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Stroke Evaluation
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Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association
This scientific statement describes a path to optimizing care for patients who experience an in-hospital stroke. Although these patients are in a monitored environment, their evaluation and treatment are often delayed compared with patients presenting to the emergency department, contributing to higher rates of morbidity and mortality. Reducing delays and optimizing treatment for patients with in-hospital stroke could improve outcomes. This scientific statement calls for the development of hospital systems of care and targeted quality improvement for in-hospital stroke 2022-03-10 |
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A systematic review and meta-analysis on transcranial Doppler in diagnosing ischemic cerebrovascular disease
The incidence of ischemic cerebrovascular disease (ICVD) has been increasing, leading to disability and deaths among middle-aged and elderly people. Digital subtraction angiography (DSA) is the gold standard for diagnosing ICVD, but it is invasive, expensive, and complex to operate. Transcranial Doppler (TCD) ultrasound is characterized by high accuracy, simplicity, and low cost, and thus became the focus of this study 2021-11-12 |
Middle cerebral artery velocity dynamic response profile during exercise is attenuated following multiple ischemic strokes:
A case report
Blood flow regulation is impaired in people with stroke. However, the time course of change in middle cerebral artery velocity (MCAv) following repeated stroke at rest and during exercise remains unknown. In this case study, we provide novel characterization of the dynamic kinetic MCAv response profile to moderate-intensity exercise before and after repeated ischemic MCA stroke. The initial stroke occurred in the left MCA. At 3 months poststroke, left MCAv amplitude (Amp) was ~50% lower than the right. At the 6-month follow-up visit, MCAv Amp declined in both MCA with the left MCAv Amp ~50% lower than the right MCAv Amp. Following a second right MCA stroke, we report further decline in Amp for the left MCA. At the 3- and 6-month visit following the second stroke, the left MCAv Amp declined further (~10%). The right MCAv Amp dramatically decreased by 81.3% when compared to the initial study visit. The MCAv kinetic analysis revealed a marked impairment in the cerebrovascular response to exercise following stroke. We discuss potential pathophysiological mechanisms contributing to poststroke cerebrovascular dysfunction and the need to test therapeutic interventions (such as exercise) that might attenuate cerebrovascular decline in people following stroke.
2020-04-01
A case report
Blood flow regulation is impaired in people with stroke. However, the time course of change in middle cerebral artery velocity (MCAv) following repeated stroke at rest and during exercise remains unknown. In this case study, we provide novel characterization of the dynamic kinetic MCAv response profile to moderate-intensity exercise before and after repeated ischemic MCA stroke. The initial stroke occurred in the left MCA. At 3 months poststroke, left MCAv amplitude (Amp) was ~50% lower than the right. At the 6-month follow-up visit, MCAv Amp declined in both MCA with the left MCAv Amp ~50% lower than the right MCAv Amp. Following a second right MCA stroke, we report further decline in Amp for the left MCA. At the 3- and 6-month visit following the second stroke, the left MCAv Amp declined further (~10%). The right MCAv Amp dramatically decreased by 81.3% when compared to the initial study visit. The MCAv kinetic analysis revealed a marked impairment in the cerebrovascular response to exercise following stroke. We discuss potential pathophysiological mechanisms contributing to poststroke cerebrovascular dysfunction and the need to test therapeutic interventions (such as exercise) that might attenuate cerebrovascular decline in people following stroke.
2020-04-01
The Effect of Stroke on Middle Cerebral Artery Blood Flow Velocity Dynamics During Exercise
Previous work demonstrates that older adults have a lower response in the middle cerebral artery velocity (MCAv) to an acute bout of moderate-intensity exercise when compared with young adults. However, no information exists regarding MCAv response to exercise after stroke. We tested whether MCAv response to an acute bout of moderate-intensity exercise differed between participants 3 months after stroke and an age- and sex-matched control group of older adults (CON). A secondary objective was to compare MCAv response between the stroke- and non-stroke-affected MCAv
2020-04-15
Previous work demonstrates that older adults have a lower response in the middle cerebral artery velocity (MCAv) to an acute bout of moderate-intensity exercise when compared with young adults. However, no information exists regarding MCAv response to exercise after stroke. We tested whether MCAv response to an acute bout of moderate-intensity exercise differed between participants 3 months after stroke and an age- and sex-matched control group of older adults (CON). A secondary objective was to compare MCAv response between the stroke- and non-stroke-affected MCAv
2020-04-15
Vascular Health is Associated with Amyloid-B in Cognitively Normal Older Adults
Background: Vascular health is closely related to Alzheimer’s disease (AD). Vascular function measured by flow mediated dilation (FMD) or pulsatility index (PI) can be used as marker of peripheral and central vascular health but is poorly characterized in those at risk for AD.
Objective: To assess the relationship of peripheral and central vascular function with amyloid- (A) and white matter lesion burden among cognitively normal older adults
2020-04-01
Background: Vascular health is closely related to Alzheimer’s disease (AD). Vascular function measured by flow mediated dilation (FMD) or pulsatility index (PI) can be used as marker of peripheral and central vascular health but is poorly characterized in those at risk for AD.
Objective: To assess the relationship of peripheral and central vascular function with amyloid- (A) and white matter lesion burden among cognitively normal older adults
2020-04-01
Dynamics of middle cerebral artery blood flow velocity during moderate-intensity exercise
The dynamic response to a stimulus such as exercise can reveal valuable insights into systems control in health and disease that are not evident from the steady-state perturbation. However, the dynamic response profile and kinetics of cerebrovascular function have not been determined to date. We tested the hypotheses that bilateral middle cerebral artery blood flow mean velocity (MCAV) increases exponentially following the onset of moderate intensity exercise in 10 healthy young subjects. The MCAV response profiles were well fit to a delay (TD) exponential (time constant, ) model with substantial agreement for baseline [left (L): 69, right (R): 64 cm/s, coefficient of variation (CV) 11%], response amplitude (L: 16, R: 13 cm/s, CV 23%), TD (L: 54, R: 52 s, CV 9%), (L: 30, R: 30 s, CV 22%), and mean response time (MRT) (L: 83, R: 82 s, CV 8%) between left and right MCAV as supported by the high correlations (e.g., MRT r 0.82, P 0.05) and low CVs. Test-retest reliability was high with CVs for the baseline, amplitude, and MRT of 3, 14, and 12%, respectively. These responses contrasted markedly with those of three healthy older subjects in whom the MCAV baseline and exercise response amplitude were far lower and the kinetics slowed. A single older stroke patient showed baseline ipsilateral MCAV that was lower still and devoid of any exercise response whatsoever. We conclude that kinetics analysis of MCAV during exercise has significant potential to unveil novel aspects of cerebrovascular function in health and disease.
2020-02-27
The dynamic response to a stimulus such as exercise can reveal valuable insights into systems control in health and disease that are not evident from the steady-state perturbation. However, the dynamic response profile and kinetics of cerebrovascular function have not been determined to date. We tested the hypotheses that bilateral middle cerebral artery blood flow mean velocity (MCAV) increases exponentially following the onset of moderate intensity exercise in 10 healthy young subjects. The MCAV response profiles were well fit to a delay (TD) exponential (time constant, ) model with substantial agreement for baseline [left (L): 69, right (R): 64 cm/s, coefficient of variation (CV) 11%], response amplitude (L: 16, R: 13 cm/s, CV 23%), TD (L: 54, R: 52 s, CV 9%), (L: 30, R: 30 s, CV 22%), and mean response time (MRT) (L: 83, R: 82 s, CV 8%) between left and right MCAV as supported by the high correlations (e.g., MRT r 0.82, P 0.05) and low CVs. Test-retest reliability was high with CVs for the baseline, amplitude, and MRT of 3, 14, and 12%, respectively. These responses contrasted markedly with those of three healthy older subjects in whom the MCAV baseline and exercise response amplitude were far lower and the kinetics slowed. A single older stroke patient showed baseline ipsilateral MCAV that was lower still and devoid of any exercise response whatsoever. We conclude that kinetics analysis of MCAV during exercise has significant potential to unveil novel aspects of cerebrovascular function in health and disease.
2020-02-27
Cardiovascular disease risk is associated with middle cerebral artery blood flow velocity in older adults
Purpose: The aim of this study was to evaluate the relationship of cardiovascular disease (CVD) on middle cerebral blood flow velocity (MCAv) at rest and during exercise. A secondary aim was to explore the relationship between MCAv and 1) the presence of white matter lesions and 2) cognitive function.
2020-02-24
Purpose: The aim of this study was to evaluate the relationship of cardiovascular disease (CVD) on middle cerebral blood flow velocity (MCAv) at rest and during exercise. A secondary aim was to explore the relationship between MCAv and 1) the presence of white matter lesions and 2) cognitive function.
2020-02-24
Transcranial Doppler: An Introduction for Primary Care Physicians
Transcranial Doppler (TCD) is a diagnostic tool that can be used at bedside to assess the cerebral vasculature noninvasively. It is inexpensive, safe, and reliable when compared with other techniques. It can be repeated multiple times and can be used for continuous monitoring if needed. Screening of children with sickle cell disease to assess and prevent ischemic strokes and monitoring for vasospasm after subarachnoid hemorrhage are well established, evidenced based utilizations of TCD. It is useful for the evaluation of occlusive intracranial vascular lesions with many emerging indications in the management of ischemic stroke. TCD with micro-bubble enhancement has comparable sensitivity to transesophageal echocardiogram in detecting right-to-left atrial cardiac shunts. TCD is underused as a clinical tool despite well established indications. The pressure to contain increasing medical cost will likely result in increased utilization of this test in future. ( J Am Board Fam Med 2007;20:65–71.)
2019-04-26
Transcranial Doppler (TCD) is a diagnostic tool that can be used at bedside to assess the cerebral vasculature noninvasively. It is inexpensive, safe, and reliable when compared with other techniques. It can be repeated multiple times and can be used for continuous monitoring if needed. Screening of children with sickle cell disease to assess and prevent ischemic strokes and monitoring for vasospasm after subarachnoid hemorrhage are well established, evidenced based utilizations of TCD. It is useful for the evaluation of occlusive intracranial vascular lesions with many emerging indications in the management of ischemic stroke. TCD with micro-bubble enhancement has comparable sensitivity to transesophageal echocardiogram in detecting right-to-left atrial cardiac shunts. TCD is underused as a clinical tool despite well established indications. The pressure to contain increasing medical cost will likely result in increased utilization of this test in future. ( J Am Board Fam Med 2007;20:65–71.)
2019-04-26
Isolated pulmonary arteriovenous fistula: insights from diagnosing young-onset stroke
Case Report
Abstract: Paradoxical embolism (PE) is considered one of the main causes in young stroke patients. The right-to-left shunt (RLS) including both intracardiac and intrapulmonary shunt is the most common cause of paradoxical embolism. Intracardiac shunt through a patent foramen oval (PFO) has already been widely reported. Rarely, paradoxical embolism can also develop at pulmonary level, such as in patients with pulmonary arteriovenous fistula (PAVF). Here we reported a case of a 43-year-old woman who presenting with an ischemic stroke and got a RoPE score of 7. She was found to have a five-degree RLS on contrast transcranial Doppler (cTCD). Intrapulmonary shunt was implied by delayed appearance of microbubbles, observed on transthoracic contrast echocardiography (TTCE). Further pulmonary angiography confirmed a PAVF. After percutaneous transcatheter embolization (TCE), RLS together with the risk of recurrent stroke was removed. As a treatable cause of ischemic stroke in the young onset stroke, PAVF should not be ignored. An optimized process is recommended to screen and confirm PAVF in young cryptogenic stroke (CS) patients.
2019-03-11
Case Report
Abstract: Paradoxical embolism (PE) is considered one of the main causes in young stroke patients. The right-to-left shunt (RLS) including both intracardiac and intrapulmonary shunt is the most common cause of paradoxical embolism. Intracardiac shunt through a patent foramen oval (PFO) has already been widely reported. Rarely, paradoxical embolism can also develop at pulmonary level, such as in patients with pulmonary arteriovenous fistula (PAVF). Here we reported a case of a 43-year-old woman who presenting with an ischemic stroke and got a RoPE score of 7. She was found to have a five-degree RLS on contrast transcranial Doppler (cTCD). Intrapulmonary shunt was implied by delayed appearance of microbubbles, observed on transthoracic contrast echocardiography (TTCE). Further pulmonary angiography confirmed a PAVF. After percutaneous transcatheter embolization (TCE), RLS together with the risk of recurrent stroke was removed. As a treatable cause of ischemic stroke in the young onset stroke, PAVF should not be ignored. An optimized process is recommended to screen and confirm PAVF in young cryptogenic stroke (CS) patients.
2019-03-11