- N Engl J Med 2022; 386:1560-1570
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...
- N Engl J Med 2022; 386:1359-1361
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...
- N Engl J Med 2022; 386:1351-1351
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.
- N Engl J Med 2022; 386:1303-1313
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.
- N Engl J Med 2022; 386:1265-1265
A 63-year-old man undergoing stenting of the left common carotid artery had shivering, sweating, and confusion, as well as livedo reticularis on the left side of his face. Cholesterol embolization syndrome was diagnosed.
- N Engl J Med 2022; 386:95-95
Forty persons in whom thrombosis and thrombocytopenia had developed after an initial ChAdOx1 nCoV-19 vaccination were given a second dose of a Covid-19 vaccine, most commonly BNT162b2. None of the patients had a recurrence of thrombosis and thrombocytopenia.
- N Engl J Med 2021; 385:2520-2530
In a trial in China, patients with a minor stroke or transient ischemic attack with CYP2C19 loss-of-function alleles as determined by point-of-care testing had modestly fewer second strokes with ticagrelor than with clopidogrel but also had more total bleeding events.
- N Engl J Med 2021; 385:2563-2572
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....
- N Engl J Med 2021; 385:2576-2577
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...
- N Engl J Med 2021; 385:2150-2160
In a randomized trial involving patients who had atrial fibrillation after TAVR, edoxaban was noninferior to vitamin K antagonists with respect to a composite outcome of death, MI, stroke, thromboembolism, valve thrombosis, or major bleeding but was associated with a higher incidence of major bleeding.
- N Engl J Med 2021; 385:1904-1905
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...
- N Engl J Med 2021; 385:1833-1844
Trials involving Asian patients with acute stroke have suggested that endovascular treatment alone is not inferior to the usual practice of thrombolysis before endovascular treatment. This trial involving European patients did not show noninferiority or superiority of endovascular treatment alone.
- N Engl J Med 2021; 385:1317-1325
A 47-year-old man with a history of cerebellar stroke presented with pain involving the left side of the neck and the right flank, which preceded pulsating head pain. Imaging studies revealed dissections of the left vertebral artery and right renal artery with infarction. Additional diagnostic tests were performed.
- N Engl J Med 2021; 385:1067-1077
In a cluster-randomized trial, villages were assigned in a 1:1 ratio to use a salt substitute (75% sodium chloride and 25% potassium chloride by mass) or regular salt. Among persons who had a history of stroke or were 60 years of age or older and had hypertension, rates of stroke,...
- N Engl J Med 2021; 385:1137-1138
For decades, opinions about the degree to which sodium intake affects the blood pressure level and the risk of adverse effects such as stroke have been varied, even partisan.1 Much relevant data have shown an association between high dietary sodium intake — and also low dietary potassium intake...
- N Engl J Med 2021; 385:1043-1044
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...
- N Engl J Med 2021; 385:971-981
Mobile stroke units have CT scanners and personnel trained to administer tissue plasminogen activator. In a multicity trial, functional outcomes at 90 days after acute stroke were better with mobile stroke units than with standard care by emergency medical services and transfer to an emergency department.
- N Engl J Med 2021; 385:720-728
A rare side effect of ChAdOx1 nCoV-19 vaccination against Covid-19 — venous or arterial thrombosis, which has been termed vaccine-induced immune thrombotic thrombocytopenia — has been reported in recent months. In this Brief Report, investigators describe the use of intravenous immune globulin in the treatment of three such vaccine recipients...
- N Engl J Med 2021; 385:65-65
An 83-year-old woman presented with swelling and discoloration of the right side of the tongue. An electrocardiogram revealed atrial fibrillation. CT angiography was performed, and a diagnosis of right lingual-artery thromboembolism was made.
- N Engl J Med 2021; 385:59-64
Cerebral venous thrombosis is characterized by infarction with focal neurologic deficits and increased intracranial pressure. As a very rare complication of some vaccines against Covid-19, the disorder is accompanied by disseminated intravascular coagulation and hemorrhage.