#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!
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!
#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
#Mondaytip
🧠Endovascular Management of LVO #stroke due to Intracranial Atherosclerotic Disease #ICAD
The #SPRINT approach:
Suspicion
Pretreatment
Retrieval
Infusion of antiplatelets
No-go decision
Treatment with angioplasty/stenting
From: https://j-stroke.org/journal/view.php?doi=10.5853/jos.2021.01375
#OpenAccess
#MondayTip
Transient ischemic attacks #Chameleons
☝️When TIA´s can look like something else
🧐We are always aware of #mimics, but sometimes we can miss a stroke or TIA if we don't consider chameleons
Can you share another one?
From: https://pn.bmj.com/content/14/1/23
#openacces
#MondayTip
#DWI can show areas of acute #ischemia within minutes of #stroke onset
☝️Some DWI lesions may be #reversible if blood flow is restored promptly👉DWI-IR
Prevalence, associated factors and clinical significance of DWIR-IR
Based on Nagaraja et al: https://www.neurology.org/doi/10.1212/WNL.0000000000009173
#MondayTip
High #Risk features in Nonstenotic #Carotid Plaque
🌒Beyond degree of #stenosis!
☝️You can use MRI, CTA, ultrasound, PET to evaluate
Intraplaque #hemorrhage, Thickness, Volume, Neovascularisation, Lipid core, #Ulceration, Thrombus, Calcifications, #Inflammation and +
References:
Vulnerable Carotid Plaques
🔗https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30035-3/abstract
High Risk carotid plaque Histopathology
🔗https://www.sciencedirect.com/science/article/abs/pii/S0895796717300091?via%3Dihub
PET in NS carotid plaques
🔗https://www.sciencedirect.com/science/article/abs/pii/S1071358123003835?via%3Dihub
Reclassification based on high-risk NS carotid plaques.
🔗https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.027970
#MondayTip
🧠In cardioembolic stroke we must look for the best moment to start anticoagulation combining the #lower risk of hemorrhagic #transformation and ischemic #recurrence ⚖️
👉Individualized strategy to start anticoagulation post EVT
(created from https://doi.org/10.5853/jos.2023.01578)
#Mondaytip
Pathophysiology of #pregnancy-related #stroke :
🌊Hemodynamic changes
🔗Vascular & connective tissue changes
🩸Changes in coagulation system
From: https://doi.org/10.1016/j.ncl.2018.09.010
#MondayTip
#Acute neurologic #worsening after AIS
🩸Spontaneous or rTPA/TNK-related bleed?
🛌BP dependent exam? flatten HoB, bolus IV, +/- pressors
🛑Reperfusion injury or reocclusion after EVT?
🪜Stuttering lacunar?
⚡️Non convulsive/post ictal state?
@caseyalbin Survival Guide
#MondayTip
👉Recurrent stroke after #PFO closure
Risk factors (univariate analysis):
⚖️Obesity
📈RoPE <7
🤕Migraine
🔗https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107448
💊Las terapias para ⬇️colesterol en prevención 2ria en ACVi:
🤔Solo para los ACV no 🫀-embolsico, con LDL>100 como dice guía AHA?
🤔Para todos los ACV/CIT como dice guía ESO?
☝️Si se indica, recordar utilidad de asociar estatinas+ezetimibe y 🎯<70 (x ahora)
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