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
☝️The detection rates of atrial #fibrillation varies between different cardiac #monitoring strategies
https://cp.neurology.org/content/4/5/386
🧠Do you want to know more? Join us in our next #webinar:
🫀A New Era in Cardiac Rhythm Monitoring Post-Stroke
👉https://world-stroke-academy.org/webinars/a-new-era-in-cardiac-rhythm-monitoring-post-stroke-discussions-between-neurologists-cardiologists/
#MondayTip
🩸#Antiphospholipid syndrome & Stroke
👉Testing for aPL should be considered in pts<50yo with AIS/TIA, and/or with Hx of autoimmune disease, VTE or obstetric morbidity
☝️Multidisciplinary approach is recommended to evaluate Dx & 2ry prevention
https://doi.org/10.1177/17474930221150349
#MondayTip
👩👵Women & stroke👳♀️👩🦱
📈Lifetime risk of stroke is ⬆️ than in men
📉Have #worse stroke #outcomes
🤰Have unique stroke risk factors (pregnancy, endogenous hormone levels, exogenous HT)
📊Underrepresented in clinical trials
Still a lot to do!
https://j-stroke.org/journal/view.php?number=466
#MondayTip
🧠Small vessel disease:
Any pathologic process that damages small end arteries/arterioles/venules/brain capillaries
Clinical 📸: lacunar stroke & cognitive impairment
☝️Others: motor impairment/parkinsonism/impaired balance/behavioral symptoms
https://bit.ly/3IAGiWX
#MondayTip
Early #reocclusion after mechanical #thrombectomy
📊Incidence~5% (<24hr & <7d)
🔮Predictors:
⬆️large artery atherosclerosis as etiology; high platelet count; transient reocc during EVT
⬇️statins;🫀embolic
↔️No association w/rTpa use
More⤵️
https://jnis.bmj.com/content/early/2022/11/03/jnis-2022-019382
#MondayTip
🧠Three 10pts scores to #predict functional #outcomes in patient w/ #BAO:
⚫️pc-ASPECTS: hypoattenuation on #CTA source images
🟣pc-CS: visibility/nonvisibility of VB side branches & PcoAs
⚪️BATMAN: quantify extent of BAO & the presence of #collateral circ from PComs
#MondayTip
#ClotBurden Score: 10 pts. 1 or 2 pts subtracted based on thrombus localization & extension, in anterior circ. #stroke
Patients w/ CBS>6 had:
⬆️ ASPECTS
⬇️ CBV & CBF volume
⬇️collateral score
⬇️final infarct size
👉Better clinical outcome
🔗http://www.ajnr.org/content/30/3/525
#MondayTip
Admission #hyperglycemia in acute #stroke patients is associated w/:
⬆️ mortality
🛏️longer hospital stay
🚶poor functional outcomes
Potential mechs of hyperglycemia-related🧠damage in stroke:
👉acidosis
👉oxidative stress
👉reperfusion injury
https://doi.org/10.15277/bjd.2016.089
#MondayTip
#Venous drainage territories
🟢Peripheral: cortical v. & SSS
🔵Central: galenic venous syst via deep cerebral v.
🟣Perisylvian: sup mcv, sphenoparietal & cavernous sinus
🟠Temporoparietal lobes: vein of Labbé, sup petrosal & transverse sinus
👉https://doi.org/10.1148/rg.352140129.pres
#MondayTip
The patient w/ a #stroke is > than an occluded artery
Is a #person, and the stroke affects:
-his/her body #structure & #function
-his/her #activities
-his/her #participation
-his/her #quality of life
#NeverForget
https://www.who.int/publications/m/item/icf-checklist
#ICF
Image from @artibiotics 🙌
#MondayTip
Thrombectomy beyond 24hr?🤔
Check this 2 registry-based studies
🧠#SelectLate:MT🆚BMT>24hr. Elegibility: case by case
mRS0-2👉38🆚10%
sICH👉10.1🆚1.7%
https://bit.ly/3WHjvyC
🧠#STAR:MT>24h🆚matched (6-24h)
mRS0-2👉18.8🆚34.9%
sICH👉10.2🆚7.6%
https://bit.ly/3jKejeC
#MondayTip
☝️Rates of stroke #chameleons (false negatives) range from 2-16%, depending on method used
👀Most studies agree in misdiagnosis-related factors:
🧑🦱Younger age
🤨Non specific, milder & transient symptoms
🥴PC symptoms: Dizziness/ nausea, vomiting
🧠FAST (-)ve
The #Mondaytip we owed you!
☝️Isolated cortical border zone infarcts (BZI) may be embolic in nature👉<frequently associated w/ hemodynamic compromise (HC)
☝️In contrast to external BZI, internal BZI are caused mainly by arterial stenosis/occlusion, or HC
https://pubs.rsna.org/doi/epdf/10.1148/rg.315105014
#MondayTip
Principles for future IS #cerebroprotective treatment research:
⏱️ Relation to #timing & succes of reperfusion therapy
🧠 Link to #specific tissue or target cell line
🎯 Targeting multiple #pathways in concert with polytherapy
#STAIR
🔗 https://jnnp.bmj.com/content/early/2022/12/06/jnnp-2022-330379?utm_source=alert&utm_medium=email&utm_campaign=jnnp&utm_content=latest&utm_term=10122022
#MondayTip
#Anterior Cerebral Artery #ACA Stroke
👉<5% of strokes: A1 diameter ~ 1/2 of MCA, majority of🩸flow➡️MCA
🦵weakness present in >80%
☝️Remember neuropsychological deficits (table)
🧠EVT: data suggest its feasibility & safety (more often as 2ry occlusions). 👀Anatomy‼️
#MondayTip
ICH & antithrombotics
👉Incidence: 0.3-0.9%/y
👉Worst outcome vs other ICH etiologies
👉Mortality: OAC>antiplatelets> no AT
👉Women received ⬇️ reversal agents , but no diffs in neurological deterioration, walking at 3m, mortality at 1y.
From @HanneKChr at #WSC2022