Questions discussed in this category
Which factors would influence your decision?
Do you favor specific medications or surgical interventions?
In light of the publication by Ganesh et al., PMID 39503052.
In light of the STOP-CAD study
Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...
It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...
Would having infarct expansion during hospitalization change your approach?
In patients who have decreased arousal after ischemic stroke, do you use amantadine or modafinil to aid with wakefulness and interaction with therapy ...
A large stroke in cortical regions might have a low NIHSS, while a small internal capsule lacune might have a large NIHSS. ICH risk is thought to be a...
Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.
In light of a recent publication by Sun et al., PMID 39235816 on the BASIS trial for balloon angioplasty for ICAS.
Would your approach differ through telemedicine for small ERs without access to onsite ophthalmology or neurology?
In light of the INSPIRES trial publication.
How would you adjust statin therapy in these patients?
In light of a publication by Sakusic et al., PMID 39102615 suggests an increased risk of ICH expansion in patients with heparin bridge compared to sta...
Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...
Would you adjust your approach based on the infarct size, symptom severity, or stroke etiology?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...
Would your management be different if the LVO was found on imaging without preceding associated symptoms?
Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...
If yes, if the assay shows they are a non-responder, do you switch to ticagrelor?
Considering the short half-life, at what point would it be deemed too late to administer any reversal agent, and to consider withholding it?
How do you guide what contraceptive type when asked by the medical team?
In light of ANNEXA-I RCT results: Connolly et al., PMID 38749032.
Are there specific mass features that would influence your treatment decision?
In light of TIMELESS and TRACE-III trials.
If so, what is the typical duration?
Would you consider using cilostazol instead of antiplatelets?
Does it influence your choice of antithrombotic therapy? Do you perform serial follow-up imaging?
In light of meta-analysis data showing favorable outcomes in this normally excluded subset of patients (Katsanos et al., PMID 37775318).
Is there management guidance on when to start after stroke onset?
When would you consider using anticoagulation and for how long?
Does your strategy change depending on whether or not it is a secured or unsecured aneurysmal SAH?
Does your approach differ if the stenosis is symptomatic or flow-limiting?
Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.
Is there any evidence supporting the use of heparin boluses?
The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...
In light of the evidence associating cerebral amyloid angiopathy (CAA) with subdural hemorrhage; Rivier et al., PMID 38147345.
If yes, is there a preference with MRI or CT technique?
We have seen 81 vs 162 vs 325 mg up to 1300 mg.
How about a distal occlusion? The patient was initially symptomatic but symptoms improved or mostly resolved.
While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...
This is not an infrequent finding in outpatient neurology practice, often in the absence of any lacunar disease in the typical regions, though I usual...
In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients.
In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.
Should MTCTA be standard for anyone with LKN>=6h?
What is the utility of it?
Current guidelines (AHA, ESO, etc.) are not clear. In addition, if a patient arrives with BP>240 how do you balance the risk of hypoperfusion with ...
Also how would you manage this perioperatively?
For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...
Would you anticoagulate if this screening is negative pending PFO closure?
The patient has no known history of autoimmune disease.
How does pravastatin differ in advantage from other high-intensity statins?
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...
Do all malignant posterior fossa infarcts need sub-occipital craniectomy or are there a subset of cases that can be managed with EVD?
For patients undergoing outpatient MR imaging for other indications who have instantly found acute stroke, do you typically recommend the patient be a...
Do you offer this person a vascular intervention (i.e., CEA or stenting)?
In what ways, if any, does the timing of perfusion imaging from onset of stroke symptoms affect its utility in informing quality of distal perfusion?
Do you order any imaging beforehand? Are there other studies that you order?
Do we prophylactically place patients on anticoagulation after one episode?
Besides MRI/MRV brain, are there other diagnostic imaging that should b...
Do you have a particular cutoff?
Do you ever recommend any specific sequences on MRA?
For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...
What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...
How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?
No thrombus detected on echocardiogram and no evidence of atrial fibrillation is present.
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...
What factors influence your thinking?
For what duration do you use therapy?
How does presence of intraventricular hemorrhage change your recommendations?
In what clinical scenario would you refer a patient for embolization? Are there any contraindications?
What is the best way to determine if patients with new PCA territory infarct can drive? Upon discharge from the hospital, do you routinely refer them ...
Thoughts on sarilumab vs methotrexate, or just treat with steroids alone
How would you treat patients with symptoms of AIS who have an allergic reaction to TPA with no evidence of large vessel occlusion on imaging? What nex...
For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...
For example, with a Watchman device? What is the evidence behind this?
If so, how do you decide when to restart anticoagulants?
When would you consider stenting or CEA even if there is less than 50 obstruction when no other etiology has been found?
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Papers discussed in this category
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The New England journal of medicine, 2014 Aug 21
Stroke, 2020 Aug 06
Neurology. Clinical practice, 2018-02
Stroke, 2015 May 28
Stroke, 2019-02
Stroke, 2011-04
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Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019-08
Stroke, 2021 Sep 14
Stroke, 2015-03
BMJ open, 2014-12-02
J Am Coll Cardiol,
Neurology, 2015-09-29
Stroke, 2017-08
Stroke, 2021 May 24
Lancet (London, England), 2014-01-25
Circulation, 2019-08-20
J Neurol, 2021 Jul 17
J Vasc Surg, 2019 Dec 31
The New England journal of medicine, 2012-05-17
The New England journal of medicine, 2018-10-04
The New England journal of medicine, 2019-05-16
Heart, 2019 Apr 08
N Engl J Med,
Lancet, 2016 Mar 04
Arthritis Rheum,
American heart journal, 2010-07
Lancet, 2021 Aug 27
Neurology, 2019 Jan 11
The New England journal of medicine, 2013-03-21
Neurology, 2013-08-13
The New England journal of medicine, 2017-09-14
Circ Cardiovasc Interv, 2022 Jun 23
JAMA, 2021 Dec 14
JAMA Neurol, 2020 Jul 01
JAMA Neurol, 2022 Nov 01
Neurology, 2015-10-13
JAMA,
eNeurologicalSci, 2017 Aug 02
Neurol Clin Pract,
J Am Heart Assoc, 2020 Nov 23
Am J Hematol,
Eur J Neurol, 2017 Aug 20
Stroke, 2016 Dec 20
Stroke, 2010 Oct 28
J Thromb Haemost, 2010 Apr 08
Lancet Neurol, 2021 Sep 03
The New England journal of medicine, 2018-07-19
N Engl J Med, 2013 Jun 26
N Engl J Med, 2021 Oct 28
N Engl J Med,
JAMA neurology, 2019-04-01
Lancet Neurol, 2019 May 23
JAMA Neurol,
Lancet Neurol, 2018 Jan 10
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Atherosclerosis, 2001-06
The American journal of clinical nutrition, 2008-10
Circulation. Cardiovascular genetics, 2008-12
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PeerJ, 2013
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Circulation, 2009-03-31
Cerebrovascular diseases (Basel, Switzerland), 2014
JAMA Neurol,
The New England journal of medicine, 2012-03-01
Neurocritical care, 2020 Aug
Neurocritical care, 2021 Feb
Stroke, 2017 Apr 12
The New England journal of medicine, 2011-12-01
The New England journal of medicine, 2018-11-29
Circulation, 2019 Nov 11
N Engl J Med, 2017 Mar 17
Stroke, 2020 Apr 21
Lancet, 2016 May 10
J Neurol Neurosurg Psychiatry, 2016 May 13
J Am Heart Assoc, 2021 Feb 15
Neurology, 2010 Sep 08
Arthritis and rheumatism, 2007-07
Stroke, 2014-07
Cochrane Database Syst Rev, 2020 Oct 12
Archives of internal medicine, 1997-10-13
Lupus, 2011-02
Annals of the rheumatic diseases, 2019-10
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Lupus,
J Autoimmun, 2018 Feb 13
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Blood Adv,
The New England journal of medicine, 2018-02-15
N Engl J Med, 2020 Mar 29
N Engl J Med, 2003 Jul 10
Stroke, 2013-10
Stroke, 2016-01
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019-08
Journal of the neurological sciences, 2019-08-15
JAMA, 2018-07-10
European stroke journal, 2017 Nov 29
Frontiers in neurology, 2021 Sep 07
Neuroradiology, 2020 Sep 08
N Engl J Med, 2005 Mar 31
Neurology, 2017-01-24
JAMA neurology, 2020 Aug 01
Stroke, 2023 Sep 07
Stroke, 2019-04
J Neurointerv Surg, 2020 Jun 19
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Stroke, 2017-02
J Clin Med, 2020 Mar 10
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JAMA Neurol, 2019 Dec 01
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Lancet, 2022 Oct 28
CJEM, 2017 Jun 09
Hemodialysis international. International Symposium on Home Hemodialysis, 2013 Oct
Circulation, 2023 Aug 27
Lancet (London, England), 2018-08-04
JAMA, 2023 Jun 27
Lancet (London, England), 2014-11-29
Stroke, 1997 Nov
The New England journal of medicine, 2023 Jan 04
The journal of prevention of Alzheimer's disease, 2023
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JAMA neurology, 2018-12-01
Stroke, 2015 Nov 03
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Radiology, 2016-06
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The New England journal of medicine, 2023 Feb 10
The New England journal of medicine, 2023 Feb 10
Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2007-01
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2010
Circulation, 2021 Apr 08
Journal of the American College of Cardiology, 2011 May 03
JAMA, 2014 Jul 16
JAMA surgery, 2022 Aug 10
JAMA neurology, 2022 Jan 01
Lancet (London, England), 2023 Mar 29
Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2020 Feb 10
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019 Oct 26
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2022 Apr 14
The Lancet. Neurology, 2021 Mar 17
The New England journal of medicine, 2024 May 16
JAMA, 2024 Mar 05
Stroke, 2024 May 15
JAMA, 2022 May 10
Stroke, 2024 Feb 09
JAMA neurology, 2019 Jun 01
The Lancet. Neurology, 2021 Mar 23
Stroke, 2024 Feb 01
JAMA neurology, 2021 Apr 01
Stroke, 2023 May 24
Stroke, 2024 Jan 29
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Stroke, 2007-12
The New England journal of medicine, 2006 Aug 10
European heart journal, 2020 Jan 01
Journal of the American Heart Association, 2023 Sep 08
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Neurology, 2024 Aug 05
Neurology, 2024 Aug 05
Neurology. Clinical practice, 2016-02
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Stroke, 2024 Nov 06