Secondary Prevention of Cardiovascular Events: Disparities Between Rich and Poor
Cardiology Summary and Comment
Free
A worldwide survey of the use of evidence-based drugs in community settings reveals many gaps; bridging them will require tough decisions.
Ultrasound Measurements May Stratify Stroke Risk with Asymptomatic Carotid Stenosis
Neurology Summary and Comment
Free
Two measurements — embolic signal and plaque echolucency — helped stratify stroke risk; a combination of the measurements increased predictive ability.
White-Matter Hyperintensities Linked to Brain Activations in Late-Life Depression
Psychiatry Summary and Comment
Emotion-laden brain activation is high in patients with high levels of hyperintensities, but which comes first — the depression or the hyperintensities?
By Joel Yager, MD
August 29, 2011
Covering:
Aizenstein HJ et al., Am J Psychiatry 2011 Jul 28
ARISTOTLE: Another Competitor Beats Warfarin
Cardiology Summary and Comment
Free
Apixaban, a factor Xa inhibitor, outperforms warfarin at stroke and systolic embolism prevention in AF patients.
By Mark S. Link, MD
August 29, 2011
Covering:
Granger CB et al., N Engl J Med 2011 Aug 28
Mega JL., N Engl J Med 2011 Aug 28
Emergency Department Presentation of Pediatric Stroke
Emergency Medicine Summary and Comment
Children with ischemic stroke were more likely to present with focal neurological signs, whereas those with hemorrhagic stroke were more likely to present with vomiting and to require intubation.
By Katherine Bakes, MD
August 26, 2011
Covering:
Yock-Corrales A et al., Ann Emerg Med 2011 Aug; 58:156
Antithrombotic Drug Discontinuation and Ischemic Stroke Risk
Neurology Summary and Comment
Free
Some support for minimization of treatment cessation comes from a new, retrospective, population-based study.
By J. Donald Easton, MD
August 23, 2011
Covering:
Broderick JP et al., Stroke 2011 Jun 30
Depression After Transient Ischemic Attack
Neurology Summary and Comment
Prospective data suggest that TIA confers an increased risk for depression over a prolonged period.
Rivaroxaban Enters the Arsenal for Stroke Prevention in AFib
Cardiology Summary and Comment
Free
Another anticoagulant proves noninferior to warfarin.
By Harlan M. Krumholz, MD, SM
August 10, 2011
Covering:
Patel MR et al. for the ROCKET AF Investigators., N Engl J Med 2011 Aug 10
del Zoppo GJ and Eliasziw M., N Engl J Med 2011 Aug 10
When LP Is Not Necessary to Detect Subarachnoid Bleed
Emergency Medicine Summary and Comment
Free
CT performed within 6 hours of symptom onset in neurologically intact patients had 100% negative predictive value in this prospective multicenter study.
ABCD2 Score Might Be Poor Predictor of Stroke Risk
Emergency Medicine Summary and Comment
Sensitivity of the score was poor in a cohort of emergency department TIA patients with a 1.8% incidence of stroke at 7 days.
Stroke Risk-Stratification Scores Have Limited Prognostic Value in Elders with AF
General Medicine Summary and Comment
The authors suggest anticoagulation for all elders with atrial fibrillation.
Prehospital Notification Shortens Delays in Stroke Evaluation
Neurology Summary and Comment
Free
Imaging and treatment were initiated significantly faster when patients with suspected stroke were brought by emergency medical services rather than by private transport, and prehospital notification enhanced that advantage.
By Chelsea S. Kidwell, MD
July 26, 2011
Covering:
Patel MD et al., Stroke 2011 Jun 9
Stenting for Symptomatic Extracranial Vertebral Artery Stenosis
Neurology Summary and Comment
Rates of periprocedural stroke, transient ischemic attack, and restenosis are low, according to a systematic literature review.
By Jaime Toro, MD
July 26, 2011
Covering:
Stayman AN et al., Stroke 2011 Jun 23
Clazosentan Fails to Improve Outcomes After Aneurysmal Subarachnoid Hemorrhage
Neurology Summary and Comment
An experimental vasodilator alleviates vasospasm but is not associated with better neurological outcomes.
By Hooman Kamel, MD
July 26, 2011
Covering:
Macdonald RL et al., Lancet Neurol 2011 Jul; 10:618
Triage for Transient Ischemic Attack in the Emergency Department
Neurology Summary and Comment
Outcomes after TIA were comparable for people managed as outpatients and those managed as inpatients, after triage with the ABCD2 risk-stratification score.
By Mathew Reeves, BVSc, PhD
July 19, 2011
Covering:
Olivot J-M et al., Stroke 2011 Jul; 42:1839
Partial Aortic Occlusion Procedure Is Safe in Patients with Ischemic Stroke
Neurology Summary and Comment
Increasing cerebral perfusion with a catheter-based balloon device was safe and possibly beneficial, but only in particular patient subgroups.
By Brett Cucchiara, MD
July 19, 2011
Covering:
Shuaib A et al. for the SENTIS Trial Investigators., Stroke 2011 Jun; 42:1680
Endovascular Coiling vs. Surgical Clipping for Unruptured Cerebral Aneurysms: Does Patient Age Matter?
Neurology Summary and Comment
Outcomes were significantly better after coiling than after clipping in all age groups, and coiling's advantage increased with advancing age.
By Salvador Cruz-Flores, MD, MPH
July 12, 2011
Covering:
Brinjikji W et al., Stroke 2011 May; 42:1320
Has Joint Commission Certification of Primary Stroke Centers Affected Outcomes?
Neurology Summary and Comment
Among Medicare beneficiaries, 30-day mortality rates after ischemic stroke, but not 30-day readmission rates, were somewhat better at certified than at noncertified centers.
By Irene Katzan, MD
July 12, 2011
Covering:
Lichtman JH et al., Neurology 2011 Jun 7; 76:1976
PERFORM: Neutral Results in a Study of a Preventive Medication for Recurrent Stroke
Neurology Summary and Comment
Free
A large randomized trial failed to show noninferiority or a safety advantage for terutroban, compared with aspirin.
By Philip B. Gorelick, MD, MPH
June 28, 2011
Covering:
Bousser M-G et al., Lancet 2011 Jun 11; 377:2013
Lee M and Ovbiagele B., Lancet 2011 Jun 11; 377:1980
Carotid Endarterectomy: Too Soon to Call It Preferred for Women
Neurology Summary and Comment
Periprocedural stroke risk in women (but not in men) was higher after stenting than after endarterectomy — a finding inconsistent with other trial data.
By Bruce Ovbiagele, MD, MS
June 28, 2011
Covering:
Howard VJ et al., Lancet Neurol 2011 Jun; 10:530
Brown MM and Raine R., Lancet Neurol 2011 Jun; 10:494
Antidepressants Are Promising for Depressed Patients with Comorbid Neurological Disorders
Psychiatry Summary and Comment
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A meta-analysis finds few relevant studies, but they indicate some efficacy.
By Jonathan Silver, MD
June 27, 2011
Covering:
Price A et al., J Neurol Neurosurg Psychiatry 2011 May 10
Causes of Ischemic Stroke in Young Adults
General Medicine Summary and Comment
Definite causes were identified in only half of 318 cases.
By Allan S. Brett, MD
June 23, 2011
Covering:
Larrue V et al., Neurology 2011 Jun 7; 76:1983
Alteplase Dose for Ischemic Stroke in Very Heavy Patients
Neurology Summary and Comment
Free
Despite a low per-kilogram dose, the current 90-mg maximum dose seems effective, according to data from a large, international thrombolysis registry.
Is Paradoxical Embolism Associated with Neurological Dysfunction After Long-Bone Fracture?
Neurology Summary and Comment
Microembolic signals detected on transcranial Doppler ultrasound were associated with neurological symptoms after fracture of the femoral shaft, but the clinical implications of this pilot study are unclear.
By Hugh Markus, DM
June 21, 2011
Covering:
Forteza AM et al., Circulation 2011 May 10; 123:1947
Coated vs. Bare-Platinum Coils for Endovascular Treatment of Intracranial Aneurysms
Neurology Summary and Comment
Angiographically determined aneurysm recurrence was less common with hydrogel-coated than with bare-platinum coils, but clinical relevance remains unclear.
By Colin Derdeyn, MD
June 14, 2011
Covering:
White PM et al., Lancet 2011 May 14; 377:1655
