Stroke
Aspirin cuts risk of clots, DVT by a third - new study
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Low dose aspirin lowers the occurrence of new venous blood clots - and represents a reasonable treatment option for patients who are not candidates for long-term anticoagulant drugs, such as warfarin, according to a new study published in today’s issue of Circulation.
“The study provides clear, consistent evidence that low-dose aspirin can help to prevent new venous blood clots and other cardiovascular events among people who are at risk because they have already suffered a blood clot,” says the study’s lead author, University of Sydney Professor, John Simes.
“The treatment effect of aspirin is less than can be achieved with warfarin or other new generation direct thrombin inhibitors, which can achieve more than an 80 per cent reduction in adverse circulatory and cardiopulmonary events.
ADHD drugs not linked to increased stroke risk among children
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Children who take medication to treat attention deficit hyperactivity disorder (ADHD) don’t appear to be at increased stroke risk, according to a study presented at the American Stroke Association’s International Stroke Conference 2014.
In a study of 2.5 million 2- to 19-year-olds over a 14-year period, researchers compared stimulant medication usage in children diagnosed with ischemic or hemorrhagic stroke to stimulant usage in children without stroke. Researchers found no association between stroke risk and the use of ADHD stimulant medications at the time of stroke or at any time prior to stroke.
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Note: Actual presentation is 5:20 p.m. PT Wednesday, Feb. 12, 2014.
Follow news from the American Stroke Association’s International Stroke Conference 2014 via Twitter: @HeartNews #ISC14.
Surgical procedure appears to improve outcomes after bleeding stroke
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A minimally invasive procedure to remove blood clots in brain tissue after hemorrhagic stroke appears safe and may also reduce long-term disability, according to late-breaking research presented at the American Stroke Association’s International Stroke Conference 2013.
Of the hundreds of thousands of Americans who have intracerebral hemorrhages (ICH) each year, most are severely debilitated, said Daniel Hanley, M.D., lead author and professor of neurology at Johns Hopkins School of Medicine in Baltimore, Md.
ICH is the most common type of bleeding stroke. It occurs when a weakened blood vessel inside the brain ruptures and leaks blood into surrounding brain tissue, causing neurological damage. There is not a specific evidence-based targeted treatment recommended for ICH and there is no long-term randomized data on surgical treatment.
In one-year results of the Phase II study, MISTIE (Minimally Invasive Surgery plus rtPA for Intracerebral Hemorrhage Evacuation), researchers found that patients treated with surgery and a clot- busting drug had less disability, spent less time in the hospital and were less likely to be in a long-term care facility than other ICH patients.
Disappearing bacterium may protect against stroke
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A new study by NYU School of Medicine researchers reveals that an especially virulent strain of the gut bacterium Helicobacter pylori (H. pylori) isn’t implicated in the overall death rate of the U.S. population, and may even protect against stroke and some cancers. The findings, based a nationwide health survey of nearly 10,000 individuals over a period of some 12 years, are published online, January 9, in the journal Gut.
Those individuals carrying the most virulent strain of H. pylori, the study found, had a 55 percent reduced risk of deaths from stroke compared with their counterparts who were not infected with H. pylori. Participants with the most virulent strain also had a 45 percent reduced risk of death from lung cancer.
These surprising findings emerged from an analysis by Yu Chen, PhD, MPH, associate professor of population health and environmental medicine, and Martin J. Blaser, MD, professor of internal medicine and professor of microbiology, of individuals who participated in a national survey designed to assess the health and nutritional status of adults and children in the United States. Previous studies by Dr. Blaser have confirmed the bacterium’s link to gastric diseases ranging from gastritis to stomach cancer. He and Dr. Chen have more recently shown that H. pylori may protect against childhood asthma. The most virulent H. pylori strains have a gene called cagA.
“The significance of this study is that this is a prospective cohort of participants representative of the U.S. population with a long follow-up,” says Dr. Chen. “We studied both the overall H. pylori as well as cagA strain of H. pylori, which is more interactive with the human body. We found that H. pylori is not related to the risk of death from all causes, despite it being related to increased risk of death from gastric cancer.”
Kirk leaves rehab center
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Sen. Mark Kirk, who suffered a major stroke in January, has left the Rehabilitation Institute of Chicago and will continue treatment there as an outpatient, his family and an aide said Thursday.
“We are happy to say … Mark has progressed to the point where he can move home with his family,” according to a news release Thursday from unidentified relatives.
Kirk already has left the rehabilitation institute and “will be staying with various family members during his continued recovery,” Andrew Flach, his communications director, said Thursday.
One official familiar with Kirk’s recovery said the goal is for him to return to the Senate in the fall after the congressional recess in August. The official spoke on condition of anonymity because he was not authorized to speak about the senator’s recovery.
Singing after stroke? Why rhythm and formulaic phrases may be more important than melody
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After a left-sided stroke, many individuals suffer from serious speech disorders but are often able to sing complete texts relatively fluently. Researchers at the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany, have now demonstrated that it is not singing itself that is the key. Instead, rhythm may be crucial. Moreover, highly familiar song lyrics and formulaic phrases were found to have a strong impact on articulation – regardless of whether they were sung or spoken. The results may lead the way to new rehabilitative therapies for speech disorders.
When a stroke damages speech areas in the brain’s left hemisphere, sufferers often have severe difficulties speaking – a condition known as non-fluent aphasia. Sometimes the inability to speak spontaneously is permanent. However, there are frequent cases of aphasics who are able to sing song lyrics and formulaic phrases relatively fluently. Until now, this astonishing observation has been explained by the fact that the right brain hemisphere, which supports important functions of singing, remains intact. Singing was thought to stimulate areas in the right hemisphere, which would then assume the function for damaged left speech areas. A treatment method known as Melodic Intonation Therapy is based on this idea.
Stroke centers no worse at weekend treatment
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Hospitals that have been designated as “stroke centers” may provide just as good care on the weekend as on weekdays, new findings suggest.
That’s important because previous studies have hinted that people who come to the hospital after having a stroke don’t do as well if they’re admitted over the weekend, when nurses and specialists might be stretched extra thin.
“This is a big concern among the physician community because we all know that not every hospital has the capacity to treat those patients on the weekend,” said Dr. Ying Xian, who studies stroke care at the Duke Clinical Research Institute in Durham, North Carolina and wasn’t involved in the new study.
Regional differences in the care of acute stroke patients
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Considerable regional differences exist in the treatment of patients with acute cerebral infarction. This is the finding presented by Erwin Stolz and his co-authors in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108[36]: 607).
The prognosis for patients with stroke largely depends on a rapid, standardized first response. Across the German federal state of Hesse, there are great differences in the time interval between symptom onset and admission to hospital or transfer to a specialist stroke unit. Percentages of patients who receive treatment with drugs that break down the blood clot (thrombolysis) also vary greatly, more than was expected. The average thrombolysis rate in patients admitted to hospital within 3 hours after the stroke was 19%, but rates varied regionally between 6% and 35%.
The authors base their study on data from the mandatory quality assurance program for stroke in Hesse. They argue that improvement is needed; in particular, they believe that treatment paths and care structures within individual hospitals must be analyzed more closely.
Scripps Research scientists find way to block stress-related cell death
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Scientists from the Florida campus of The Scripps Research Institute have uncovered a potentially important new therapeutic target that could prevent stress-related cell death, a characteristic of neurodegenerative diseases such as Parkinson’s, as well as heart attack and stroke.
In the study, published recently in the journal ACS Chemical Biology, the scientists showed they could disrupt a specific interaction of a critical enzyme that would prevent cell death without harming other important enzyme functions.
The enzyme in question is c-jun-N-terminal kinase (JNK), pronounced “junk,” which has been implicated in many processes in the body’s response to stresses, such as oxidative stress, protein misfolding, and metabolic disorder. JNK also plays an important role in nerve cell survival and has become a target for drugs to treat neurodegenerative disorders such as Parkinson’s disease.
Treating mild strokes with clot-busting drug could save $200 million annually, study shows
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Treating mild strokes with the clot-busting drug approved for severe stroke could reduce the number of patients left disabled and save $200 million a year in disability costs, according to new research from the University of Cincinnati (UC).
The study led by Pooja Khatri, MD, an associate professor in the department of neurology, examined the public health impact of treating mild strokes with the clot-busting drug intravenous tissue plasminogen activator (tPA). It is being presented Wednesday, Feb. 9, in Los Angeles at International Stroke Conference 2011, the annual meeting of the American Stroke Association.
The research is part of the Greater Cincinnati/Northern Kentucky Stroke Study, begun in 1993 at the UC College of Medicine, which is funded by the National Institutes of Health (NIH) and identifies all hospitalized and autopsied cases of stroke and transient ischemic attack (TIA) in a five-county region. The NIH also funded the study led by Khatri.
Hope for stroke victims
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Much of the devastation of stroke and head trauma is due to damage caused the overproduction of a substance in the brain called glutamate. Preventing this damage has been impossible, until now, as many drugs don’t cross the so-called blood-brain barrier, and those that do often don’t work as intended. But a method originally devised at the Weizmann Institute of Science may, in the future, offer a way to avert such glutamate-induced harm.
Prof. Vivian I. Teichberg of the Institute’s Neurobiology Department first demonstrated a possible way around these problems in 2003. Glutamate – a short-lived neurotransmitter – is normally all but absent in brain fluids. After a stroke or injury, however, the glutamate levels in brain fluid become a flood that over-excites the cells in its path and kills them. Instead of attempting to get drugs into the brain, Teichberg had the idea that one might be able to transport glutamate from the brain to the blood using the tiny “pumps,” or transporters, on the capillaries that work on differences in glutamate concentration between the two sides. Decreasing glutamate levels in blood would create a stronger impetus to pump the substance out of the brain. He thought that a naturally-occurring enzyme called glutamate-oxaloacetate transaminase (GOT, for short) could “scavenge” blood glutamate, significantly lowering its levels. By 2007, Teichberg and his colleagues had provided clear evidence of the very strong brain neuroprotection that oxolacetate (a chemical similar to GOT) afforded rats exposed to a head trauma.
Two new studies – conducted by Fransisco Campos and others from the lab of Prof. Jose Castillo in theUniversity of Santiago de Compostela, Spain – now provide a definitive demonstration of Teichberg’s results.
Most Medicare stroke patients rehospitalized or dead within year
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Nearly two-thirds of Medicare beneficiaries discharged from hospitals after ischemic stroke die or are readmitted within one year, researchers report in Stroke: Journal of the American Heart Association.
Stroke is the second leading cause of hospital admissions among older adults in the United States, according to American Heart Association/American Stroke Association statistics. Ischemic stroke, which occurs as a result of an obstruction within a blood vessel supplying blood to the brain, accounts for 87 percent of all strokes.
Only a few contemporary studies have examined the full burden of hospital readmission and death after ischemic stroke, said Gregg C. Fonarow, M.D., study lead author and professor of cardiovascular medicine at the University of California-Los Angeles.
UK starts world’s first stroke stem cell trial
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Doctors in Scotland working with British biotech company ReNeuron have injected stem cells into the brain of a man in a pioneering clinical trial to test the safety of a therapy for patients disabled by stroke.
The trial is the first in the world to use neural stem cell therapy in stroke patients, its organisers said on Tuesday, and external experts said it was grounds for “cautious optimism.”
Keith Muir of the University of Glasgow’s Institute of Neuroscience and Psychology, the principal investigator, said the surgery on the first patient, a man in his 60s, had gone well and he had been discharged from hospital.
Study reveals why brain has limited capacity for repair after stroke, IDs new drug target
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Stroke is the leading cause of adult disability, due to the brain’s limited capacity for recovery. Physical rehabilitation is the only current treatment following a stroke, and there are no medications available to help promote neurological recovery.
Now, a new UCLA study published in the Nov. 11 issue of the journal Nature offers insights into a major limitation in the brain’s ability to recover function after a stroke and identifies a promising medical therapy to help overcome this limitation.
Researchers interested in how the brain repairs itself already know that when the brain suffers a stroke, it becomes excitable, firing off an excessive amount of brain cells, which die off. The UCLA researchers found that a rise in a chemical system known as “tonic inhibition” immediately after a stroke causes a reduction in this level of excitability.
Key to blood-brain barrier opens way for treating Alzheimer’s and stroke
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While the blood-brain barrier (BBB) protects the brain from harmful chemicals occurring naturally in the blood, it also obstructs the transport of drugs to the brain. In an article in Nature scientists at the Swedish medical university Karolinska Institutet now present a potential solution to the problem. The key to the BBB is a cell-type in the blood vessel walls called pericytes, and the researchers hope that their findings will one day contribute to new therapies for diseases like Alzheimer’s and stroke.
“Our new results show that the blood-brain barrier is regulated by pericytes, and can be opened in a way that allows the passage of molecules of different sizes while keeping the brain’s basic functions operating properly,” says Christer Betsholtz, professor of vascular biology at the Department of Medical Biochemistry, who has led the study.
The blood-brain barrier is a term denoting the separation of blood from tissue by blood vessels that are extremely tight? Impermeable?. In other organs, the capillary walls let certain substances carried by the blood, such as the plasma proteins albumin and immunoglobulin, out into the surrounding tissue. In the brain, however, this pathway is closed off. This is essential for many reasons, one being that the plasma proteins are harmful to nerve cells.
