Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 438 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Thursday, October 30, 2014

Hospital business to dwindle as patients become consumers

As a consumer, would you ever patronize a business that only delivered what you wanted 10% of the time? It's time to call your hospital president and ask when their stroke rehabilitation business will actually deliver what their consumers/survivors want. Don't let them deflect answering the question by saying they are Joint Commission certified or are following Get With the Guidelines. These are practically worthless because they don't focus on results.
Only 10% get to full recovery.


Hospital business to dwindle as patients become consumers

Smoke without fire: What's the truth on e-cigarettes?

I would demand my doctor get me this or maybe nictotine gum for the nicotine needed for my recovery. Your doctor better know which way delivers it better.

Could E-Cigarettes Someday Be Used to Combat Alzheimer's Disease?

Nicotine for these reasons:
1.  Nicotine Holds Promise for Stronger Stroke Recovery
2.  Nicotine Patch Appears To Help Mild Cognitive Loss
3.  A Nicotine Patch a Day Keeps the Cognitive Impairment Away
4. Chronic nicotine restores normal Aβ levels and prevents short-term memory and E-LTP impairment in Aβ rat model of Alzheimer's disease
5. Nicotinic receptors in aging and dementia
6. nicotine and stroke rehab


behind a paywall.
Smoke without fire: What's the truth on e-cigarettes?

IBM's Watson Comes to the Bedside

I would prefer Dr. Watson to any human doctor for my stroke care. Although the Dr. is only as good as the input supplied. And that is the major problem with stroke. There seems to be NO written protocols for stroke rehabilitation, and of course no efficacy percentages.  There is so much to accomplish and we have the stroke world working on World Stroke Day - Oct. 29.  What a joke and waste of time.
http://www.medpagetoday.com/Neurology/MultipleSclerosis/47992?
If a physician or a patient could tap a clinical question into a smartphone and get an answer -- not just a list of references or websites -- and that answer came with a 82% likelihood that it is the "best" answer, would it make a difference in clinical care?
The IBM Watson folks and a handful of healthcare startups are betting that it will, and that was the theme of a daylong rollout of "Watson at Scale," designed to show off Watson's new global headquarters at 51 Astor Place, where the elevators have no buttons and one can be "immersed" in the Watson cognitive computing experience.
Most Americans know Watson as the computer that took on "Jeopardy" champ Ken Jennings and summarily defeated him.

More at link.

Baptist Health Paducah has just received a trio of national honors for its five-year-old stroke program, including the Joint Commission's Gold Seal of Approval as an Advanced Primary Stroke Center for the third consecutive cycle - PADUCAH, Ky.

I hate these backpatting displays. Once again they are congratulating themselves on processes not results. They imply this is better but never prove that it is. These people would be fired under my watch.
Big f*cking whoopee.

http://surfky.com/index.php/news/local/mccracken/54270-multiple-awards-recognize-baptist-health-paducah-stroke-program-for-turning-guidelines-into-lifelines
Mary Legge, RN, Baptist's stroke team leader, said the program's success has been the difference between life and death, disability and health, for many patients.
"We reached our goal of having 50 percent of all eligible patients receive tPA within 60 minutes from arrival to administering the drug," Legge said. "We turn guidelines into lifelines. We take these evidence-based standards very seriously because it results in the best possible outcome for the patient. We save lives and reduce devastating disabilities."
Stroke is one of the nation's leading causes of death and serious, long-term disability. On average, someone suffers a stroke every 40 seconds and someone dies of a stroke every four minutes.
Baptist Health Paducah received The Get With the Guidelines, Stroke Gold Plus Quality Achievement Award for the second year for meeting national guidelines for stroke care, as outlined by the American Heart Association/American Stroke Association.
In addition, the hospital received the associations' Target: Stroke Honor Roll for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA, (So what? tPA has only a 12% efficacy)the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. People who suffer a stroke may recover quicker and are less likely to suffer severe disability if they receive the drug within three hours of experiencing symptoms.
"These awards say we strive for the best possible care for our patients," said neurologist Joseph Ashburn, MD, stroke services director. "While meeting the minimum requirements for a stroke center is considered acceptable, we at Baptist Health believe the people of our region deserve nothing less than the very best medicine has to offer. We are always moving forward to take it to the next level."
Baptist Health Paducah became the region's first certified primary stroke center in 2009. Since then, the average time for tPA treatment has gone from 90 minutes to 54, a significant difference, considering that two million brain cells die each minute the drug is delayed, he said.
Emergency department physician Tariq Sayyad, MD, said staff receives extensive training on how to recognize stroke symptoms, so treatment can begin as soon as possible. "Each patient that enters our doors is offered the same state-of-the art care," he said. "The care our patients receive is our No. 1 priority."
William A. Brown, Baptist Health Paducah president, commended the team for making such a positive difference in the quality of life for many patients. "Baptist Health Paducah is dedicated to providing quality care based on internationally-respected clinical guidelines," Brown said, "and these achievements recognize our ability to provide the appropriate care as soon as possible to minimize any lasting impact for our patients."
In achieving Joint Commission advanced certification, Baptist has demonstrated its commitment to the highest level of care for its stroke patients, said Michele Sacco, interim executive director, Joint Commission Certification Programs. "Certification is a voluntary process, and The Joint Commission commends Baptist Health Paducah for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves."

New Technology Shows Promise for Delivery of Therapeutics to the Brain

Would this help us get drugs to the brain if we ever get some useful ones created for stroke?
http://www.alphagalileo.org/ViewItem.aspx?ItemId=146701&CultureCode=en
A new technology that may assist in the treatment of brain cancer and other neurological diseases is the subject of an article in a recent issue of the journal Technology, published by World Scientific Publishing Company http://www.worldscientific.com/doi/abs/10.1142/S2339547814500186.
According to the authors, the current medical use of chemotherapy to treat brain cancer can be inefficient because of the blood-brain-barrier that impedes the delivery of drugs out of blood vessels and into the tumor.
The researchers from the Virginia Tech – Wake Forest University School of Biomedical Engineering and Sciences described in their article that they have created “a tool for blood-barrier-brain disruption that uses bursts of sub-microsecond bipolar pulses to enhance the transfer of large molecules to the brain.”
The members of the biomedical school are: Rafael V. Davalos, associate professor of biomedical engineering; John H. Rossmeisl Jr., of the Virginia-Maryland Regional College of Veterinary Medicine; Christopher Arena, Paulo A. Garcia, and Michael B. Sano of the Bioelectromechanical Systems Laboratory; and John D. Olson of the Center for Biomolecular Imaging . Garcia is also employed by the Laboratory for Energy and Microsystems innovation at the Massachusetts Institute of Technology. Arena holds a second appointment with the Laboratory for Ultrasound Contract Agent Research at the University of North Carolina – North Carolina State University, Joint Department of Biomedical Engineering.
The new tool is called Vascular Enabled Nanosecond pulse or VEIN pulse. It will “reversibly open the blood-brain-barrier to facilitate the treatment of brain cancer,” Davalos explained.
“The sub-lethal nature of these electrical bursts indicates that the VEIN pulse may be useful for treating other neurological disorders such as Parkinson’s disease, epilepsy, and Alzheimer’s disease,” Davalos added.
In their testing, the VEIN pulse treatments were administered using minimally invasive electrodes inserted into the skull of each of the 18 anesthetized male rats. They varied the pulse duration within a burst, the total number of bursts (90 to 900), and the applied field. A key element of their success was that the pulses alternated in polarity to help eliminate muscle contractions and the need for a neuromuscular blockade.
The research was supported by the Golfers Against Cancer, the Center for Biomolecular Imaging in the Wake Forest School of Medicine, a National Science Foundation (NSF) CAREER Award, and an NSF I-Corps Award.
The next step in this research would be to move to large animal, pre-clinical trials.

Davalos has been using electrical impulses in his biomedical research since his days as a graduate student at the University of California – Berkeley. More recently, in a February 2011 article in the Journal of Clinical Oncology, Davalos, Gacia and Rossmeisl were among the authors who described a successful use of irreversible electroporation to achieve complete remission and improved quality of life in a seven-year old Labrador retriever with a large and complex tumor.

Nano Ruffles in Brain Matter

How might this explain problems we are having post-stroke?
http://www.alphagalileo.org/ViewItem.aspx?ItemId=146703&CultureCode=en
Freiburg researchers decipher the role of nanostructures around brain cells in central nervous system function

An accumulation of a protein called amyloid-beta into large insoluble deposits called plaques is known to cause Alzheimer's disease. One aspect of this illness that has not received much attention is which role the structure of the brain environment plays. How do macromolecules and macromolecular assemblies, such as polysaccharides, influence cell interaction in the brain? In a paper published in the journal "Proceedings of the National Academy of Sciences", Prof. Prasad Shastri and graduate student Nils Blumenthal, in collaboration with Prof. Bernd Heimrich and Prof. Ola Hermanson, have discovered that macromolecules or support cells like astrocytes provide well-defined physical cues in the form of random roughness or ruffles that have a crucial role in promoting and maintaining healthy interactions between cells in the hippocampus. This brain area is regarded as the brain's GPS system: It processes and stores spatial information. In Alzheimer's disease, this area degenerates. Shastri says, "It has been long thought that only biological signals have a role in health and function of brain cells, but here we show that the structure of the molecules that surround these cells may be equally important."

The researchers found that there is a restricted regime of roughness at the nanoscale that is beneficial to neurons. If the magnitude of roughness exceeds or is below this regime, neurons experience detrimental changes to their function. By analyzing human brain tissue from patients who suffered from Alzheimer's disease, Shastri's team has found a crucial link between regions in the brain that have amyloid-beta plaque accumulation - which are responsible for neuron death - and unfavorable changes to the nanotopography in the tissue surrounding these neurons, that is the features of its surface..

Shastri and his co-workers have found that astrocytes provide a nanoscale physical environment that neurons need to function well. "Our discovery shows for the first time that stretch-activated ion channels may have a role in central nervous system function and disease. Hence, our findings offer new pharmacological targets", says Blumenthal. Using synthetic substrates of precise roughness, they found out that stretch-sensitive molecules, including the so-called Piezo-1 ion channel in murine brain cells, direct the interaction between nanotopography, astrocytes and neurons. Former research has shown that the expression of MIB-1, a human analog of Piezo-1, is altered in human Alzheimer's patients.

Prof. Prasad Shastri conducts his research at the Institute for Macromolecular Chemistry and the Excellence Cluster BIOSS Centre for Biological Signalling Studies of the University of Freiburg. Graduate student Nils Blumenthal is funded by BIOSS. Prof. Bernd Heimrich is at the Institute of Anatomy and Cell Biology of the University of Freiburg and Prof. Ola Hermanson is from the Karolinska Institute in Stockholm/Sweden.

May BDNF be Implicated in the Exercise-Mediated Regulation of Inflammation? Critical Review and Synthesis of Evidence

You'll have to ask your doctor about the benefits of exercising and producing BDNF. Some articles to bring to their attention.

Gradually Increased Training Intensity Benefits Rehabilitation Outcome after Stroke by BDNF Upregulation and Stress Suppression

Serum Brain-Derived Neurotrophic Factor and the Risk for Dementia

Promoting neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic variation on brain-derived neurotrophic factor

Microglia Promote Learning-Dependent Synapse Formation through Brain-Derived Neurotrophic Factor

Newly identified protein helps explain how exercise boosts brain health 

Brain Derived Neurotrophic Factor Key Element in Recovery from Stroke

Individual Differences in Novelty Seeking Predict Subsequent Vulnerability to Social Defeat through a Differential Epigenetic Regulation of Brain-Derived Neurotrophic Factor Expression 



The latest here:
May BDNF be Implicated in the Exercise-Mediated Regulation of Inflammation? Critical Review and Synthesis of Evidence555411.abstract?
  1. Elizabeth D. E. Papathanassoglou, PhD, MSc, RN1
  2. Panagiota Miltiadous, PhD1
  3. Maria N. Karanikola, PhD, MSc, RN1
  1. 1Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
  1. Elizabeth D. E. Papathanassoglou, PhD, MSc, RN, Department of Nursing, Cyprus University of Technology, 15 Vragadinou str., 3041 Limassol, Cyprus. Email: e.papathanassoglou@cut.ac.cy

Abstract

Introduction: Exercise attenuates inflammation and enhances levels of brain-derived neurotrophic factor (BDNF). Exercise also enhances parasympathetic tone, although its role in activating the cholinergic anti-inflammatory pathway is unclear. The physiological pathways of exercise’s effect on inflammation are obscure.
Aims: To critically review the evidence on the role of BDNF in the anti-inflammatory effects of exercise and its potential involvement in the cholinergic anti-inflammatory pathway.
Methods: Critical literature review of studies published in MEDLINE, PubMed, CINAHL, Embase, and Cochrane databases.
Results: BDNF is critically involved in the bidirectional signaling between immune and neurosensory cells and in the regulation of parasympathetic system responses. BDNF is also intricately involved in the inflammatory response: inflammation induces BDNF production, and, in turn, BDNF exerts pro- and/or anti-inflammatory effects. Although exercise modulates BDNF and its receptors in lymphocytes, data on BDNF’s immunoregulatory/anti-inflammatory effects in relation to exercise are scarce. Moreover, BDNF increases cholinergic activity and is modulated by parasympathetic system activation. However, its involvement in the cholinergic anti-inflammatory pathway has not been investigated.
Conclusion: Converging lines of evidence implicate BDNF in exercise-mediated regulation of inflammation; however, data are insufficient to draw concrete conclusions. We suggest that there is a need to investigate BDNF as a potential modulator/mediator of the anti-inflammatory effects of exercise and of the cholinergic anti-inflammatory pathway during exercise. Such research would have implications for a wide range of inflammatory diseases and for planning targeted exercise protocols

Cleveland Clinic’s Top 10 Medical Innovations for 2015 #1 mobile stroke units

Even the vaunted Cleveland Clinic can't seem to read news about stroke. This is going to be an expensive short term test.  Do they not know that the Qualcomm Xprize for the tricorder has selected 10 finalists? How long before this comes to fruition and makes the expensive and time-consuming MRI and CT scans obsolete? We also shouldn't need neurologists on call to interpret those scans.
But do you really think your hospital will recommend this when it goes to production? It's a neurologist job killer and I doubt the stroke department head will recommend reducing head count unless you call the hospital president and make the case.
http://medcitynews.com/2014/10/cleveland-clinics-top-10-medical-innovations-2015/
1. Mobile Stroke Unit Time lost is brain lost. High-tech ambulances bring the emergency department straight to the patient with stroke symptoms. Using telemedicine, in-hospital stroke neurologists interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist perform neurological evaluation and administer t-PA after stroke detection, providing faster, effective treatment for the affected patient. (Do they not know that tPA has only a 12% efficacy rate?)
2. Dengue Fever Vaccine One mosquito bite is all it takes. More than 50 to 100 million people in more than 100 countries contract the dengue virus each year. The world’s first vaccine has been developed and tested, and is expected to be submitted to regulatory groups in 2015, with commercialization expected later that year.
3. Cost-effective, Fast, Painless Blood-Testing Have the days of needles and vials come to an end? The new art of blood collection uses a drop of blood drawn from the fingertip in a virtually painless procedure. Test results are available within hours of the original draw and are estimated to cost as little as 10% of the traditional Medicare reimbursement.
4. PCSK9 Inhibitors for Cholesterol Reduction Effective statin medications have been used to reduce cholesterol in heart disease patients for over two decades, but some people are intolerant and cannot benefit from them. Several PCSK9 inhibitors, or injectable cholesterol lowering drugs, are in development for those who don’t benefit from statins. The FDA is expected to approve the first PCSK9 in 2015 for its ability to significantly lower LDL cholesterol to levels never seen before.
5. Antibody-Drug Conjugates Chemotherapy, the only form of treatment available for treating some cancers, destroys cancer cells and harms healthy cells at the same time. A promising new approach for advanced cancer selectively delivers cytotoxic agents to tumor cells while avoiding normal, healthy tissue.
6. Checkpoint Inhibitors Cancer kills approximately 8 million people annually and is difficult to treat, let alone cure. Immune checkpoint inhibitors have allowed physicians to make significantly more progress against advanced cancer than they’ve achieved in decades. Combined with traditional chemotherapy and radiation treatment, the novel drugs boost the immune system and offer significant, long-term cancer remissions for patients with metastatic melanoma, and there is increasing evidence that they can work on other types of malignancies.
7. Leadless Cardiac Pacemaker Since 1958, the technology involved in cardiac pacemakers hasn’t changed much. A silver-dollar-sized pulse generator and a thin wire, or lead, inserted through the vein kept the heart beating at a steady pace. Leads, though, can break and crack, and become infection sites in 2 percent of cases. Vitamin-sized wireless cardiac pacemakers can be implanted directly in the heart without surgery and eliminate malfunction complications and restriction on daily physical activities.
8. New Drugs for Idiopathic Pulmonary Fibrosis Nearly 80,000 American adults with idiopathic pulmonary fibrosis may breathe easier in 2015 with the recent FDA-approval of two new experimental drugs. Pirfenidone and nintedanib slow the disease progress of the lethal lung disease, which causes scarring of the air sacs. Prior to these developments, there was no known treatment for IPF, in which life expectancy after diagnosis is just three to five years.
9. Single-Dose Intra-Operative Radiation Therapy for Breast Cancer Finding and treating breast cancer in its earliest stages can oftentimes lead to a cure. For most women with early-stage breast cancer, a lumpectomy is performed, followed by weeks of radiation therapy to reduce the likelihood of recurrence. Intra-operative radiation therapy, or IORT, focuses the radiation on the tumor during surgery as a single-dose, and has proven effective as whole breast radiation.
10. New Drug for Heart Failure Angiotensin-receptor neprilysin inhibitor, or ARNI, has been granted “fast-track status” by the FDA because of its impressive survival advantage over the ACE inhibitor enalapril, the current “gold standard” for treating patients with heart failure. The unique drug compound represents a paradigm shift in heart failure therapy.

How Tripping On Mushrooms Changes The Brain

A serious question. Would this be helpful post-stroke in creating new connections?  Something that I think should be researched. No self-prescription.
http://finance.yahoo.com/news/tripping-mushrooms-changes-brain-204500998.html
Tripping on magic mushrooms may actually free the mind, a new study says. The compounds in the (illegal) mushrooms change the way the brain works.
New research suggests that psilocybin, the main psychoactive ingredient in magic mushrooms, sprouts new links across previously disconnected brain regions, temporarily altering the brain's entire organizational framework.
These new connections are likely what allow users to experience things like seeing sounds or hearing colors. And they could also be responsible for giving magic mushrooms some of their antidepressant qualities.
When researchers compared the brains of people who had received IV injections of psilocybin with those of people given a placebo, they found that the drug changed how information was carried across the brain. (Subjects received 2 milligrams of psilocybin; the dose and concentration of the chemical in actual mushrooms — which are eaten, not injected — varies.) Typically, brain activity follows specific neural networks. But in the people given psilocybin injections, cross-brain activity seemed more erratic, as if freed from its normal framework.
When the researchers looked more closely, however, they noticed that the sparks of activity across the brains of their drugged volunteers wasn't as chaotic as it seemed.
Instead, the activity formed distinct patterns, or cycles.
"The brain does not simply become a random system after psilocybin injection," the researchers wrote, "but instead retains some organizational features, albeit different from the normal state."
Picture the information in your brain being shared across an interconnected and heavily-trafficked system of highways. In that example, psilocybin isn't removing the highways. Instead, it's simply building new ones.


Cool pictures and more at the link.

Wednesday, October 29, 2014

Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial

So which is more important lowering blood pressure for stroke prevention OR keep blood pressure higher #5 on elderly to prevent dementia? Does your doctor even know about this issue?
Someday our medical teams will figure out exactly what should be done for blood pressure lowering post-stroke. Maybe create a f*cking protocol and publish it for the world to see. Other research here:


1. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset
2. Early Intensive Blood-Pressure Lowering Improves Recovery in Patients With Acute Intracerebral Haemorrhage
 3.  Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly
 4. External Counterpulsation Augments Blood Pressure and Cerebral Flow Velocities in Ischemic Stroke Patients With Cerebral Intracranial Large Artery Occlusive Disease
5.  The One Benefit Of High Blood Pressure? It May Prevent Dementia
6.  Stopping Pre-Stroke Antihypertensive Medication Advised During Acute Stroke 
7.  Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia
8.  Low Diastolic Pressure Linked to Brain Atrophy 
9.  New Treatment for Stroke Set to Increase Chances of Recovery - haemorrhage blood pressure lowering

The latest research here:
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2814%2970224-8/abstract
Lesly A Pearce MS a, Leslie A McClure PhD b, Prof David C Anderson MD c, Claudia Jacova PhD d, Mukul Sharma MD e, Prof Robert G Hart MD e, Prof Oscar R Benavente MD f Corresponding AuthorEmail Address, for the SPS3 Investigators

Summary

Background

The primary outcome results for the SPS3 trial suggested that a lower systolic target blood pressure (<130 mm Hg) might be beneficial for reducing the risk of recurrent stroke compared with a higher target (130—149 mm Hg), but that the addition of clopidogrel to aspirin was not beneficial compared with aspirin plus placebo. In this prespecified secondary outcome analysis of the SPS3 trial, we aimed to assess whether blood pressure reduction and dual antiplatelet treatment affect changes in cognitive function over time in patients with cerebral small vessel disease.

Methods

In the SPS3 trial, patients with recent (within 6 months) symptomatic lacunar infarcts from 81 centres in North America, Latin America, and Spain were randomly assigned, in a two-by-two factorial design, to target levels of systolic blood pressure (1:1; 130—149 mm Hg vs <130 mm Hg; open-label) and to a once-daily antiplatelet treatment (1:1; aspirin 325 mg plus clopidogrel 75 mg vs aspirin 325 mg plus placebo; double-blind). For this analysis, the main cognitive outcome was change in Cognitive Abilities Screening Instrument (CASI) during follow-up. Patients were tested annually for up to 5 years, during which time the mean difference in systolic blood pressure was 11 mm Hg (SD 16) between the two targets (138 mm Hg vs 127 mm Hg at 1 year). We used linear mixed models to compare changes in CASI Z scores over time. The SPS3 trial is registered with ClinicalTrials.gov, number NCT00059306.

Findings

The study took place between March 23, 2003, and April 30, 2012. 2916 of 3020 SPS3 participants (mean age 63 years [SD 11]) with CASI scores at study entry were included in the analysis, with a median follow-up of 3·0 years (IQR 1·0—4·9). Mean changes in CASI Z scores from study entry to assessment at years 1 (n=2472), 2 (n=1968), 3 (n=1521), 4 (n=1135), and 5 (n=803) were 0·12 (SD 0·83), 0·15 (0·84), 0·16 (0·95), 0·19 (0·99), and 0·14 (1·09), respectively. Changes in CASI Z scores over time did not differ between assigned antiplatelet groups (p=0·858) or between assigned blood pressure target groups (p=0·520). There was no interaction between assigned antiplatelet groups and assigned blood pressure target groups and change over time (p=0·196).

Interpretation

Cognitive function is not affected by short-term dual antiplatelet treatment or blood pressure reduction in fairly young patients with recent lacunar stroke. Future studies of cognitive function after stroke should be of longer duration or focus on patients with higher rates of cognitive decline.

GW25-e0837 Effects of tea intake on blood pressure: a meta-analysis of 21 randomized controlled trials

You'll have to ask your doctor what you need to do about your blood pressure. Ask for the protocol. Because if we don't start demanding protocols our doctors will never write one up. That is because they probably still believe in the incredibly stupid comment, 'All strokes are different, all stroke recoveries are different'. Challenge them on that and ask for published research. Or are they just pulling crap out of thin air because they need to say something to sound knowledgeable.
http://content.onlinejacc.org/article.aspx?articleID=1914421
Liu Gang; Huang Xiaohong
J Am Coll Cardiol. 2014;64(16_S):. doi:10.1016/j.jacc.2014.06.519
text A A A
To read this abstract, download the PDF from the toolbox at the top right.

The effect of tea intake on blood pressure (BP) is controversial. We undertook a meta-analysis of randomized controlled trials to determine changes in systolic and diastolic BP due to the intake black and green tea.

MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched from 1966 until January 2014 for studies in parallel group or crossover design in which BP was assessed before and after receiving black or green tea for at least 1 week. The weighted mean difference was calculated for net changes in BP by using fixed-effects or random-effects models. Previously defined subgroup analyses were performed to explore the influence of study characteristics.

21 eligible randomized controlled trials with 1323 subjects were enrolled. After the tea intake, the pooled mean systolic and diastolic BP were −1.8 mmHg (95% confidence interval [CI], −2.4- −1.1 mmHg) and −1.4mmHg (95% CI, −2.2- −0.6 mm Hg) lower, respectively, compared with the tea-free controls. Subgroup analyses showed that the BP-lowering effect was apparent in the subjects who consumed a tea over a median of 12 weeks (systolic/diastolic BP, -2.6/-2.1 mmHg, both P <0.001). Stratified by type of tea, green tea significantly reduced systolic and diastolic BP of -2.1 (95% CI, −2.9- −1.2) and -1.7 (95% CI, −2.9- −0.5) mm Hg, and black tea significantly reduced systolic and diastolic BP of -1.4 (95% CI, −2.4- −0.4) and -1.1 (95% CI, -1.9- −0.2) mm Hg, respectively. The benefits of tea intake were not influenced by ethnicity, treatment dose of tea catechins, individual health status, or caffeine intake.

Diets high in fruit, vegetables, whole grains and nuts among factors to lower first-time stroke risk

Well duh, but they don't provide any research links to back up these assertions. It quite likely is true but there is enough wiggle room in these to still use 'Blame the Patient' to deflect any responsibility from landing on the doctor.
Mine are here with research links;
Here are my ideas on stroke prevention: Never, ever follow me.
Like my 11 Stroke risk reduction ideas.

 
http://www.alphagalileo.org/ViewItem.aspx?ItemId=146570&CultureCode=en
Eating Mediterranean or DASH-style diets, regularly engaging in physical activity and keeping your blood pressure under control can lower your risk of a first-time stroke, according to updated AHA/ASA guideline published in the American Heart Association’s journal Stroke[KA1] .
“We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled — especially high blood pressure — account for 90 percent of strokes,” said James Meschia, M.D., lead author of the study and professor and chairman of neurology at the Mayo Clinic in Jacksonville, Florida.
The updated guidelines recommend these tips to lower risk:
  • Eat a Mediterranean or DASH-style diet, supplemented with nuts.
  • Monitor high blood pressure at home with a cuff device.  
  • Keep pre-hypertension from becoming high blood pressure by making lifestyle changes such as getting more physical activity, eating a healthy diet and managing your weight.
  • Reduce the amount of sodium in your diet; sodium is found mostly in salt.
  • Visit your healthcare provider annually for blood pressure evaluation.
  • If your medication to lower blood pressure doesn’t work or has bad side effects, talk to your healthcare provider about finding a combination of drugs that work for you.
  • Don’t smoke. Smoking and taking oral birth control pills can significantly increase your stroke risk. If you’re a woman who experiences migraines with aura, smoking raises your risk of stroke even more than in the general population. 
Mediterranean-style or DASH-style diets are similar in their emphasis on fruits, vegetables, whole grains, legumes, nuts, seeds, poultry and fish. Both are limited in red meat and foods containing saturated fats, which are mostly found in animal-based products such as meat, butter, cheese and full-fat dairy.
Mediterranean-style diets are generally low in dairy products and DASH-style diets emphasize low-fat dairy products.
Avoiding secondhand smoke also lowers stroke and heart attack risks, according to the guidelines.
The writing committee reviewed existing guidelines, randomized clinical trials and some observational studies.
“Talking about stroke prevention is worthwhile,” Meschia said. “In many instances, stroke isn’t fatal, but it leads to years of physical, emotional and mental impairment that could be avoided.”

“Abandoned” stroke survivors need better longer-term care, expert says

What do you expect when there are no published stroke rehabilitation protocols with efficacy percentages? It becomes quite obvious to survivors that their doctors know absolutely nothing about how to get them to recovery. They are just 'winging it' all the time.  Or you solve the neuronal cascade of death and as a result of that you have much less disability.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=146678&CultureCode=en
Stroke patients need better long-term support to ensure their health and social care needs are met and prevent them feeling “abandoned”, a University of Leeds expert says.
Speaking on World Stroke Day (October 29), Professor Anne Forster, from the School of Medicine, one of the UK’s leading experts in care for stroke patients, suggests that although survival rates have improved significantly, with stroke mortality rates halving over the last 20 years, more needs to be done to safeguard the long-term welfare of stroke patients and their families.
Professor Forster said: “There are many stroke patients who feel abandoned and lost once they are discharged from hospital. In many cases, they may only receive three months of after-care, even though national clinical guidelines recommend a review of their condition after six months.
“But there is no defined care pathway for these patients and their families after a short period of post-hospital rehabilitation. The UK is very good at looking after patients in a hospital setting but it is the responsibility of clinical commissioning groups to make sure the longer-term needs of stroke patients and their carers are met.”
In the UK, someone suffers a stroke every five minutes and one in five strokes is fatal. Strokes are caused either by a blockage on a blood vessel, which accounts for about 85% of cases, or bleeding in the brain, which accounts for the other 15%.
A third of stroke patients suffer some physical impairment as a result of a stroke, with a third left prone to depression. Patients can require help with mobility, managing emotions and maintaining relationships.
Professor Forster leads on the Lots2Care programme, a research project which is working with centres in England to trial interventions to address the longer-term needs of stroke survivors and their families.
She added: “My research group, based in Bradford and Leeds, is trying to examine ways in which the longer-term unmet needs of stroke survivors can be identified and addressed, but that’s just the tip of the iceberg. What’s required is a nationally co-ordinated programme so that everyone, stroke survivors and health professionals, has a clearly defined longer-term care pathway to work to.”

4 Ways Science Can Predict Death, Rate Of Aging

Test yourself including the speed test.
http://www.medicaldaily.com/4-ways-science-can-predict-death-rate-aging-308217

Your Brain On Exercise: 30 Minutes Of Physical Activity Makes Your Brain More ‘Plastic’

How is your doctor incorporating this into your stroke protocols?  This is so f*cking stupid and easy, your stroke associations should be writing this up as a stroke protocol and distribute it to every single stroke doctor in the word. A shitty stroke association would even know that this is the right thing to do. But it won't get done because we have ones even worse than shitty.
http://www.medicaldaily.com/your-brain-exercise-30-minutes-physical-activity-makes-your-brain-more-plastic-308155

World Stroke Day - Oct. 29

Big f*cking whoopee.
 The only way this should be celebrated is by pointing out all the f*cking failures and problems in stroke.
What you need to tell the world;
If you just had a stroke, You are F*cking screwed
 
First you have to at least acknowledge that stroke is hopelessly lost and needs to be on the 'Sky is falling' press releases.

Tuesday, October 28, 2014

Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation

Instead of just talking about this stuff write up some damned stroke protocols.
http://journals.lww.com/co-neurology/Abstract/publishahead/Telerehabilitation_and_emerging_virtual_reality.99477.aspx

Putrino, David


Abstract

Purpose of review: Stroke is the leading cause of permanent motor disability in the United States, and the rapidly aging population makes finding large-scale treatment solutions to this problem a national priority. Telerehabilitation is an emerging approach that is being used for the effective treatment of multiple diseases, and is beginning to show promise for stroke. The purpose of this review is to identify and highlight the areas of telerehabilitation that require the most research attention.
Recent findings: Although there are many different forms of telerehabilitation approaches being attempted for stroke, the only approach that is currently showing moderate-strong evidence for efficacy is videogame-driven telerehabilitation (VGDT). However, targeted research is still required to determine the feasibility of VGDT: metrics regarding system usability, cost-effectiveness, and data privacy concerns still require major attention.
Summary: VGDT is an emerging approach that shows enormous promise for stroke rehabilitation. Future studies should focus less on developing custom task controllers and therapy games and more on developing innovative, online data acquisition and analytics pipelines, as well as understanding the patient population so that the rehabilitation experience can be better customized.

Considerations in the Efficacy and Effectiveness of VR Interventions for Stroke Rehabilitation: Moving the Field Forward

Write up your damned stroke protocols you lazy bastards. 
http://ptjournal.apta.org/content/early/2014/10/16/ptj.20130571.abstract
  1. Belinda Lange
+ Author Affiliations
  1. R. Proffitt, OTD, OTR/L, Division of Occupational Science and Occupational Therapy, University of Southern California, CHP 133, 1540 Alcazar St, Los Angeles, CA 90089 (USA).
  2. B. Lange, PhD, Institute for Creative Technologies, University of Southern California.

Abstract

In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions.1 Much of the research has been focused on the Exploratory Phase and jumps to Intervention Efficacy trials and Scale Up Evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke.2,3 The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement and motor control and learning. In this paper, we argue for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools in order to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This paper is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research.4

Effects of nutrition on leucocyte infiltration and neurogenesis after stroke in aged rats

Probably another reason drugs that work in rodents don't always work in humans.
http://www.jni-journal.com/article/S0165-5728%2814%2900597-9/abstract

Aim: The role of inflammation in stroke lesion development is currently intensively investigated. Most experimental models make use of young animals with normal nutritional status despite the fact that ageing and obesity are important risk factors for patients to suffer from cerebrovascular disease. Both ageing and nutritional customs are known to alter inflammatory responses and to affect stroke outcome. However, no data are available on the effect of nutrition regimen on stroke outcome and brain inflammation in aged animals.

The lonely are more likely to die. But why?

Is your doctor making sure your social connections are a central part of your recovery?

Links between emotion perception and social participation restriction following stroke

Gut microbes can help in improving your social life 

Love thy neighbor: It could lower your risk of stroke

New form of brain plasticity: Study shows how social isolation disrupts myelin production

Social interaction plays a critical role in neurogenesis and recovery after stroke

 



http://scopeblog.stanford.edu/2014/10/28/the-lonely-are-more-likely-to-die-but-why/

Diet Soda vs. Regular Soda: Is One Worse For You Than The Other?

Good luck. I try not to drink either very much.
http://www.medicaldaily.com/diet-soda-vs-regular-soda-one-worse-you-other-308063

Heart Failure Among Meat-Eaters A Byproduct Of How Gut Bacteria Digests Food

But what about this?

Study: Protein from meat, fish may help men age well

Ask your doctor, s/he should know the answer as to which study has more power.

I will continue eating meat.

http://www.medicaldaily.com/heart-failure-among-meat-eaters-byproduct-how-gut-bacteria-digests-food-308056 

Our bodies are filled with bacteria, with the majority of them living in our guts, outnumbering our own cells 10 to one. For the most part, these bacteria live in harmony with our bodies, eating what we eat, and regulating our metabolism and energy. But when they’re not living in peace, they may be causing disease, as one new Cleveland Clinic study found; a byproduct of their digestion may influence a person’s heart health.
The byproduct, trimethylamine N-oxide, or TMAO, is produced when gut bacteria digest the amino acid carnitine, which is commonly found in animal food products like beef, fish, chicken, milk, and cheese. The body already produces carnitine, and stores it in almost every cell in the body, where it’s used to produce energy. Because of this, it’s not really necessary to get more. The new study found that once gut bacteria produced TMAO, it traveled to the bloodstream where it clogged arteries, leading to heart failure and overall worse outcomes.
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“I am excited that these studies suggest TMAO testing may not only help identify those patients at greatest risk, and for whom more aggressive monitoring is needed, but also that TMAO testing may help to tailor dietary efforts to the individual in the hopes of reducing future risks among those high-risk subjects,” said Dr. W.H. Wilson Tang, of the Department of Cardiovascular Medicine at the Miller Family Heart and Vascular Institute, in a press release.
For the study, the researchers followed 720 heart failure patients over the course of five years. They found that there were lower mortality rates when there were high levels of natriuretic peptides, a compound indicative of heart failure, and low levels of TMAO, when compared to patients who had high levels of both. The findings, that TMAO contributed to heart failure and death, were further supported when they found that high levels of TMAO and BNP — another peptide indicative of heart failure — increased risk of death by 50 percent.
Tang’s study builds on a study from 2013, in which he found that TMAO also contributed to a person’s risk of heart disease and stroke, even if a person has no history of either. Though the researchers aren’t suggesting we all stop eating meat, their findings support previous claims that red meat consumption should be limited — and they have good reason to suggest that. “A diet high in carnitine shifts our gut ‘biology’ so meat eaters actually generate more TMAO and compound their risk of cardiovascular disease,” Cleveland Clinic’s website says.
Heart failure is very common, affecting 5.1 million people in the U.S., according to the National Heart, Lung, and Blood Institute. It develops over time and causes the heart to weaken, making it harder for blood to flow to some parts of the body. In turn, a person’s extremities can swell, they can have trouble breathing, or feel tired.
Source: Tang WH, Hazen S, et al. Journal of the American College of Cardiology. 2014. 

 

The link between mental-health conditions and cardiovascular disease

You'll have to read it at the link but it does give us some concerning information.
http://scopeblog.stanford.edu/2014/10/27/patients-with-mental-health-conditions-may-have-an-increased-risk-of-heart-disease-stroke/

UCLA Comprehensive Stroke Center at Ronald Reagan UCLA Medical Center Honored with Quality Achievement Award for Stroke Care

I'm sorry but I think these back patting demonstrations are a pile of steaming crap. I don't give a damn about how well you do the f*cking processes, I want to know your results. You'd be fired in no time under my leadership if you tried to pass off crap like this for your performance evaluations.
(Notice there is nothing about how low their 30 day death rate is or how many fully recovered)
http://www.newswise.com/articles/ucla-comprehensive-stroke-center-at-ronald-reagan-ucla-medical-center-honored-with-quality-achievement-award-for-stroke-care2
Big f*cking whoopee.Guidelines here: You can see how this is nothing to be impressed about. This is all indirect action, not results.
http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelinesHFStrokeResus/GetWithTheGuidelinesStrokeHomePage/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp

University Hospitals to open Avon rehabilitation hospital in 2016 - CLEVELAND, Ohio

You are going to have to get involved and insist that the goals of the stroke unit focus on results, reducing 30-day deaths substantially, 100% recovery. None of this process crap like the Joint Commission certification or Get With the Guidelines. If this is left to the medical staff survivors will not be served with the best rehabilitation.
http://www.cleveland.com/healthfit/index.ssf/2014/10/university_hospitals_to_open_a.html

Connectomics at the cutting edge: Challenges and opportunities in high-resolution brain mapping

I'm sure the stroke department head at your hospital is not insisting that all staff attend this because they already  know exactly how the brain connects up and they have proven working stroke protocols to get survivors brains back to normal. That statement is quite the whopper, your doctor won't be attending this and has no stroke protocols that work at all. I would love to be proved wrong.

New complimentary webinar from Science:
Connectomics at the cutting edge: Challenges and opportunities in high-resolution brain mapping
You are invited to hear our panel of experts on November 3, 2014, in this live, online educational seminar. For more information and complimentary registration visit: webinar.sciencemag.org
    Date: Monday, November 3, 2014
    Time: 12 Noon Eastern, 9 a.m. Pacific, 5 p.m. UK, 6 p.m. Central Europe
    Duration: 1 hour
About This Webinar
Researchers in the field of connectomics endeavor to analyze the complex synaptic network formed by the billions of interconnected neurons. By thinly slicing neural tissue and imaging each section with a scanning electron microscope at high resolution, fine structural details can be visualized. Careful delineation of each neuron in the 3-D volume allows for the high-resolution mapping of all connections made by each cell, providing a detailed wiring diagram of the brain: the connectome. The sheer size and complexity of this scientific challenge is daunting. Tens of thousands of sections or more need to collected and hundreds of thousands of images recorded, resulting in many terabytes of data that require rapid processing, making connectomics a real “speed game.” Automated sample preparation robots and high throughput electron microscopes have now become available, bringing the promise of a larger (1 mm³), high-resolution connectome within reach. However, extracting neuronal circuit information from such large datasets is still a daunting task. This webinar will outline the challenges of connectomics, explain the latest methodological developments that are bringing imaging and data analysis closer to the desired throughput, and provide insights into how this research can provide a deeper understanding of brain function and dysfunction.
During the webinar, the speakers will:
• Provide an overview of high-resolution connectomics and the methods currently used to create dense reconstructions of the brain
• Discuss new advances in the field that are enabling researchers to take the next quantum leap
• Present their own research and provide some thoughts on how connectomics might evolve in the future
• Discuss the limitations of what can be learned with these new approaches
• Answer your questions live during the webinar!
Participants:

Jeffrey Lichtman, M.D., Ph.D.
Harvard University
Cambridge, MA
Moritz Helmstaedter, M.D.
Max Planck Institute for Brain Research
Frankfurt, Germany
Questions? E-mail: webinar@aaas.org.
Produced by the Science/AAAS Custom Publishing Office and sponsored by ZEISS.

Monday, October 27, 2014

Improved care for stroke patients at home - Newry and Mourne area, Northern Ireland

Nothing in here talks about the recovery results are better doing it this way. So that is obviously not the reason for doing this. I bet it is cost saving and lack of medical staff. So you will need to ask uncomfortable questions and keep asking until they tell you the real reason.
http://newrytimes.com/2014/10/27/improved-care-for-stroke-patients-at-home/
To achieve the best possible outcomes for stroke patients, the Southern Trust aims to provide shorter intensive care in hospital followed by tailored support at home, says Angela McVeigh, Director of Older People and Primary Care Services at the Southern Health and Social Care Trust.
Angela McVeigh (seated, right), Director of Older People and Primary Care Services at the Southern Trust, with Newry and Mourne Community Stroke Team staff
“Getting specialised intensive care in hospital following a stroke can enable patients to leave hospital sooner, and continue their care in a home environment, with tailored support to achieve the best possible outcomes,” Mrs McVeigh says.
“Research shows that more than 75 per cent of strokes occur in people over 65 years of age and it can have a devastating impact on people’s lives affecting their ability to move, eat, speak or carry out simple tasks.
“The Community Stroke Team in Newry and Mourne works with patients and their carers on discharge from hospital and for up to a further 12 weeks in their own homes.
“The team works closely with medical and healthcare staff for the safe and appropriate discharge from hospital to ensure support networks are available in the home or alternative place of rehabilitation.”
Any patient referred to the team gets input from a range of professionals depending on their particular needs including a specialist stroke nurse, speech and language therapist, occupational therapist, physiotherapist, rehabilitation worker and social worker.
“The team provides assessment, information, advice and support to stroke patients and their families,” adds Mrs McVeigh. “Carers are vital in assisting the person with a stroke to come to terms with their illness and in making lifestyle changes.
“The carer is often involved in sessions to practice specific treatment, handling techniques and the use of equipment. To build strength and increase independence, some patients will have a home treatment programme developed with the therapist which they undertake every day with the support of a family member or carer.”

OMgp! Molecules that make Neuron Growth a Nogo

Ask your doctor exactly what they are doing post-stroke to make sure your axons are growing and extending properly. No answer or a blank look is a reason to drop that doctor immediately because they obviously know nothing about  axon pathfinding and neurite outgrowth.
 You want to recover? Don't you? Then we are going to have to fire one hell of a lot of doctors until they actually know something about how to recover from a stroke.  This is all part of us paying it forward for future survivors.  If we have to fire a lot of doctors to accomplish that that is a small price to pay for something our doctors should have been doing all along. Eg. keeping up with the current stroke research.
http://ucsdneuro.wordpress.com/2014/10/26/omgp-molecules-that-make-neuron-growth-a-nogo/

Prevalence of Brain Arteriovenous Malformations in First-Degree Relatives of Patients With a Brain Arteriovenous Malformation

For those that have AVMs.
http://stroke.ahajournals.org/content/45/11/3231.abstract?etoc
  1. Catharina J.M. Klijn, MD, PhD
+ Author Affiliations
  1. From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and Radiology (P.A.B.), Leiden University Medical Center, Leiden, The Netherlands.
  1. Correspondence to Janneke van Beijnum, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. E-mail J.vanBeijnum@gmail.com

Abstract

Background and Purpose—It is uncertain whether familial occurrence of brain arteriovenous malformations (BAVMs) represents coincidental aggregation or a shared familial risk factor. We aimed to compare the prevalence of BAVMs in first-degree relatives (FDRs) of patients with BAVM and the prevalence in the general population.
Methods—We sent a postal questionnaire to 682 patients diagnosed with a BAVM in 1 of 4 university hospitals to retrieve information about the occurrence of BAVMs among their FDRs. We calculated a prevalence ratio using the BAVM prevalence among FDRs and the prevalence from a Scottish population-based study (93 per 628 788 adults). A prevalence ratio of ≥9 with a lower limit of the 95% confidence interval of 3 was considered indicative of a shared familial risk factor.
Results—Informed consent was given by 460 (67%) patients, who had 2992 FDRs. We identified 3 patients with a FDR with a BAVM, yielding a prevalence ratio of 6.8 (95% CI, 2.2–21).
Conclusions—The prevalence of BAVMs in FDRs of patients with a BAVM was increased but did not meet our prespecified criterion for a shared familial risk factor. In combination with the low absolute risk of a BAVM in FDRs, our results do not support screening of FDRs for BAVMs.

Atherosclerotic Plaque in the Left Carotid Artery Is More Vulnerable Than in the Right

Well I didn't match the distribution normality. My right carotid dissected and is now completely closed up. The clot got thrown into the MCA of my right brain causing left sided hemiparesis.
http://stroke.ahajournals.org/content/45/11/3226.abstract?etoc

  1. Meike Vernooij, MD, PhD
+ Author Affiliations
  1. From the Departments of Epidemiology (M.S., Q.v.d.B., R.S.v.O., A.H., O.H.F., M.V.), Radiology (Q.v.d.B., A.v.d.L., M.V.), and Cardiology (J.J.W.), Erasmus MC, Rotterdam, The Netherlands.
  1. Correspondence to Meike Vernooij, MD, PhD, Erasmus MC, PO Box 2014, 3000 CA Rotterdam, The Netherlands. E-mail m.vernooij@erasmusmc.nl

Abstract

Background and Purpose—Ischemic stroke is more often diagnosed in the left hemisphere than in the right. It is unknown whether this asymmetrical prevalence relates to differences in carotid atherosclerosis. We compared atherosclerotic plaque prevalence, severity, and composition between left and right carotid arteries.
Methods—In a population-based cohort, carotid MRI scanning was performed in 1414 stroke-free participants (≥45 years). Using a multisequence MRI protocol, we assessed the prevalence, stenosis, and thickness of the plaque and its predominant component (ie, lipid core, intraplaque hemorrhage, calcification, or fibrous tissue in each carotid artery). Differences between left and right side were tested using paired t tests, McNemar test and Generalized Estimating Equation analyses.
Results—The majority (85%) of the participants had bilateral carotid plaques. Unilateral plaques were twice more prevalent on the left than on the right side (67% versus 33%; P<0.001). Plaque thickness was also greater on the left (3.1±1.2 versus 2.9±1.3 mm; P<0.001); degree of stenosis did not differ. Intraplaque hemorrhage and fibrous tissue were more prevalent on the left (9.1 versus 5.9%; P<0.001 and 45.0 versus 38.5%; P<0.001), whereas calcification occurred more often on the right (37.4 versus 31.6% at the left; P<0.001). Lipid was equally distributed.
Conclusions—Carotid atherosclerotic plaque size and composition are not symmetrically distributed. Predominance of intraplaque hemorrhage in left-sided carotid plaques suggests a greater vulnerability as opposed to right-sided plaques, which are more calcified and therefore considered more stable.