mixed TNAs, have a higher risk of major vascular diseases and dementia than persons without TNA.”

Infection After Acute Ischemic Stroke. A Manifestation of Brain-Induced Immunodepression. (Stroke. 2007) "Summary of Review--Many patients develop infections shortly after acute stroke regardless of optimal management. Mortality is higher in these patients and the severity of stroke is the strongest determinant of the infectious risk. However, it is controversial whether infections promote neurological worsening or alternatively represent a marker of severe disease."

Infection after acute stroke is associated with poor short-term outcome. (Acta Neurol Scand. 2007) "Conclusions - Post-stroke infection can affect patients admitted with TIA as well as acute stroke, and it may be associated with poor short-term outcomes."

Intracerebral haemorrhage: an often neglected medical emergency. (Intern Emerg Med. 2007)

Is the ‘Stroke Belt’ Worn From Childhood?. Risk of First Stroke and State of Residence in Childhood and Adulthood (Stroke 2007)

[Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients.] (Med Clin (Barc). 2007) "PATIENTS AND METHOD: We validated the ABCD score (age >= 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes >= 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. … CONCLUSIONS: Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies."

Lancet Neurology Series Highlights Worldwide Stroke Epidemic "The world is facing a major stroke epidemic, the bulk of which is occurring in developing countries and threatening to overwhelm the health resources of these low- to middle-income nations. A series of 5 review articles on the global incidence, prevalence, and burden of stroke, published online February 7 in Lancet Neurology, point out that internationally, almost 90% of all strokes occur in low- or middle-income countries."

Morbidity and mortality among elderly americans with different stroke subtypes. (Adv Ther. 2007)

Outcomes after first-ever stroke. (Hong Kong Med J. 2007) "RESULTS. The mortality rate was 15.1% at 30 days, 22.5% at 1 year, and 39.7% at 5 years from the onset of the first-ever stroke. The rate of stroke recurrence was 0.9% at 30 days, 7.0% at 1 year, and 21.2% at 5 years from the onset of first-ever stroke. Among patients presenting with ischaemic strokes, 109 (20.6%) had a recurrence, of which 92 (84%) were ischaemic strokes and 17 (16%) were haemorrhagic. Among patients presenting with intracerebral haemorrhage, 25 (23.1%) had a recurrence, of which 12 (48%) were haemorrhagic strokes and 13 (52%) patients were ischaemic. After 5 years, 11% of the patients were dependent in terms of activity of daily living. CONCLUSIONS. The long-term prognosis after first-ever stroke is poor--5 years after their stroke, 39.7% of patients had died and 10.7% were dependent in terms of activity of daily living; 136 (21%) who survived at least 30 days after the initial stroke, had a recurrence within 5 years."

Prevention of recurrent ischemic stroke. (Am Fam Physician. 2007)

[Prognostic factors of functional recovery in very elderly stroke patients. A one-year follow-up study.] (Rev Neurol. 2007)

Rates of Depression at 3 and 15 Months Poststroke and Their Relationship With Cognitive Decline: the Sydney Stroke Study. (Am J Geriatr Psychiatry. 2007)

Readmission and Death After Hospitalization for Acute Ischemic Stroke (Stroke. 2007) "Conclusions— Few stroke patients survive for 5 years without a hospital readmission. Between the acute care setting and readmission to the hospital, a window of opportunity may exist for interventions, beyond prevention of recurrent vascular events alone, to reduce the huge public health burden of poststroke morbidity."

Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis. (Circulation. 2007) "CONCLUSIONS: In patients with intracranial stenosis, higher blood pressure is associated with increased (not decreased) risk of ischemic stroke and stroke in the territory of the stenotic vessel. These findings argue strongly against the common clinical practice of maintaining high blood pressure in patients with intracranial stenosis."

Risk of ischemic stroke and lifetime estrogen exposure. (Neurology. 2007) "CONCLUSIONS: Longer lifetime exposure to ovarian estrogens may protect against noncardioembolic ischemic stroke. However, a very early age of exposure onset could be disadvantageous."

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke (Stroke. 2007)

Shoulder Pain After Stroke (Stroke. 2007) "Conclusion— Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate– severe pain. Shoulder pain restricts patients’ daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care."

Silent brain infarcts: a systematic review. (Lancet Neurol. 2007) "In this systematic review, we give an overview of the frequency, causes, and consequences of MRI-defined silent brain infarcts, which are detected in 20% of healthy elderly people and up to 50% of patients in selected series. Most infarcts are lacunes, of which hypertensive small-vessel disease is thought to be the main cause. Although silent infarcts, by definition, lack clinically overt stroke-like symptoms, they are associated with subtle deficits in physical and cognitive function that commonly go unnoticed. Moreover, the presence of silent infarcts more than doubles the risk of subsequent stroke and dementia."

Stroke Symptoms in Individuals Reporting No Prior Stroke or Transient Ischemic Attack Are Associated With a Decrease in Indices of Mental and Physical Functioning (Stroke 2007) "Conclusions—Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called "silent stroke," there appear to be many individuals with possibly symptomatic cerebrovascular disease—either stroke or transient ischemic attack—who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign."

Subarachnoid haemorrhage. (Lancet. 2007) " Subarachnoid haemorrhage accounts for only 5% of strokes, but occurs at a fairly young age. Sudden headache is the cardinal feature, but patients might not report the mode of onset. CT brain scanning is normal in most patients with sudden headache, but to exclude subarachnoid haemorrhage or other serious disorders, a carefully planned lumbar puncture is also needed. Aneurysms are the cause of subarachnoid haemorrhage in 85% of cases. The case fatality after aneurysmal haemorrhage is 50%; one in eight patients with subarachnoid haemorrhage dies outside hospital. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysm."

The ABCD, California, and unified ABCD2 risk scores predicted stroke within 2, 7, and 90 days after TIA (Evidence-Based Medicine 2007)

The association of post-stroke neurological improvement with risk of subsequent deterioration due to stroke events. (Eur J Neurol. 2007) " This study confirms the association between recovery and subsequent neurological deterioration and is the first to indicate the greater importance of acute recovery at day 1 in comparison with later recovery."

The prevalence and determinants of subclinical brain infarction. The Northern Manhattan Study. (Neurology. 2007) "CONCLUSIONS: SBI were detected in nearly 18% of subjects in a multiethnic community-based cohort. Age, male sex, and hypertension were independently associated with SBI. Subclinical cerebral infarcts are more prevalent than symptomatic infarcts and may increase the true public health burden of stroke."

The risk of recurrent stroke after intracerebral haemorrhage. (J Neurol Neurosurg Psychiatry. 2007)

The Time Course and Determinants of Temperature within the First 48 h after Ischaemic Stroke. (Cerebrovasc Dis. 2007) "Conclusions: Temperature spontaneously rises during the first 36 h after stroke, particularly after severer stroke and in the presence of infection."

Urinary Incontinence After Stroke. Identification, Assessment, and Intervention by Rehabilitation Professionals in Canada. (Stroke. 2007)

Why identification of stroke syndromes is still important. (Curr Opin Neurol. 2007) "PURPOSE OF REVIEW: Recent trends in the practice of stroke neurology lay a strong and excessive reliance on data generated from large epidemiological and clinical trials to direct patient care. This article highlights some of the pitfalls of this approach. It discusses the continuing importance of identifying stroke syndromes in implementing individualized patient care. RECENT FINDINGS: Stroke is a heterogeneous disease and occurs through a variety of mechanisms. With the help of examples, the article illustrates some of the complexities of clinical decision making in an individual patient."

Go to the top