by PWeekly | Jul 11, 2016 | Articles, Cardiology, Demo Articles, Demo Tablet, Emergency Medicine, Guidelines, Hospital Medicine, Neurology, Primary Care, Recent Features, Slider
The American Heart Association and American Stroke Association (AHA/ASA) have updated guidelines on primary stroke prevention based on comprehensive and timely evidence from clinical investigations and research trials. Recommendations are included for controlling risk factors, using interventional approaches to atherosclerotic disease, and antithrombotic treatments for preventing stroke. The guidelines were published in Stroke and are available for free online at http://stroke.ahajournals.org. “One of the most important changes in the AHA/ASA guidelines is that newer anticoagulants can be used as alternatives to warfarin to prevent stroke in patients with atrial fibrillation (AF),” says James F. Meschia, MD, FAHA, who chaired the AHA/ASA committee that developed the recommendations. The guidelines note that although some of the new AF drugs are more expensive, they require less ongoing monitoring and therefore represent reasonable options for patients. Another key recommendation from the guidelines is that clinicians are urged to use of statins, along with diet and exercise, to help lower the stroke risk in patients at high risk for experiencing a stroke within the next 10 years. “In addition, the CHA2DS2-VASc is recommended for stratifying the risk for stroke,” says Dr. Meschia. “Patients with a score of 0 on the CHA2DS2-VASc do not require anticoagulants, but those with a score of 2 or higher should receive these therapies.” He adds that patients with a score of 1 on CHA2DS2-VASc can be considered for anticoagulants. Women & Stroke According to the AHA/ASA, women have higher stroke risks if they are pregnant, use oral contraceptives, use hormone replacement therapy, have migraines, and/or have depression. The guidelines recognize the different risk factors women face throughout their...
by PWeekly | Jun 7, 2016 | Articles, Emergency Medicine, Hospital Medicine, Neurology, Pain, Primary Care, Recent Features, Slider
Migraines affect more than 10% of all Americans and are three times more common in women than in men, according to data from the National Institute of Neurological Disorders and Stroke (NINDS). Although the link between migraine and stroke is not fully understood, research suggests that the two conditions have some clinical features that overlap. The NINDS has reported that risk factors for stroke with migraine-like features include being female, being older than 40, and having low cardiovascular risk profiles. Over the years, many studies have suggested that migraine is a risk factor for stroke. Some analyses have shown that stroke risks are twice as high in people who suffer from migraine with aura than those without aura. For women, stroke risks have been reported to be three times higher when they have migraine with aura. “To date, most of the research examining the link between stroke and migraine has shown that there is a correlation in migraineurs with aura,” says Teshamae S. Monteith, MD. Taking a Deeper Look For a study published in Neurology, Dr. Monteith and colleagues aimed to determine the association between migraine and stroke and a combination of vascular events, including stroke, heart attack, and death. Participants in the study were from the Northern Manhattan Study, a population-based cohort of stroke incidence. The participants were from an older, ethnically-diverse community in which the population was predominately Hispanic, a patient group that has historically been at a higher risk for stroke. The association between migraine and the combination of vascular events was estimated over an average follow-up of 11 years. After reviewing 1,292 people who reported...
by TimH | Apr 13, 2015 | Articles, Cardiology, Conference Coverage, Stroke
ISC 2015 New research was presented at ISC 2015, the annual International Stroke Conference, from February 11 to 13 in Nashville. The features below highlight some of the studies emerging from the conference that are relevant to emergency physicians. Differentiating Acute Stroke From Mimics The Particulars: At hospital admission, elevated blood pressure (BP) in acute stroke is common and has been linked to poor outcomes. However, little is known about the natural history of prehospital BP in suspected stroke patients. Data Breakdown: Investigators analyzed data on nearly 900 patients with emergency medical services dispatch codes for suspected stroke for a study. Average systolic BP levels were higher in acute stroke (155 mm Hg) when compared with stroke mimics (143 mm Hg), and higher in intracerebral hemorrhage (171 mm Hg) than both ischemic stroke (155 mm Hg) and transient ischemic attack (153 mm Hg). Take Home Pearl: Prehospital systolic BP appears to be higher in patients with acute stroke when compared with those who have stroke mimics and may help differentiate these patients. A Different Way to Predict Stroke Outcomes The Particulars: Elevated intracranial pressure (ICP) can help predict long-term neurologic deficits and mortality in stroke patients, but current methods for measuring ICP have limited accuracy. Optic nerve ultrasound may provide a non-invasive way to measure optic nerve sheath dimension for valuable ICP monitoring. Data Breakdown: For a study, bedside optic nerve ultrasound was performed on the day of admission and the following day among stroke patients. Significant differences in average optic nerve sheath diameter were observed between patients who died and those who did not. For every 0.1 cm...
by TimH | Oct 12, 2014 | Articles, Cardiology, Guidelines, Recent Features, Slider, Stroke
Fibromuscular dysplasia (FMD) has been defined as a non-atherosclerotic, non-inflammatory vascular disease that can result in arterial stenosis, occlusions, aneurysms, or dissections. Although the cause of FMD and its prevalence in the general population are unknown, research has shown that it has been reported in virtually every arterial bed. Most commonly, FMD affects the renal and extracranial carotid and vertebral arteries. When the renal artery is involved, the most frequent finding is hypertension. Carotid or vertebral artery FMD may lead to dizziness, pulsatile tinnitus, transient ischemic attack (TIA), or stroke. According to Jeffrey W. Olin, DO, FACC, FAHA, there is an average delay of 4 to 9 years from the time of the first symptom or sign to a diagnosis of FMD. “Many consider this disease rare, but in reality, the diagnosis is often overlooked,” he says. “Thus, it’s not considered in a differential diagnosis. In addition, FMD is poorly understood by many healthcare providers. Many of the signs and symptoms are non-specific, which in turn can lead clinicians down the wrong diagnostic pathway.” He notes that a delayed diagnosis can impair quality of life and result in poor outcomes. In 2014, the American Heart Association (AHA) released a scientific statement on FMD that addressed the state of the science and critical unanswered questions. “Over the last several years, we have learned that FMD is more common than previously thought,” says Dr. Olin, who chaired the AHA writing committee that developed the scientific statement. “FMD is frequently being discovered incidentally while imaging is performed for other reasons in asymptomatic patients without classic risk factors for atherosclerosis. The clinical manifestations...
by TimH | Sep 19, 2014 | Articles, Cardiology, Emergency Medicine, Guidelines, Hospital Medicine, Neurology, Recent Features, Slider, Stroke
Both men and women share many of the same high-risk predictors for stroke, such as smoking, family history, and physical inactivity. However, some risk factors are either exclusive to women or affect women disproportionately. The American Heart Association (AHA) and American Stroke Association (ASA) recently convened a panel of experts in neurology, obstetrics, cardiology, epidemiology, and internal medicine to review and assess the literature on stroke risk in adults. This resulted in the publishing of the first gender-specific AHA/ASA guidelines for stroke prevention in women. “The development of these guidelines is important because women differ from men in many ways with regard to stroke,” explains Cheryl B. Bushnell, MD, who chaired the AHA/ASA writing group that developed the document. Several characteristics can influence stroke risk and impact outcomes, including genetic differences in immunity, coagulation, hormonal factors, reproductive factors (eg, pregnancy and childbirth), and social factors. “Many of the unique risk factors for women present at younger ages due to things like oral contraceptive use and pregnancy complications,” Dr. Bushnell explains. “Recognition of stroke risk and identification of prevention strategies could start early in at-risk women.” Highlighting Key Recommendations Based on available evidence, the AHA/ASA guidelines categorized risk factors by those that were sex-specific, more prevalent in women, or similar between women and men (Table 1). Dr. Bushnell says it is critical to recognize that women with a history of hypertension or preeclampsia during pregnancy are at risk for stroke and hypertension later in life. “Before this guideline emerged, few providers and women knew about this risk,” she says. “The evidence for this relationship is strong, and multiple meta-analyses have...
