World Stroke Organization #MondayTips
Every Monday, WSA Social Media Leader Rodrigo Guerrero publishes a #MondayTip on the WSA WorldStrokeEd Twitter account, covering a specific stroke related topic. You can find a compilation of our #MondayTips here!
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#MondayTip
Early neurological #deterioration in acute #lacunar stroke
📊15-20% of lacunar stroke
🕜Most common in the first 24-48hr
😥Associated with poor functional outcome
☝️Factors associated with END
From: https://doi.org/10.1177/17474930241273685
#MondayTip
#Lacunar ischaemic stroke is a combination of
🟢clinical findings suggestive of AIS
🟢due to a small subcortical ischaemic lesion
🟢thought to be due to cerebral small arterial disease #cSVD
https://doi.org/10.1177/23969873231219416
Clues to non cSVD etiologies in suspected lacunar AIS
#MondayTip
The #BrushSign in #CVT
Hypointensity of the subependymal & deep medullary veins in 🧠MRI
👉In CVT is associated with higher thrombus load
☝️This sign may be a marker of CVT severity and should prompt close monitoring during the acute phase
https://doi.org/10.1161/strokeaha.119.025342
#MondayTip
#Stroke in Bacterial #Meningitis
Cerebrovascular complications are #common in patients with bacterial meningitis and are associated with #unfavorable outcome and #death
🟢Cerebral infarction~9-25%
🔵CVT~1-10%
🔴ICH~1-7%
🟤SAH~1-5%
From https://doi.org/10.1161/SVIN.123.001435
🆓
#MondayTip
Lateral Medullary Region Arterial Supply
💡The lateral medulla is supplied by 5-6 small arterial branches
☝️Most lateral medullary infarcts result from vertebral artery compromise rather than PICA involvement
From CM Fisher, Kernes, and Kubik:
https://doi.org/10.1097/00005072-196107000-00001
#MondayTip
Ok, this is not actually a "tip", but we couldn't help but highlight the recent Leading Opinion paper by Bruce Campbell @TheRMH , on :
The current treatment and future direction of #hyperacute stroke care
#TNK #LVO
#openacces via @IntJStroke
https://journals.sagepub.com/doi/full/10.1177/17474930241267353
#MondayTip
#Cancer-associated stroke
🌎1 in 10 patients w/stroke also have comorbid cancer
☝️Cancer can also directly cause stroke
Mechanisms
🔸Tumor-induced hypercoagulability
🔸Direct invasion/compression of arteries
🔸Infection
🔸2ry effects of RT/CT
🔗https://doi.org/10.5853/jos.2023.03279
#MondayTip
☝️Cervical artery #dissection contributes to 2% of all ischemic strokes but up to 25% of ischemic stroke in adults <50 years of age
💎Predictors of ischemic stroke after #CAD
From: https://doi.org/10.1161/STR.0000000000000457
#OpenAccess
#MondayTip
Advances in Cerebral Venous Thrombosis
#CVT
From recent review by @Diana_A_Sousa and @LiaLucasNeto in @StrokeAHA_ASA
#OpenAcces
https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.123.044266
#MondayTip
#StaminaMRI study
💊High dose statin treatment effectively stabilized #sICAD on serial HR-MRI
☝️A significant % were non or poor responders
🎯Achieving a >50%📉in LDL-C🔗to👉good responders
https://doi.org/10.1136/jnnp-2019-320893
🆕#PCSK9i could⏫this effect
https://doi.org/10.3389/fnagi.2023.1127534
#MondayTip
#Missed Ischemic stroke in the ED:
☝️ If we don't recognize a stroke in the ED, the patient could miss the #opportunity for acute interventions
🚩 #Atypical symptoms from #posterior circulation stroke are most associated with misdiagnosis
🆓https://doi.org/10.1161/STROKEAHA.115.010613
#MondayTip
"New" drugs to know in the #cholesterol management
#LDL
💊Ezetimibe: already shown in TST to be a good add on in order to reach LDL targets
💊PCSK9 inh.: probable the most promising drugs. Waiting for ORION 4 (MACE outcomes)
💊Bempedoic Acid: good in statin intolerants
#MondayTip
The #Hyperdense MCA sign
🩸More seen with red cells-rich thrombi https://doi.org/10.1161/STROKEAHA.121.034289
🛑Specificity 95%/Sensibility~50% for arterial #occlusion
https://doi.org/10.1161/STROKEAHA.114.007036
🫀Associated with non-cardioembolic etiologies in MRCLEAN registry
https://doi.org/10.1161/STROKEAHA.119.027749
#MondayTip
🩸ICH Dawn of a New Era
🌎"ICH is a devastating disease, causing high rates of death, disability, and suffering across the world"
🎉2023 was a good year in ICH field:
INTERACT3
ENRICH
ANNEXa-1
💪and 2024 is not disappointing:
INTERACT4
SWITCH
🔗https://journals.sagepub.com/doi/10.1177/17474930241250259
#MondayTip
👉The more we look for #atrial fibrillation after #stroke, the more we find it,
BUT
The #AF-related risk of stroke varies in relation to the duration of cardiac #monitoring
eg:
🫀AF on 12 lead ECG➡️ 5x more risk than PCM-detected AF
🔗https://academic.oup.com/eurheartj/article-abstract/45/5/396/7453176?redirectedFrom=fulltext
#AFDAS
#Mondaytip
#SmallVesselDisease vs other causes of subcortical infarcts
☝️About 15% of recent small #subcortical infarcts or incidental DWI-positive lesions are due to #emboli from the 🫀or atheroma in the large head and neck arteries
From #STRIVE 🔗https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(23)00131-X/abstract
Great presentation and discussion at today‘s @WorldStrokeEd webinar about ICH! Well done @sheilambrasil @opontesnetoMD ! @FishingNeurons on the role of surgery in ICH @SWITCH_Trial @StrokeBern @MASStroke @Ash_Shoamanesh @BleedingStroke @laura_wsa
