Spotlight on Stroke therapy

Stroke treatment is an emergency, and options for treatment have increased since the FDA approval of intravenous t-PA use in acute ischemic stroke in 1996. In this recently updated article, Dr. Carolyn Brockington, Director of the Stroke Center at St. Luke’s-Roosevelt Hospital, provides information about the scientific basis and adverse effects of acute stroke as well as prevention strategies and treatment guidelines. Also discussed is the use of combination antiplatelet therapy in patients with minor stroke or transient ischemic attack and the latest on blood pressure management in the setting of intracerebral hemorrhage.

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Spotlight on MELAS

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a multisystem disorder characterized by: (1) stroke-like episodes, typically before age 40 years; (2) encephalopathy, characterized by seizures, dementia, or both; and (3) evidence of a mitochondrial myopathy with lactic acidosis, ragged-red fibers, or both.

Although at least 30 distinct mitochondrial DNA mutations have been associated with MELAS, about 80% of patients have the m.3243A>G tRNALeu(UUR) gene mutation. One study has suggested that screening urinary epithelial cells for the m.3243A>G mutation may be the most sensitive non-invasive diagnostic test for MELAS.

In this article, Dr. Thomas Klopstock of Ludwig Maximilian University of Munich discusses the clinical manifestations, pathogenesis, and diagnosis of this multisystem disorder. He puts particular emphasis on work showing (1) that the m.3243A>G mutation may sometimes arise “de novo”; (2) that there is nitric oxide deficiency in MELAS underpinning the current recommendations of arginine supplementation in the treatment and prophylaxis of stroke-like episodes; and (3) that the advent of mitochondrial replacement technologies may enable affected women to have a genetically-related child with a greatly reduced risk of mtDNA disease in the near future.

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Spotlight on Pregnancy and stroke

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality. In this article, Dr. Adrian Marchidann of SUNY Health Science Center discusses the etiologies of pregnancy-specific ischemic and hemorrhagic strokes, diagnostic approaches, and therapeutic challenges. The updated article includes the revised definition of preeclampsia and the recommendations for its treatment; new data on the risk of hemorrhage of cavernous hemangioma, arteriovenous malformation, and aneurysm; and the recommendations for antiplatelet and anticoagulation management for secondary stroke prevention during pregnancy and puerperium.

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Spotlight on Affective disorders in neurologic disease

In this article, Dr. Sergio Starkstein of the University of Western Australia and Dr. Jaime Pahissa of the Instituto Universitario CEMIC review the frequency, diagnostic strategies, clinical correlates, mechanism, differential diagnoses, and management of affective disorders in frequent acute and chronic neurologic disorders, such as stroke, traumatic brain injury, dementia, Parkinson disease, Huntington disease, multiple sclerosis, and epilepsy. Studies using sophisticated neuroimaging techniques have provided important clues regarding the mechanism of depression and disinhibition in neurologic conditions. Randomized clinical trials have been reported for depression in stroke, Parkinson disease, and Alzheimer disease as well as for the prevention of depression after stroke.

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Spotlight on Sleep and stroke

It may be difficult to differentiate the sleepiness and other symptoms associated with obstructive sleep apnea from such acute manifestations of cerebrovascular disease as lethargy, apathy, and neglect, particularly with strokes in specific locations, such as bilateral paramedian thalamic infarctions. The spouse of a stroke victim may describe a lack of energy, falling asleep during activities, and fatigue. Additional questioning may elicit a history of snoring (with repetitive respiratory interruptions), restless sleep, nonrestorative sleep, and weight gain prior to or following the stroke.

In this article, Dr. Antonio Culebras of SUNY Upstate Medical University highlights the importance of obstructive sleep apnea as a risk factor for stroke. Rehabilitation and recovery 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.

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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. Dr. Murray Flaster and colleagues from the Stritch School of Medicine at Loyola University of Chicago provide an overview of the current literature, including the most recent guidelines from the American Stroke Association.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

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, like hemorrhagic conversion or cerebral edema, account for the majority of deaths within the first week, but other medical complications that include cardiac causes (arrhythmias, myocardial infarction), infections (pneumonia, urosepsis), and venous thromboembolism account for at least 50% of mortality thereafter. In this clinical summary, Dr. Adrian Marchidann of SUNY Downstate Health Science Center discusses the medical complications of stroke-related deficits, their workup, and treatment modalities. Venous thromboembolism care information was updated according to the 9th edition of the American College of Chest Physicians guidelines.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Sleep and stroke

In this clinical summary, Dr. Culebras of SUNY Upstate Medical University and the Sleep Center at Upstate University Hospital in Syracuse, New York highlights the importance of obstructive sleep apnea as a risk factor for stroke. Rehabilitation and recovery 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.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Aortic atherosclerosis and stroke

Aortic atheroma is an important risk factor for ischemic stroke. In particular, large and complex aortic arch atheroma has been associated with an increased risk of ischemic stroke. The optimal treatment of patients with aortic arch atheroma is still uncertain and is the subject of ongoing clinical trials. In this review, Dr. Brian Silver of the Warren Alpert Medical School of Brown University reviews the current knowledge regarding aortic arch atherosclerosis and treatment options.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Pregnancy and stroke

Stroke during pregnancy is an uncommon but serious cause of morbidity and mortality among women of childbearing age. In this review, we discuss the etiologies of pregnancy-specific ischemic and hemorrhagic strokes, diagnostic approaches, and therapeutic challenges. The clinical summary has been updated by Dr. Adrian Marchidann of SUNY Downstate Health Science Center in Brooklyn, New York. The most important additions to this update are clarification of the relationship between preeclampsia-related stroke and posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome and hemolysis, and elevated liver enzymes and low platelet syndrome. In addition, the acute treatment of intracerebral hemorrhage and ischemic stroke were updated in light of recently published guidelines and interventional trials.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

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