Neurology

Vascular Neurology

Questions discussed in this category

Would you start anticoagulation in a patient with a history of CVA 1 year ago and high risk APL profile who was never started on anticoagulation, but is now presenting for follow up and without recurrent thrombotic events?

The patient has no known history of autoimmune disease.

4 Answers available

Is LP indicated for patients with recurrent thunderclap headaches over a 4-week period and negative head imaging for SAH?

2 Answers available

How do you approach a patient with atrial fibrillation on Apixaban who has a new cardioembolic stroke?

3 Answers available

Is there a risk of CYP2C19 gene testing only being adopted by wealthier health systems, thereby creating a disparity gap in treatment?

What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...

3 Answers available

Does the overall conclusion of the CHANCE-2 trial make ticagrelor + ASA a worthwhile transition given the data showing cumulative hazard of stroke diverged during the first week and was subsequently similar, which suggests the benefit of ticagrelor over clopidogrel is seen predominantly soon after stroke?

4 Answers available

Do you ever do surveillance MR imaging in patients with stable exam and history of cardioembolic stroke?

1 Answer available

Would you generalize the data from the CHANCE-2 trial to a broader clinic population given that the study was specific to Han Chinese patients?

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

3 Answers available

Do you recommend genetic testing after a patient on clopidogrel has a stroke based on the results of the CHANCE-2 trial?

3 Answers available

Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?

No thrombus detected on echocardiogram and no evidence of atrial fibrillation is present.

1 Answer available

Do you recommend antiplatelet therapy for patients who have suffered stroke due to CADASIL?

3 Answers available

Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?

Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...

3 Answers available

Would you recommend short-term dual antiplatelet therapy for a patient who received tPA, and is otherwise eligible for dual antiplatelet therapy per POINT or SAMMPRIS trial?

3 Answers available

How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?

0 Answers available

Do you always pursue stroke work up in patients diagnosed with transient global amnesia?

For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...

8 Answers available

What is your approach for a patient with an acute ischemic stroke caused by an aortic thrombus?

2 Answers available

How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

4 Answers available

How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?

1 Answer available

What duration of dual antiplatelet therapy do you use for secondary prevention of ischemic stroke due to intracranial atherosclerotic disease?

While some have the practice of 90 days per SAMMPRIS, the lower rates of ischemic stroke in the medical therapy group were driven by events within the...

8 Answers available

What is your approach to a patient who has an ischemic stroke while on clopidogrel despite strict compliance and normal results on clopidogrel response assay?

5 Answers available

How do you decide between TCAR vs. carotid stenting for patients unstable for CEA?

2 Answers available

When do you start anticoagulation in a patient with cardioembolic CVA secondary to new onset atrial fibrillation with hemorrhagic conversion?

1 Answer available

How does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

1 Answer available

How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?

What factors influence your thinking?

1 Answer available

Would you favor restarting anticoagulation or pursuing left atrial appendage closure in a patient with hemorrhagic stroke on anticoagulation for non-valvular atrial fibrillation?

3 Answers available

How do you acutely manage a free-floating thrombus in a major artery in a patient with a stroke as a result of it?

4 Answers available

What is your practice for the timing of resumption of oral anticoagulation after ICH?

Do you order any imaging beforehand? Are there other studies that you order?

1 Answer available

Do you use a combination of anticoagulant and antiplatelet therapy for treating intraluminal internal cerebral artery thrombus causing stroke?

For what duration do you use therapy?

1 Answer available

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

1 Answer available

Would it be prudent to complete long term cardiac monitoring (ie. 30 day) in a patient with a new typical appearing lacunar type thalamic infarct and history of hypertension?

1 Answer available

Do you treat cerebral vein thrombosis with parenchymal hemorrhage using full dose heparin protocol rather than the high risk protocol?

1 Answer available

Do you start anticoagulation in a patient with infective endocarditis who also has atrial fibrillation and stroke ?

1 Answer available

Is angioedema secondary to IV tPA considered an absolute contraindication for tPA in future?

3 Answers available

For patients with atrial fibrillation on DOAC, when should they resume DOAC after a thalamic bleed without intraventricular bleed?

How does presence of intraventricular hemorrhage change your recommendations?

2 Answers available

When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?

3 Answers available

When do you consider middle meningeal artery embolization in patients with recurrent subdural hemorrhages?

In what clinical scenario would you refer a patient for embolization? Are there any contraindications?

1 Answer available

For which stroke patients, if any, do you recommend implantable loop recorder for long-term cardiac monitoring and why?

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...

1 Answer available

How do you determine if a patient is safe to drive after having a PCA infarct?

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 ...

1 Answer available

What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

1 Answer available

How do you treat patients with symptoms of acute ischemic stroke who have an allergic reaction to alteplase?

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...

1 Answer available

When do you start anticoagulation for secondary prevention in patients with HFrEF and history of embolic strokes?

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 ...

1 Answer available

For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention?

For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...

1 Answer available

When is the best time to consider left atrial appendage closure for secondary stroke prevention in patients with atrial fibrillation?

For example, with a Watchman device? What is the evidence behind this?

1 Answer available

When do you restart anticoagulation in patients with atrial fibrillation who just had an ischemic stroke?

1 Answer available

When do you consider starting hypertonic saline solution in patients with an acute ischemic stroke?

1 Answer available

How do you approach management of cerebral venous sinus thrombosis in a patient with severe thrombocytopenia?

1 Answer available

Should patients who have had hemorrhagic strokes be restarted on oral anticoagulation?

If so, how do you decide when to restart anticoagulants?

1 Answer available

How do you determine the timing of anticoagulation for patients with large MCA strokes secondary to atrial fibrillation?

1 Answer available

Should patients with cerebral amyloid angiopathy have any statin medications discontinued?

1 Answer available

In what clinical settings is acute ICH clot removal recommended?

1 Answer available

In patients with recurrent ischemic infarcts on the same side as an internal carotid artery lesion, is intervention warranted even if there is less than 50% obstruction?

When would you consider stenting or CEA even if there is less than 50 obstruction when no other etiology has been found?

1 Answer available

How do you limit the onset of new strokes in patients with Moya-Moya syndrome?

1 Answer available

Papers discussed in this category

Stroke, 2020 Aug 06

Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study.

Neurology. Clinical practice, 2018-02

Anticoagulation for atrial fibrillation after intracranial hemorrhage: A systematic review.

Stroke, 2015 May 28

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Stroke, 2019-02

Ischemic Stroke and Internal Carotid Artery Web.

Stroke, 2011-04

Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

Ann Neurol, 2020 Aug 05

Anticoagulation Timing in Cardioembolic Stroke and Recurrent Event Risk.

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019-08

Treatment Approaches to Lacunar Stroke.

Stroke, 2021 Sep 14

Cilostazol for Secondary Stroke Prevention: History, Evidence, Limitations, and Possibilities.

Stroke, 2015-03

Outcome in patients previously on antithrombotic therapy in the SAMMPRIS trial: subgroup analysis.

BMJ open, 2014-12-02

Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.

J Am Coll Cardiol,

Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.

Neurology, 2015-09-29

Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE.

Stroke, 2017-08

Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting.

Stroke, 2021 May 24

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association.

Lancet (London, England), 2014-01-25

Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial.

Circulation, 2019-08-20

Time Course for Benefit and Risk of Clopidogrel and Aspirin After Acute Transient Ischemic Attack and Minor Ischemic Stroke.

J Neurol, 2021 Jul 17

Frequency of silent brain infarction in transient global amnesia.

J Vasc Surg, 2019 Dec 31

Duration of blood flow reversal during transcarotid artery revascularization does not affect outcome.

The New England journal of medicine, 2012-05-17

Warfarin and aspirin in patients with heart failure and sinus rhythm.

The New England journal of medicine, 2018-10-04

Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease.

The New England journal of medicine, 2019-05-16

Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source.

Heart, 2019 Apr 08

Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis.

N Engl J Med,

Trial of Tocilizumab in Giant-Cell Arteritis.

Lancet, 2016 Mar 04

Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.

Arthritis Rheum,

Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis.

American heart journal, 2010-07

Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale.

Lancet, 2021 Aug 27

Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial.

The New England journal of medicine, 2013-03-21

Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.

Neurology, 2013-08-13

An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.

The New England journal of medicine, 2017-09-14

Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

Neurology, 2015-10-13

Clinical Reasoning: An 87-year-old woman with left-sided numbness.

JAMA,

Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: The STROKE-AF Randomized Clinical Trial.

eNeurologicalSci, 2017 Aug 02

Successful systemic thrombolysis with rtPA in a patient with history of a life-threatening rtPA-associated orolingual angioedema.

Neurol Clin Pract,

Thrombolysis of a stroke patient with history of rtPA-associated angioedema.

J Am Heart Assoc, 2020 Nov 23

Direct Oral Anticoagulants in Patients With Inherited Thrombophilia and Venous Thromboembolism: A Prospective Cohort Study.

Am J Hematol,

Protein S abnormalities: a diagnostic nightmare.

Eur J Neurol, 2017 Aug 20

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology.

Stroke, 2016 Dec 20

Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation.

Stroke, 2010 Oct 28

Optimal timing of resumption of warfarin after intracranial hemorrhage.

J Thromb Haemost, 2010 Apr 08

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk.

Lancet Neurol, 2021 Sep 03

Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage in the UK: a randomised, open-label, assessor-masked, pilot-phase, non-inferiority trial.

The New England journal of medicine, 2018-07-19

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.

N Engl J Med, 2013 Jun 26

Clopidogrel with aspirin in acute minor stroke or transient ischemic attack.

N Engl J Med, 2021 Oct 28

Ticagrelor versus Clopidogrel in Loss-of-Function Carriers with Stroke or TIA.

N Engl J Med,

Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.

JAMA neurology, 2019-04-01

Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity: A Meta-analysis.

Lancet Neurol, 2019 May 23

Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies.

JAMA Neurol,

Assessment of Incidence and Risk Factors of Intracerebral Hemorrhage Among Participants in the Framingham Heart Study Between 1948 and 2016.

Lancet Neurol, 2018 Jan 10

The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study.

Cancer causes & control : CCC, 2010-03

Germline polymorphisms in the one-carbon metabolism pathway and DNA methylation in colorectal cancer.

Atherosclerosis, 2001-06

The 1298A-->C polymorphism in methylenetetrahydrofolate reductase (MTHFR): in vitro expression and association with homocysteine.

The American journal of clinical nutrition, 2008-10

Associations between single nucleotide polymorphisms in folate uptake and metabolizing genes with blood folate, homocysteine, and DNA uracil concentrations.

Circulation. Cardiovascular genetics, 2008-12

Variants of folate metabolism genes and the risk of conotruncal cardiac defects.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2012-01

Methylenetetrahydrofolate reductase (MTHFR) polymorphism A1298C (Glu429Ala) predicts decline in renal function over time in the African-American Study of Kidney Disease and Hypertension (AASK) Trial and Veterans Affairs Hypertension Cohort (VAHC).

Human genetics, 2012-05

Strong protective effect of the aldehyde dehydrogenase gene (ALDH2) 504lys (*2) allele against alcoholism and alcohol-induced medical diseases in Asians.

PeerJ, 2013

Integrating precision medicine in the study and clinical treatment of a severely mentally ill person.

Nature, 2016-08-18

Analysis of protein-coding genetic variation in 60,706 humans.

Circulation, 2009-03-31

Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial.

Cerebrovascular diseases (Basel, Switzerland), 2014

Recurrent stroke in the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial.

JAMA Neurol,