Browse Stroke (Emergency Medicine)

A 41-year-old woman with transient dysarthria and facial droop was evaluated for mitral valve masses. Three weeks earlier, she had heavy vaginal bleeding with crampy abdominal pain, fatigue, and lightheadedness. CT imaging was notable for small chronic cerebral infarcts and uterine fibroids. Diagnostic test results were received, and management decisions...

In this issue of the Journal, Yoshimura and colleagues¹ report the favorable results of a well-conducted randomized trial comparing mechanical thrombectomy (endovascular therapy) with medical care in patients with large-vessel occlusion and large cerebral infarctions. Previous trials of endovascular therapy in selected populations of patients with...

A 63-year-old man presented with weakness on the left side and difficulty speaking, both of which had begun 6 hours earlier. Imaging revealed a complete occlusion of the right internal carotid artery. He received emergency endovascular therapy.

Endovascular therapy for stroke is generally avoided if the cerebral infarction is large. In a trial conducted in Japan, the percentage of patients who had a good functional outcome at 90 days was higher with endovascular therapy than with medical care, but there were more cerebral hemorrhages with endovascular therapy.

A 9-year-old boy was transferred to this hospital because of transient weakness, facial droop, and slurred speech that occurred after an episode of crying. The symptoms lasted approximately 2 minutes and then resolved. Two years earlier, the patient had been evaluated for episodes of shaking in the arms and legs....

The late 20th and early 21st centuries have seen a reduction in stroke risk resulting from lifestyle changes such as widespread smoking cessation and more regular exercise, advances in the treatment of hypertension and hyperlipidemia, and better control of the vascular complications of diabetes.¹ Antiplatelet agents have played...

In the past few years, thrombectomy — the removal of a thrombus under angiographic guidance — has become an accepted treatment for acute ischemic stroke caused by occlusion of a large cerebral vessel.¹ Guidelines have included the use of intravenous alteplase preceding thrombectomy¹ if there are...

In their article in this issue of the Journal on emergency medical response in cases of stroke, Grotta and colleagues¹ report several positive findings for mobile stroke units in comparison with conventional medical service ambulances. These include 22% greater access to intravenous thrombolysis treatment with mobile...

The benefits of endovascular therapy provided soon after the onset of acute ischemic stroke due to large-vessel occlusion in the proximal anterior cerebral circulation were established by five clinical trials, the results of which were published in 2015.¹ The DAWN (DWI or CTP Assessment with Clinical Mismatch in...

Treatment for patients with acute ischemic stroke is guided by the time from the onset of stroke, the severity of neurologic deficit, and findings on neuroimaging. Recommended treatments in selected patients include intravenous thrombolysis with alteplase and mechanical thrombectomy.

Without urgent treatment, the risk of major stroke in the week after a transient ischemic attack (TIA) or minor stroke can be as high as 10%.¹ Some studies have shown that immediate medical treatment with antiplatelet agents and statins, as well as blood-pressure control, reduces that risk by...

Endovascular thrombectomy has been shown to be safe and effective for the treatment of appropriately selected patients with acute ischemic stroke up to 24 hours after symptom onset.^1-3 Several trials are attempting to expand the selection criteria for thrombectomy, in the hope of finding additional populations of patients...