Spotlight on Anterior cerebral artery stroke syndromes

Contralateral monoplegia with mild upper-extremity involvement is an unusual condition classically described as occurring when ischemia involves the anterior cerebral artery territory. A broad spectrum of complex cognitive, behavioral, and emotional disorders accompanied by other patterns of motor and sensory deficits may also be observed in the setting of infarcts in this territory or its branches.

In this article, Dr. Jorge Moncayo-Gaete of the International University of Ecuador and Dr. Julien Bogousslavsky of the Genolier Swiss Medical Network provide a comprehensive description of the clinical manifestations, topographical distribution, etiology, and outcome of anterior cerebral artery stroke.

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Spotlight on Stroke: Supportive care

Acute ischemic stroke accounts for more than half of the hospitalizations for neurologic disease. Meticulous, aggressive supportive care for the acute stroke patient is imperative in order to achieve the best possible outcome and to avoid the many medical complications that frequently follow stroke.

In this article, Dr. Chawla of Loyola University Medical Center and Chief of Neurology at Hines VA Hospital provides an overview of the current literature, including the most recent guidelines from the American Stroke Association.

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Spotlight on Neuroimaging in acute stroke

Rapid diagnosis of acute ischemic stroke has become exceedingly important given modern stroke therapies and is highly dependent on neuroimaging findings. Neuroimaging directly guides treatment of acute stroke patients by identifying appropriate candidates for acute therapies and informing the workup of stroke etiology.

In this article, Dr. Jason Tarpley and Dr. George Teitelbaum of Pacific Neuroscience Institute Providence Southern California as well as Dr. Steven Levine of the SUNY Health Science Center at Brooklyn provide an update on the use of neuroimaging in the diagnosis and management of the acute ischemic stroke patient.

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Spotlight on Pregnancy and stroke

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality. In this review, Dr. Adrian Marchidann of SUNY Stony Brook University Hospital discusses the etiologies, diagnostic approaches, and therapeutic challenges of pregnancy-specific ischemic and hemorrhagic strokes. This updated article includes revised epidemiologic data, the potential mechanism of preeclampsia, peripartum infection as a risk factor for stroke, moyamoya disease in pregnancy, and the treatment of antiphospholipid syndrome.

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Spotlight on Medical complications of stroke

Medical complications following stroke account for significant morbidity and mortality. These clinical conditions need to be recognized and managed effectively for a more favorable outcome. Direct effects of ischemic stroke account for most deaths within the first week. Other medical complications that include cardiac abnormalities, infections, and venous thromboembolism increase mortality thereafter. These clinical conditions need to be recognized and managed effectively for a more favorable outcome.

In this article, Dr. Adrian Marchidann of SUNY Stony Brook University Hospital discusses the medical complications of stroke-related deficits, their workup, and treatment modalities.

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Spotlight on Sleep, stroke, and vascular dementia

In this article, Dr. Antonio Culebras of SUNY Upstate Medical University at Syracuse highlights the importance of obstructive sleep apnea as a risk factor for stroke and vascular dementia. Rehabilitation and recovery of stroke are less successful in the presence of sleep apnea. Habitual short and long sleep durations, long-standing night shift work, and periodic leg movements of sleep negatively affect cerebrovascular morbidity and mortality. Vascular dementia may be a complication of uncontrolled sleep apnea with hypoxemia.

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Spotlight on Cerebellar infarction and cerebellar hemorrhage

Cerebellar infarct and hemorrhage account for about 2% of all strokes. Both conditions are critical neurologic disorders with potential catastrophic outcomes. They frequently present with headache, nausea and vomiting, dizziness, and a striking difficulty standing or walking. Their management often requires surgical intervention, and the prognosis is usually good when the intervention is performed before the patient becomes comatose.

In this article, Dr. Winnie Lau and Dr. J Dedrick Jordan of the University of North Carolina School of Medicine discuss the clinical presentations associated with the different vascular territories within the cerebellum, the potential to confuse its presentation with peripheral causes of vertigo, and the usefulness of the head thrust test to differentiate between peripheral and central causes of dizziness.

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Spotlight on Stroke therapy

The treatment of acute ischemic stroke is considered an emergency. The clock starts with the interruption of blood flow to the brain. The goal of each therapeutic intervention is to reestablish blood flow to viable brain tissue to reduce the degree of injury. Since the FDA approval of intravenous tPA for acute ischemic stroke in 1996, the options for treatment have increased considerably. Despite the advances, the key to good clinical outcomes remains the same: rapid identification of patients coupled with fast assessment and treatment.

In this article, Dr. Carolyn Brockington, Director of the Stroke Center at Mount Sinai St. Luke’s and Mount Sinai Hospital, provides the latest information on the treatment and management of acute ischemic stroke.

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Spotlight on Basilar artery stroke

Infarcts in the distribution of the basilar artery are perhaps the most feared and devastating of all ischemic strokes. However, an important minority of patients can have good outcomes, especially with time-sensitive treatment approaches. In this article, Dr. Sean Ruland, Dr. Jose Biller, Dr. Cara Joyce, and Dr. Camilo R Gomez, all of Stritch School of Medicine at Loyola University Chicago, review 4 distinct syndromes of basilar artery stroke, including proximal and middle basilar artery occlusions, top of the basilar artery syndrome, basilar artery branch occlusions, and dolichoectasia of the basilar artery.

Pertinent vertebral and basilar artery anatomy and physiology are discussed. Emerging assessment and treatment strategies for acute basilar artery occlusion and strategies for prevention of recurrent basilar artery stroke are reviewed, and potential causes of posterior circulation ischemic stroke are highlighted. Finally, pediatric ischemic stroke in the posterior circulation and intravenous thrombolytic use in children and during pregnancy are also discussed.

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Spotlight on Basal ganglia hemorrhage

Basal ganglia intracerebral hemorrhage remains among the most deadly of stroke types. Intracerebral hemorrhage in the basal ganglia is usually caused by hypertension. Patients presenting within the first few hours have a high risk of hemorrhage expansion and neurologic deterioration. Prognosis is based on multiple factors, including volume and location of hemorrhage, age, level of consciousness, presence of intraventricular hemorrhage, and warfarin use.

This update highlights some important clinical trial results on intracerebral hemorrhage, including blood pressure management and surgical interventions. Dr. Adrian Marchidann of SUNY Downstate Medical Center discusses these advances and updates on the epidemiology and pathophysiology of intracerebral hemorrhage.

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