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  • 1
    Online Resource
    Online Resource
    Making Sense of Recent Acute Stroke Trial Results
    Springer Science and Business Media LLC ; 2014
    In:  Current Radiology Reports Vol. 2, No. 4 ( 2014-4)
    Details
    In: Current Radiology Reports, Springer Science and Business Media LLC, Vol. 2, No. 4 ( 2014-4)
    Type of Medium: Online Resource
    ISSN: 2167-4825
    URL: Article
    DOI: 10.1007/s40134-014-0046-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2014
    detail.hit.zdb_id: 2708002-X
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  • 2
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    The Spot Sign and Tranexamic Acid on Preventing ICH Growth – AUStralasia Trial (STOP-AUST): Protocol of a Phase II Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial
    SAGE Publications ; 2014
    In:  International Journal of Stroke Vol. 9, No. 4 ( 2014-06), p. 519-524
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 4 ( 2014-06), p. 519-524
    Abstract: No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions. Aim The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation ‘spot sign’ will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4·5-hours of stroke onset compared with placebo. Design The Spot sign and Tranexamic acid On Preventing ICH growth – AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale 〉 7, intracerebral hemorrhage volume 〈 70 ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months. Study outcomes The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either 〉 33% or 〉 6 ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score. Discussion This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1111/ijs.12132
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2211666-7
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  • 3
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    Online Resource
    32.
    Elsevier BV ; 2014
    In:  Journal of Clinical Neuroscience Vol. 21, No. 11 ( 2014-11), p. 2043-
    Details
    In: Journal of Clinical Neuroscience, Elsevier BV, Vol. 21, No. 11 ( 2014-11), p. 2043-
    Type of Medium: Online Resource
    ISSN: 0967-5868
    URL: Article
    DOI: 10.1016/j.jocn.2014.06.046
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2009190-4
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  • 4
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    Online Resource
    A Rare Cause of Embolic Stroke in Hereditary Hemorrhagic Telangiectasia
    Elsevier BV ; 2014
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 23, No. 5 ( 2014-05), p. 1245-1246
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 23, No. 5 ( 2014-05), p. 1245-1246
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.037
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 2052957-0
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  • 5
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    Online Resource
    Prediction of Poststroke Hemorrhagic Transformation Using Computed Tomography Perfusion
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 11 ( 2013-11), p. 3039-3043
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 11 ( 2013-11), p. 3039-3043
    Abstract: Intracerebral hemorrhage is a serious potential complication of stroke thrombolysis. We investigated the optimal computed tomography perfusion (CTP) parameter to predict cerebral parenchymal hematoma (PH) in acute ischemic stroke. Methods— Patients with hyperacute ischemic stroke had whole-brain CTP and follow-up computed tomography/MRI to identify hemorrhagic transformation. The association of the 3 parameters relative cerebral blood flow, relative cerebral blood volume, and time to maximum ( T max ) with PH was examined using receiver operating characteristic analysis and multivariate logistic regression. Results— Of 132 patients, 70 were treated with thrombolysis, and 14 (10.6%) developed PH on follow-up imaging. Baseline National Institutes of Health Stroke Scale score ( P =0.033) and thrombolysis ( P =0.003) were both predictive of PH. Receiver operating characteristic analysis revealed that T max 〉 14 s (area under the curve=0.748; P =0.002) and relative cerebral blood flow 〈 30% of contralateral mean (area under the curve=0.689, P =0.021) were the optimal thresholds, and the Bayesian information criterion (+2.6) indicated that T max was more strongly associated with PH than relative cerebral blood flow. T max 〉 14 s volumes of 〉 5 mL allowed prediction of PH with sensitivity of 79%, specificity of 68%, and negative likelihood ratio of 3.16. T max 〉 14 s volume and thrombolysis were both independently predictive of PH in a multivariate logistic regression model ( P 〈 0.05). Conclusions— T max 〉 14 s was the CTP parameter most strongly associated with PH. This outperformed relative cerebral blood flow 〈 30%, which closely equates to CTP estimates of ischemic core volume. Although ischemic core volume on CTP is useful in the pretreatment prediction of PH, severe hypoperfusion on T max is more strongly associated and may allow better prediction of the likely anatomic location of hemorrhage.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002396
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Abstract T P73: Peri Infarct N-Acetylaspartic Acid Predicts White Matter Atrophy After Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Objective: Cerebral volume changes post stroke have recently been described and may correlate with clinical outcome. We aimed to determine whether peri infarct measurement of the neuronal marker N-Acetylaspartic acid (NAA) on Magnetic Resonance Spectroscopy (MRS) predicts progressive cerebral volume change after stroke. Methods: 11 patients (7 male) with supratentorial ischemic stroke underwent serial MRI within 1 week of onset, and at 1 and 3 months. Imaging was performed on a 3T Siemens Trio scanner. Structural imaging utilized a T1-weighted axial MPRAGE acquisition (1mm slices, TR1.9sec, TE2.82msec). NAA estimation was performed at the baseline scan using single voxel MRS (TE30msec, 3x3x3cm voxels). The voxel was placed in the peri infarct region as determined by assessment of the diffusion weighted image. Quantitative MRS analysis was performed using LCmodel using water referencing. Brain tissue volume, normalized for subject head size, was estimated with SIENAX, part of FSL. Due to anticipated effects of edema on initial cerebral volume, changes in grey, white and total brain volume were assessed as percentage change between the 1 and 3 month scans. Results: Mean age was 71yr (IQR 62-79yr). Median baseline NIHSS was 11 (IQR 6-14). Mean baseline grey, white and total brain volume were 713ml (IQR 683-749), 731mL (IQR 721-747) and 1444mL (IQR 1384-1503) respectively. There was a significant correlation between age and baseline grey matter volume (r2=0.73, p=0.001) and total brain volume (r2=0.74, p=0.001). Mean peri infarct NAA concentration was 6.2mM (SD 1.3) compared with 7.0mM (SD 1.2) in the contralateral hemisphere (p=0.09, paired t-test). Mean percentage grey, white and total brain volume changes were 1.2% (IQR -1.8-4.1), 0.4% (IQR -2.2-3.7) and 0.8% (IRQ -1.0-2.6) respectively. There was a significant correlation between baseline NAA in the peri infarct region and change in white matter volume between the 1 and 3 month time points (r2=0.26, p=0.008). Conclusions: Estimation of the neuronal marker NAA using MRS may signify varying degrees of neuronal damage after stroke which may correlate with the severity of axonal degeneration and subsequent white matter volume changes. Further validation and correlation with clinical outcomes is required.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.tp73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Commentary: A cohort study of patients with anemia on admission and fatality after acute ischemic stroke
    Elsevier BV ; 2013
    In:  Journal of Clinical Neuroscience Vol. 20, No. 1 ( 2013-1), p. 43-
    Details
    In: Journal of Clinical Neuroscience, Elsevier BV, Vol. 20, No. 1 ( 2013-1), p. 43-
    Type of Medium: Online Resource
    ISSN: 0967-5868
    URL: Article
    DOI: 10.1016/j.jocn.2012.05.022
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 2009190-4
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  • 8
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    Online Resource
    Spectroscopy of Reperfused Tissue after Stroke Reveals Heightened Metabolism in Patients with Good Clinical Outcomes
    SAGE Publications ; 2014
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 34, No. 12 ( 2014-12), p. 1944-1950
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 34, No. 12 ( 2014-12), p. 1944-1950
    Abstract: The aim of acute stroke treatment is to reperfuse the penumbra. However, not all posttreatment reperfusion is associated with a good outcome. Recent arterial spin labeling (ASL) studies suggest that patients with hyperperfusion after treatment have a better clinical recovery. This study aimed to determine whether there was a distinctive magnetic resonance spectroscopy (MRS) metabolite profile in hyperperfused tissue after stroke reperfusion therapy. We studied 77 ischemic stroke patients 24 hours after treatment using MRS (single voxel spectroscopy, point resolved spectroscopy, echo time 30 ms), ASL, and diffusion-weighted imaging (DWI). Magnetic resonance spectroscopy voxels were placed in cortical tissue that was penumbral on baseline perfusion imaging but had reperfused at 24 hours (and did not progress to infarction). Additionally, 20 healthy age matched controls underwent MRS. In all, 24 patients had hyperperfusion; 36 had reperfused penumbra without hyperperfusion, and 17 were excluded due to no reperfusion. Hyperperfusion was significantly related to better 3-month clinical outcome compared with patients without hyperperfusion ( P = 0.007). Patients with hyperperfusion showed increased glutamate ( P 〈 0.001), increased N-Acetylaspartate (NAA) ( P = 0.038), and increased lactate ( P 〈 0.002) in reperfused tissue compared with contralateral tissue and healthy controls. Hyperperfused tissue has a characteristic metabolite signature, suggesting that it is more metabolically active and perhaps more capable of later neuroplasticity.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/jcbfm.2014.166
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2039456-1
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  • 9
    Online Resource
    Online Resource
    Abstract WP45: Comparison of Automated Whole Brain CT Perfusion Analysis with Perfusion-Diffusion MRI in Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background and purpose: CT perfusion (CTP) provides rapid and accessible imaging of ischemic stroke pathophysiology. Studies with limited brain coverage CTP have suggested that relative cerebral blood flow (relCBF) is the optimal CTP parameter to define irreversible infarction. We analyzed patients with whole brain CT perfusion and contemporaneous MR perfusion-diffusion imaging to confirm the optimal CTP parameter for infarct core and compare mismatch classification between MR and CT. Methods: Acute ischemic stroke patients 〈 6hr after onset had whole brain CTP (320slice) closely followed by perfusion-diffusion MRI. Maps of CBF, CBV and time-to-peak of the deconvolved tissue residue function (Tmax) were generated by RAPID automated perfusion analysis software (Stanford University) using delay insensitive deconvolution. The optimal CTP map to identify infarct core was selected by maximizing the average Dice co-efficient across the same threshold range for all patients using co-registered diffusion lesion (manually outlined to its maximal visual extent) as reference region. Mismatch classification agreement between CT and MRI was then assessed using 2 definitions: mismatch ratio a) 〉 1.2 or b) 〉 1.8, absolute mismatch a) 〉 10mL or b) 〉 15mL, infarct core 〈 70mL. Results: In 28 patients imaged 〈 6hr from stroke onset (median age 69, median onset to CT 180min, median CT to MR 69min), relCBF provided the most accurate estimate for infarct core, significantly better than absolute or relative CBV (both p 〈 0.001). Using relCBF to generate acute CTP infarct core volumes, the median magnitude of volume difference versus diffusion MR was 6.9mL, interquartile range 1.6-27.4mL. CTP mismatch between relCBF core and Tmax 〉 6sec perfusion lesion was assessed in 25 patients (3/28 had no MR perfusion). CTP and MR perfusion-diffusion mismatch classification agreed in 23/25 (92%) patients (kappa 0.84) using either definition. Conclusions: This study using whole brain CTP confirms the greater accuracy of CBF over CBV for estimation of the infarct core. The 〉 90% agreement in mismatch classification between CTP and MRI supports the concept that both modalities can identify similar patient populations for clinical trials of reperfusion therapies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP45
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 10
    Online Resource
    Online Resource
    Abstract WP33: Reduced Cerebral Blood Flow on Acute Whole Brain CT Perfusion Best Predicts Hemorrhagic Transformation
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Objective: Hemorrhagic transformation in ischemic stroke is a potentially life threatening complication of thrombolysis. Using perfusion MRI, very low cerebral blood volume (VLCBV) strongly predicts hemorrhagic transformation after reperfusion. CT perfusion (CTP) is currently more widely accessible than MRI and recent data have shown that CT relative cerebral blood flow (relCBF) provides a better estimate of infarct core than CBV. We aimed to determine the optimal parameter to predict hemorrhagic transformation using whole brain CTP. Methods: Patients with ischemic stroke were imaged with whole brain CTP within 6hrs of symptom onset. Hemorrhagic transformation was assessed on CT/MRI within 7 days of stroke using ECASS grade. CBF and CBV were analyzed within a relative time to peak 〉 4sec region of interest. Results were expressed as volumes below a given percentile relative to the contralateral hemisphere (relCBF and relCBV). Receiver operating characteristic (ROC) and logistic regression analysis were performed to determine the optimal parameter and percentile threshold correlating with parenchymal hemorrhage (PH). Results: 128 patients with acute CTP were analyzed, median age 76yr (IQR 66-83), median NIHSS 13 (IQR 9-16), 59% received IV thrombolysis. 11 patients had PH on follow-up. On ROC analysis, the optimal threshold for very low CBF (VLCBF) was at the 〈 0 th centile. VLCBF was significantly associated with PH in ROC analysis (AUC=0.760, p 〈 0.01) whereas VLCBV (AUC 0.638 at 〈 5 th centile, 0.618 at 〈 2.5 th centile, 0.440 at 〈 0 th centile) was not significant. Using VLCBF, the optimal lesion volume to predict PH was 〉 3mL with OR 12.0 (95%CI 2.4-58), sensitivity 0.82 (95%CI 0.48-0.98), specificity 0.73 (95%CI 0.64-0.80), negative predictive value 0.98 (95%CI 0.92-1.0) and positive predictive value 0.22 (95%CI 0.11-0.38). In logistic regression, PH was associated with increased VLCBF (p 〈 0.01) but not with VLCBV (p=0.08). The Bayesian information criterion for VLCBF compared to VLCBV was +5 indicating improved model fit. Conclusions: VLCBF appears to be more reliably associated with hemorrhagic transformation than VLCBV when CT perfusion is used. This may be due to reduced ability of VLCBV to distinguish regions of ischemia from normal white matter.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP33
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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