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Ahmed Koriesh
@drkoriesh
Director Hospital Neurology Service @ Cleveland Clinic Florida Comprehensive Stroke Center Director @ Cleveland Clinic Florida Vascular Neurology, Medical Educa
Weston, Florida
Joined September 2025
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đ§đľđśđťđ¸ đđźđ đ¸đťđźđ đđľđŽđ đŚđđđ đśđ? đ§đľđśđťđ¸ đŽđ´đŽđśđť.
đ Itâs not âasymptomatic AFâ â and it matters for stroke prevention.
A very common misconception:
đŚđđđ đąđźđ˛đ đĄđ˘đ§ đşđ˛đŽđť âđŽđđżđśđŽđš đłđśđŻđżđśđšđšđŽđđśđźđť đđśđđľđźđđ đđđşđ˝đđźđşđ.â
đđ đ°đšđŽđđđśđłđśđ°đŽđđśđźđť đśđ đťđźđ đŻđŽđđ˛đą đźđť đđđşđ˝đđźđşđ â itâs based on đľđźđ đđľđ˛ đżđľđđđľđş đśđ đąđ˛đđ˛đ°đđ˛đą.
đŚđź, đđľđŽđ đśđ đ°đźđťđđśđąđ˛đżđ˛đą đđ đđ đŚđđđ?
đšÂ đđšđśđťđśđ°đŽđš đđ
AF documented on đŽ đđđżđłđŽđ°đ˛ đđđ âĽ30 đđ˛đ°đźđťđąđ
(symptoms may be present or absent â irrelevant), including:
12-lead ECG, Holter monitor, event monitor, Zio / patch monitors.
đšÂ đŚđđŻđ°đšđśđťđśđ°đŽđš đđ (đŚđđđ)
AF detected by đťđźđť-đđđżđłđŽđ°đ˛ đşđ˛đđľđźđąđ, such as:
Implantable loop recorders, pacemakers / ICDs (atrial lead), smartwatch irregular rhythm alerts.
â ď¸Â đđ
đ°đ˛đ˝đđśđźđť:
Apple Watch đđđ đŽđ˝đ˝Â uses two electrodes (finger on crown) â this is đŽ đđđżđłđŽđ°đ˛ đđđ, not SCAF.
đŞđľđ đąđźđ˛đ đŚđđđ đşđŽđđđ˛đż?
⢠SCAF episodes >6 đşđśđťđđđ˛đ are associated with:
â Higher likelihood of progression to clinical AF
â ~2â2.5Ă increased stroke risk
đđđ đđľđ˛ đżđ˛đŽđš đąđ˛đŻđŽđđ˛ đśđ: đŚđľđźđđšđą đđ˛ đŽđťđđśđ°đźđŽđ´đđšđŽđđ˛ đźđż đťđźđ?
Anticoagulation depends on đ˝đżđśđşđŽđżđ đđ đđ˛đ°đźđťđąđŽđżđ đ˝đżđ˛đđ˛đťđđśđźđť.
đšÂ đŁđżđśđşđŽđżđ đ˝đżđ˛đđ˛đťđđśđźđť (đťđź đ˝đżđśđźđż đđđżđźđ¸đ˛):
ARTESIA â modest stroke reduction, â bleeding
NOAH-AFNET â no clear net benefit
âĄď¸Â đđťđđśđ°đźđŽđ´đđšđŽđđśđźđť đżđ˛đşđŽđśđťđ đ°đźđťđđżđźđđ˛đżđđśđŽđš
đšÂ đŚđ˛đ°đźđťđąđŽđżđ đ˝đżđ˛đđ˛đťđđśđźđť (đ˝đżđśđźđż đđđżđźđ¸đ˛ / đđŚđ¨đŚ):
ARTESIA subgroup:
⢠Stroke/SE 1.20% vs 3.14% / year
⢠HR 0.40
â˘Â ~7% absolute risk reduction at 3.5 years
âĄď¸Â đ đźđđ đťđ˛đđżđźđšđźđ´đśđđđ đŽđťđđśđ°đźđŽđ´đđšđŽđđ˛
đ§đŽđ¸đ˛-đľđźđşđ˛
âď¸Â đŚđđđ â đŽđđđşđ˝đđźđşđŽđđśđ° đđ
âď¸ AF is defined by đąđ˛đđ˛đ°đđśđźđť đşđ˛đđľđźđą, not symptoms
âď¸ Anticoagulation differs for đ˝đżđśđşđŽđżđ đđ đđ˛đ°đźđťđąđŽđżđ đ˝đżđ˛đđ˛đťđđśđźđť
âď¸ Context matters â especially đ˝đżđśđźđż đđđżđźđ¸đ˛
đ§đľđ˛ đżđ˛đŽđš đžđđ˛đđđśđźđť đśđđťâđ âđđżđ˛ đđľđ˛đ đđđşđ˝đđźđşđŽđđśđ°?â
đđâđ âđđźđ đđŽđ đđ đąđ˛đđ˛đ°đđ˛đą â đŽđťđą đđľđŽđâđ đđľđ˛ đđđżđźđ¸đ˛ đżđśđđ¸?â
#Stroke #AtrialFibrillation #SCAF #CardioNeurology #StrokePrevention #VascularNeurology #ClinicalTrials #ARTESIA #NOAHAFNET #EvidenceBasedMedicine
https://t.co/cvBRks524a
đđđŽđš đđťđđśđđľđżđźđşđŻđźđđśđ° đ§đľđ˛đżđŽđ˝đ â đđ đđľđ˛đżđ˛ đŽ đżđźđšđ˛ đłđźđż đđźđťđ´-đđ˛đżđş đđđ˛?
đđđŽđš đŽđťđđśđđľđżđźđşđŻđźđđśđ° = đđťđđśđ˝đšđŽđđ˛đšđ˛đ + đđťđđśđ°đźđŽđ´đđšđŽđťđ
A common clinical question in stroke prevention:
Patient with AF on DOAC presents with lacunar or ICAD related stroke
đ Should we keep him on đšđźđťđ´-đđ˛đżđş dual therapy for better prevention?
Recent clinical trials from both cardiology and neurology now give us clearer guidance:
⸝
đđ˛đ đżđ˛đ°đ˛đťđ đđżđśđŽđšđ:
đš đđ§đđŚ-đĄđŠđđ (JAMA Neurology 2025)
AF + non-cardioembolic stroke (atherothrombotic, lacunar, ICAD)
âĄď¸ DOAC alone is better than DOAC + antiplatelet
⢠Bleeding risk more than doubled with dual therapy (19% vs 8.6%)
đš đđŁđđ-đđđ (NEJM 2024)
AF + stable CAD
âĄď¸ Edoxaban monotherapy was safer than Edoxaban + single antiplatelet
⢠Lower net adverse clinical events with monotherapy
⢠Major bleeding significantly reduced (4.7% vs 14.2%)
đš đđ¤đ¨đđ§đđ (NEJM 2024)
AF + stable CAD
âĄď¸ Anticoagulation alone was safer (trial stopped early due to higher bleeding with dual)
⢠Major bleeding markedly increased (10.2% vs 3.4%) with dual therapy
đš Parallel cardiology evidence (AFIRE, AUGUSTUS, others)
Consistent message: once coronary disease is stable, anticoagulation alone is safer.
đđźđťđ´-đđ˛đżđş đđđŽđš đđťđđśđđľđżđźđşđŻđźđđśđ°đ = đŽâđŻĂ đĽđśđđ¸ đźđł đ đŽđˇđźđż đđšđ˛đ˛đąđśđťđ´
⸝
đđşđ˝đźđżđđŽđťđ đ°đšđśđťđśđ°đŽđš đ°đźđťđđ˛đ
đ:
đ¸ đŚđľđźđżđ-đđ˛đżđş dual therapy is be appropriate for:
⢠Recent stent (cardiac, carotid, intracranial), Acute coronary syndrome
⢠Highly selected cases with acute ICAD-related stroke and concurrent AF (individualized, time-limited)
đ¸ For đđźđťđ´-đđ˛đżđş, evidence increasingly supports moving away from chronic antiplatelet + anticoagulation, because of markedly increased bleeding risk.
⸝
đđźđđđźđş đšđśđťđ˛:
â ď¸ Chronic dual antithrombotic therapy (anti-platelet + anticoagulation) â or prolonged DAPT â should be avoided unless there is a strong, clearly documented indication.
Thoughtful de-escalation is often the safest strategy for both brain and heart.
#Stroke #StrokePrevention #AtrialFibrillation #AntithromboticTherapy #Neurology #VascularNeurology #CardioNeurology #EvidenceBasedMedicine #ClinicalTrials #PatientSafety
đđźđ đşđŽđťđ đ˝đŽđđśđ˛đťđđ đľđŽđđ˛ đđźđ đđ˛đ˛đť đđśđđľ đđđżđźđ¸đ˛ đźđż đŻđšđ˛đ˛đąđśđťđ´ đżđ˛đšđŽđđ˛đą đđź đđŽđżđłđŽđżđśđť đśđť đđŠđđ đ˝đŽđđśđ˛đťđđ?
A recent trial in LVAD patients compared apixaban with warfarin over 2 years:
đš Lower HRAEs (stroke, bleeding, thrombosis):
12.5% vs 43% (p=0.087)
đš Significantly fewer transfusions:
0.69 vs 4.82 EPPY (p<0.01)
đš Win ratio favored apixaban:
2.30 (95% CI 0.95â5.60)
Although underpowered, the signals consistently leaned toward apixaban with đťđź đ˛đ
đ°đ˛đđ đđľđżđźđşđŻđźđđśđ đźđż đşđźđżđđŽđšđśđđ observed.
Bottom line:
Apixaban is showing a promise as a safe alternative to warfarin in selected LVAD patients â larger trials are needed before changing practice.
#LVAD #HeartFailure #Stroke #Anticoagulation #Apixaban #MedTwitter #CardioTwitter #EBM
đŞđľđśđ°đľ đ˝đŽđđśđ˛đťđđ đđśđđľ đŽđđđşđ˝đđźđşđŽđđśđ° đđđ đđđ˛đťđźđđśđ đđľđźđđšđą đ´đ˛đ đŽ đđđ˛đťđ?
This is the real question after CREST-2.
Carotid stenting should be selective, focused on higher-risk patients.
đď¸âŁ đđśđ´đľ-đżđśđđ¸ đ˝đšđŽđžđđ˛ đłđ˛đŽđđđżđ˛đ
â˘Ulcerated plaque
â˘Intraplaque hemorrhage
â˘Microembolic signals on TCD
â˘Silent ipsilateral embolic infarcts on MRI
â˘Rapid progression despite optimal medical therapy
đŽď¸âŁ đŁđŽđđśđ˛đťđ-đżđ˛đšđŽđđ˛đą đłđŽđ°đđźđżđ
â˘Reasonable life expectancy (>5â10 years)
â˘Few competing comorbidities
â˘Failure or intolerance of medical therapy (e.g., refractory BP control, statin intolerance)
đŻď¸âŁ đŁđżđźđ°đ˛đąđđżđ˛-đżđ˛đšđŽđđ˛đą đłđŽđ°đđźđżđ
â˘Expected peri-procedural stroke/death risk <2â3%
â˘High-volume centers with experienced operators and transparent outcomes
đđźđđđźđş đšđśđťđ˛:
After CREST-2, the question is no longer âstent or not?â â itâs âwho will benefit most?â
#Stroke #Neurology #VascularNeurology #CarotidStenosis #CREST2 #CAS #TCAR #MedTwitter #NeuroTwitter #EBM
đđĽđđŚđ§-đŽ â đŞđľđŽđ đđšđśđťđśđ°đśđŽđťđ đŚđľđźđđšđą đđťđźđ?
The debate around asymptomatic ICA stenosis continues, from ECST2 to CREST2.
đŚđđđąđ đŻđźđđđźđş đšđśđťđ˛:
In patients with asymptomatic ICA stenosis âĽ70%, 4-year stroke risk was đŽ.đ´% with stenting + intensive medical therapy vs đ˛.đŹ% with medical therapy alone â an absolute risk reduction of ~0.8% per year.
CEA did not show a statistically significant benefit over medical therapy alone in this population.
đđ¤âŚ đđđ¤đŞđĄđ đŹđ đ¨đŠđđŁđŠ đđŤđđ§đŽ đĽđđŠđđđŁđŠ đŹđđŠđ đđ¨đŽđ˘đĽđŠđ¤đ˘đđŠđđ âĽ70% đđžđź đ¨đŠđđŁđ¤đ¨đđ¨?
đ§đľđ˛ đŽđťđđđ˛đż đśđ: đĄđź, đťđźđ đ˛đđ˛đżđ đźđťđ˛
đđ˛đ đ°đŽđđ˛đŽđđ:
1ď¸âŁÂ đĄđĄđ§ đśđ đŻđ.
We need to treat 31 asymptomatic patients with stenting to prevent 1 stroke over 4 years. Thatâs a modest effect size.
2ď¸âŁÂ đŠđ˛đżđ đšđźđ đ˝đ˛đżđśđ˝đżđźđ°đ˛đąđđżđŽđš đżđśđđ¸ đśđť đđĽđđŚđ§-đŽ.
Periprocedural stroke rate was đ.đŻ% for stenting â lower than what many centers report. This was achieved with:
- Strict operator credentialing and training, and
- Ongoing site monitoring; centers with rising complication rates were reviewed and could be restricted.
3ď¸âŁÂ đđźđ°đŽđš đ°đźđşđ˝đšđśđ°đŽđđśđźđť đżđŽđđ˛đ đşđŽđđđ˛đż.
If your institutionâs periprocedural stroke rate âđŻ%, the small absolute benefit is essentially washed out.
If itâs >đ°%, you may be causing net harm in asymptomatic patients.
4ď¸âŁ đ đ˛đąđśđ°đŽđš đşđŽđťđŽđ´đ˛đşđ˛đťđ đľđŽđ đśđşđ˝đżđźđđ˛đą.
In ACAS (1990s), the 5-year ipsilateral stroke risk on medical therapy was â11%.
In CREST-2, with modern intensive therapy, the 4-year risk fell to â6%.
5ď¸âŁÂ đđđđşđ˝đđźđşđŽđđśđ° â đđđşđ˝đđźđşđŽđđśđ°.
Not all asymptomatic disease pose very high stroke risk like symptomatic ones.
Without intervention, stroke risk in NASCET (symptomatic âĽ70%) was 26% over 2 years, compared to 11% over 5 years in ACAS/ACST (asymptomatic âĽ60%) in the same era.
đŚđź, đđľđŽđ đđľđźđđšđą đđ˛ đąđź đśđť đ˝đżđŽđ°đđśđ°đ˛?
đ¸đđźđťđđśđąđ˛đż đđđ˛đťđđśđťđ´Â for selected asymptomatic patients with âĽ70% stenosis, especially those with high-risk features, and good life expectancy.
đ¸đđśđşđśđ đ˝đżđźđ°đ˛đąđđżđ˛đ đđź đľđśđ´đľ-đđźđšđđşđ˛ đđ˛đżđđśđŽđżđ đ°đ˛đťđđ˛đżđ with documented low complication rates.
đ¸đ đźđťđśđđźđż đđźđđż đźđđť đťđđşđŻđ˛đżđ: periprocedural stroke/death should be <2â3% for asymptomatic cases.
đđ§đľđśđťđ¸ đđđśđ°đ˛Â before intervening in low-risk asymptomatic patients, or those with limited life expectancy.
đAnd for every patient, intensive medical management is non-negotiable: LDL <70, SBP <130, diabetes control, smoking cessation, exercise, weight management.
#Stroke #VascularNeurology #CarotidStenosis #CREST2 #NeuroTwitter #MedTwitter #ClinicalTrials #EBM #VascularSurgery
@IbrahimKD16 You need large volume tap first before shunt
â¨Â đ§đľđ˛ đĄđ˛đđżđźđšđźđ´đśđ°đŽđš đđ
đŽđş đśđ đśđťđđżđśđ´đđśđťđ´.
When we teach the neurological exam, few things capture learnersâ attention like đżđ˛đłđšđ˛đ
đ˛đ â and none more so than the đ˝đšđŽđťđđŽđż đżđ˛đđ˝đźđťđđ˛.
The story of the đđŽđŻđśđťđđ¸đś đđśđ´đťÂ â and the many ways it can be elicited â always fascinates students.
In the late 19th century, neurologists struggled to differentiate organic paralysis from functional or hysterical weakness.There were no MRIs, no labs â only the exam.
đđŽđŻđśđťđđ¸đś noticed something curious in 1896 while examining a patient with hemiplegia:
đ Stroking the sole of the foot caused the big toe to extend upward rather than flex downward â a pattern consistent across patients with corticospinal tract lesions.
đĄÂ đĽđ˛đđźđšđđđśđźđťđŽđżđ: A single reflex that spoke for the integrity of the entire corticospinal tract.
A few years later, his student Oppenheim described a variant of the same reflex. Over time, many others followed â each variant earning its own eponym.
đđšđŽđđđśđ° đŽđťđą đŽđšđđ˛đżđťđŽđđśđđ˛ đşđ˛đđľđźđąđ to elicit an đ˛đ
đđ˛đťđđźđż đ˝đšđŽđťđđŽđż đżđ˛đđ˝đźđťđđ˛ đŁ
â  đđŽđŻđśđťđđ¸đśÂ â Scratch the lateral sole â across the ball of the foot
âĄÂ đđľđŽđąđąđźđ°đ¸Â â Stroke below the lateral malleolus
â˘Â đ˘đ˝đ˝đ˛đťđľđ˛đśđşÂ â Knuckle down the tibial crest
âŁÂ đđźđżđąđźđťÂ â Firmly squeeze the calf muscles
â¤Â đŚđ°đľđŽđ˛đłđ˛đżÂ â Compress the Achilles tendon
âĽÂ đđźđťđąđŽÂ â Flex and suddenly release the 4th toe
âŚÂ đ§đľđżđźđ°đ¸đşđźđżđđźđťÂ â Stroke the dorsum of the foot from the base of the great toe
â§Â đđśđťđ´Â â Lightly prick the dorsum or sole with a pin
â¨Â đŁđśđźđđżđźđđđ¸đśÂ â Tap the tibialis anterior tendon
âŠÂ đŚđđżđĚđşđ˝đ˛đšđšÂ â Ask the patient to flex the knee against resistance
âŞÂ đ đŽđżđśđ˛âđđźđśđ
 â Flex the knee and ankle quickly
âŤÂ đ đźđťđśđ â Apply pressure over the external malleolus
âŹÂ đ đ˛đťđąđ˛đšâđđ˛đ°đľđđ˛đżđ˛đ â Percuss the dorsum of the foot
â đĽđźđđđźđšđśđşđźÂ â Tap the ball of the toes (often positive in pyramidal tract lesions)
đĄÂ đ§đ˛đŽđ°đľđśđťđ´ đŁđ˛đŽđżđš:
There are many ways â but đđŽđŻđśđťđđ¸đśÂ and đ˘đ˝đ˝đ˛đťđľđ˛đśđşÂ remain the most useful and reproducible in practice.
Because in đťđ˛đđżđźđšđźđ´đ, even a single toe movement can be đđľđ˛ đ°đšđđ˛ đđź đđľđ˛ đ˝đđđđšđ˛. đ§Š
#Neurology #ClinicalExam #Reflexes #NeuroEducation #Babinski #NeurologyResidents #NeuroPearls #MedicalEducation #UpperMotorNeuron #BedsideNeurology
𧠠đŞđźđżđšđą đŚđđżđźđ¸đ˛ đđźđťđ´đżđ˛đđ (đŞđŚđ) â đ§đżđśđŽđš đ¨đ˝đąđŽđđ˛ #đŽ
đšÂ đđđ§-đ§đ˘đŁ đ§đżđśđŽđš
Intra-arterial tPA for posterior-circulation LVO after successful thrombectomy
đĄÂ đđźđđđźđş đšđśđťđ˛: IA tPA is safe after posterior-circulation thrombectomy but shows no added benefit.
đšÂ đđ đ đ-đđđĄ
MMA embolization + surgery for chronic SDH
đĽđŽđąđśđźđ´đżđŽđ˝đľđśđ° đżđ˛đ°đđżđżđ˛đťđ°đ˛: đđ°% đđ đ°đľ.đą%
đŚđđşđ˝đđźđşđŽđđśđ° đżđ˛đ°đđżđżđ˛đťđ°đ˛: đ°.đŻ% đđ đŽđ´%
đĄÂ đđźđđđźđş đšđśđťđ˛: MMA embolization continues to show strong benefit in reducing SDH recurrence.
đšÂ đđ˘đđ¨đŚ đ§đżđśđŽđš
Ganglioside GM1 (100 mg Ă 14 days) for AIS < 24 h
đľđŹ-đąđŽđ đşđĽđŚ đŹâđŽ: đ˛đł.đ˛% đđ đąđł.đą% (OR 1.5)
đĄ This may be the first drug to show neuroprotective potential in acute stroke â pending further confirmation.
đšÂ đ§đĽđđ đđŚ
EVT for mild ischemic stroke (NIHSS < 6)
đđŠđ˘ + đ đ˛đŠđ˘: overall no difference
đđŠđ˘ đźđťđšđ: better outcomes with EVT
đ đ˛đŠđ˘/đđśđŠđ˘: no benefit, higher sICH
đĄÂ đđźđđđźđş đšđśđťđ˛: EVT helps in low-NIHSS LVO, but not in MeVO/DiVO.
đšÂ đŚđ§đđđđđ
Atrial-fibrillation ablation in patients on Edoxaban after stroke
đĄÂ đđźđđđźđş đšđśđťđ˛: No additional stroke-prevention benefit from adding ablation to DOAC therapy.
đšÂ đŤđđĄđđĄđđ˘đđđĄđ (đŤđĄđ)
Traditional Chinese medicine for AIS post-EVT
đ§ŞÂ đ˘đťđ´đźđśđťđ´ đđżđśđŽđšÂ â evaluating safety and efficacy after EVT.
đšÂ đđ˘đĄđ-đŚđŹđ đŁđđ
EVT up to 72 h for anterior-circulation LVO
đĄÂ đŚđđśđšđš đ˛đťđżđźđšđšđśđťđ´.
đšÂ đŁđĽđ˘đđđŠđđŚ
Levetiracetam for cortical ischemic stroke
đĄÂ đđźđđđźđş đšđśđťđ˛: No evidence to support empirical AED use for cortical ischemic stroke.
#Stroke #WSC2025 #Neurology #ClinicalTrials #NeuroIntervention #VascularNeurology #NeuroIntervention #NeuroCriticalCare #NeuroTrials #StrokeResearch #StrokeCare #IschemicStroke
#HemorrhagicStroke #Thrombectomy #Thrombolysis #TNK #tPA #EVT #Neuroprotection #ClinicalTrials
#EvidenceBasedMedicine #RandomizedTrials #MMAEmbolization
⨠đŞđľđź đđŽđśđą đđđđąđđśđťđ´ đťđ˛đđżđźđšđźđ´đ đ°đŽđťâđ đŻđ˛ đłđđť?
Now you actually can â  đđśđ´đľđŹđśđ˛đšđą đĄđ˛đđżđź đđ˛đźđ˝đŽđżđąđ! đŻ
A Jeopardy-style learning game that turns studying for the RITE and Neurology Boards into something engaging, fast-paced, and fun.
đŚđ˛đ đśđ đđ˝ đłđźđż đđźđđż đđ˛đŽđş, đŽđťđą đ°đľđŽđšđšđ˛đťđ´đ˛ đđźđđżđđ˛đšđł:
đĄ Stroke
đĄ Epilepsy
đĄ Movement disorders
đĄ Neuroimmunology
đĄ Headache
đĄ Child Neurology
đĄ Neuroimmunology
đĄ Neuro-pharmacology
đĄ Neuroanatomy
Go ahead, give it a try â and see if you can beat your own score
đŽÂ https://t.co/k2h9hMiQKh
đđ˛đ°đŽđđđ˛ đšđ˛đŽđżđťđśđťđ´ đťđ˛đđżđźđšđźđ´đ đąđźđ˛đđťâđ đľđŽđđ˛ đđź đŻđ˛ đŻđźđżđśđťđ´.
#Neurology #MedicalEducation #RITE #BoardReview #NeuroJeopardy #ResidencyLife #HighYieldLearning #NeuroEducation #MedicalTraining
⨠đŞđľđź đđŽđśđą đđđđąđđśđťđ´ đťđ˛đđżđźđšđźđ´đ đ°đŽđťâđ đŻđ˛ đłđđť?
Now you actually can â  đđśđ´đľđŹđśđ˛đšđą đĄđ˛đđżđź đđ˛đźđ˝đŽđżđąđ! đŻ
A Jeopardy-style learning game that turns studying for the RITE and Neurology Boards into something engaging, fast-paced, and fun.
đŚđ˛đ đśđ đđ˝ đłđźđż đđźđđż đđ˛đŽđş, đŽđťđą đ°đľđŽđšđšđ˛đťđ´đ˛ đđźđđżđđ˛đšđł:
đĄ Stroke
đĄ Epilepsy
đĄ Movement disorders
đĄ Neuroimmunology
đĄ Headache
đĄ Child Neurology
đĄ Neuroimmunology
đĄ Neuro-pharmacology
đĄ Neuroanatomy
Go ahead, give it a try â and see if you can beat your own score
đŽ https://t.co/k2h9hMiQKh
đđ˛đ°đŽđđđ˛ đšđ˛đŽđżđťđśđťđ´ đťđ˛đđżđźđšđźđ´đ đąđźđ˛đđťâđ đľđŽđđ˛ đđź đŻđ˛ đŻđźđżđśđťđ´.
đ§ đđź đđźđ đđľđśđťđ¸ đśđâđ đŽ đ°đŽđđđŽđš đżđ˛đšđŽđđśđźđťđđľđśđ˝ đźđż đˇđđđ đŽđť đŽđđđźđ°đśđŽđđśđźđť?
𦷠đŚđđżđźđ¸đ˛ đŽđťđą đđ˛đ˛đđľ đľđ˛đŽđšđđľ â đŽ đťđ˛đ đŽđťđą đśđťđđ˛đżđ˛đđđśđťđ´ đłđśđťđąđśđťđ´.
A new NeurologyÂŽ Open Access study found that people with both gum disease and cavities had an 86% higher risk of stroke compared with those with healthy mouths.
𩸠Poor oral health was also linked to a 36% higher risk of heart attacks and other cardiovascular events.
𦷠Regular dental visits were associated with 81% lower odds of having both gum disease and cavities.
But hereâs the real question:
Is oral inflammation causing vascular disease â or do people who neglect oral care tend to neglect other aspects of health as well?
https://t.co/mCDFf0tfwF
#Neurology #Stroke #OralHealth #BrainHealth #VascularNeurology #EvidenceBasedMedicine #Dentistry #Prevention #AAN #NeuroResearch
đ§ đŞđźđżđšđą đŚđđżđźđ¸đ˛ đđźđťđ´đżđ˛đđ đŽđŹđŽđą â đ§đżđśđŽđš đ¨đ˝đąđŽđđ˛đ
đš đđĄđđđđđ˘đđŚđ§: Aspiration vs stent retriever for basilar occlusion
â Better first-pass reperfusion, same final mRS outcomes
đš đđ§đđđŚ đşđ˛đđŽ-đŽđťđŽđšđđđśđ: EVT benefit across large-core strokes
â mRS 0â2: 19.5 % vs 7.5 %, benefit persists even with ASPECTS 0â2
đš đ§-đđđđŠđ˘đĽ (Japan): TNK 0.25 mg/kg > tPA 0.6 mg/kg for LVO before EVT
â Higher reperfusion (10.3 % vs 3.6 %)
đš đđđ§đđđŹđŚđ§âđ§đĄđ: Non-inferior, trend toward better outcomes
đš đ§đĽđđđđĄđ§: Post-ICH âtriple pillâ (Telmisartan + Amlodipine + Indapamide) â Stroke â (HR 0.6)
#WorldStrokeCongress #Stroke #Neurology #VascularNeurology #EVT #TNK #ClinicalTrials #EvidenceBasedMedicine
đđđ˛đ¨đ§đ đđ đđ¨đŽđŤđŹ: đđđ§đđđđđŠđĽđđŹđ đđŽđŹđĄđđŹ đđĄđ đđĽđ¨đđ¤ đ
đŽđŤđđĄđđŤ
Last month we asked: âAre we there yet?â
Now â the answer may be closer than ever.
đ đđđ đ.đâđđđĄ đđđđ-đđ§đđĽđ˛đŹđ˘đŹ (đđđđ)
𧊠1,278 patients across 4 RCTs
đ§ Imaging-based selection (DWI-FLAIR mismatch or CT/MR perfusion)
Results:
⢠đđ
đ°đ˛đšđšđ˛đťđ đźđđđ°đźđşđ˛ (mRS 0â1 @ 90 d): 35.1 % vs 28.9 % (đ˘đĽ 1.34, p = 0.02)
⢠đĽđ˛đ°đŽđťđŽđšđśđđŽđđśđźđť: 46.6 % vs 28.4 % (đ˘đĽ 3.30, p = 0.001)
⢠đĄđź đśđťđ°đżđ˛đŽđđ˛ đśđť đđŹđ đŁ đđđ đźđż đşđźđżđđŽđšđśđđ
⢠đđ˛đťđ˛đłđśđ đ´đżđ˛đŽđđ˛đż đđľđ˛đť đđŠđ§ đťđźđ đŽđđŽđśđšđŽđŻđšđ˛
đŹ đđ§đđđŤđŠđŤđđđđđ˘đ¨đ§:
IV đ§đ˛đťđ˛đ°đđ˛đ˝đšđŽđđ˛ up to đŽđ° đľđźđđżđ after onset appears safe and effective with imaging guidance.
đĄ đđĽđ˘đ§đ˘đđđĽ đđđđŤđĽ:
From 3 â 4.5 â 9 â 24 hours â đđľđżđźđşđŻđźđšđđđśđ is no longer about đđśđşđ˛, but about đđśđđđđ˛.
𩺠đđ¨đđđ¨đŚ đđ˘đ§đ:
The line keeps moving â and thatâs good for stroke patients.
Tenecteplase continues to stretch the window without increasing risk.
#Stroke #Thrombolysis #TNK #LateWindow #VascularNeurology #Tenecteplase #IVT #NeuroTrials #EvidenceBasedMedicine
đ§ đ§đľđżđźđşđŻđźđšđđđśđ đśđť đŚđđżđźđ¸đ˛ đŁđŽđđśđ˛đťđđ đźđť đđ˘đđđ â đ§đśđşđ˛ đđź đĽđ˛đđľđśđťđ¸ đđľđ˛ đĽđđšđ˛
For years:
â âđ˘đť đđ˘đđ = đĄđź đđŁđâ
But new data are changing that.
đ đđ˘-đđ§ đ§đŽđżđ´đ˛đ đ§đżđśđŽđš (đŽđŹđŽđą)
⢠28 centers, 1,342 DOAC patients
⢠đŚđđşđ˝đđźđşđŽđđśđ° đđđ: 3.0% IVT vs 5.9% no IVT
⢠đđźđźđą đźđđđ°đźđşđ˛ (mRS 0â2): 62% vs 44%
⢠đĽđ˛đđ˛đżđđŽđš (đśđąđŽđżđđ°đśđđđşđŽđŻ) đđ đťđź đżđ˛đđ˛đżđđŽđš: đťđź đąđśđłđłđ˛đżđ˛đťđ°đ˛ đśđť đŻđšđ˛đ˛đąđśđťđ´ đźđż đ˛đłđłđśđ°đŽđ°đ
đ đđ˘đđ-đđŠđ§ (đŽđŹđŽđŻ)
⢠64 centers, >33,000 patients
⢠đŚđđşđ˝đđźđşđŽđđśđ° đđđ: 2.5% DOAC vs 4.1% controls
⢠đŚđŽđłđ˛ đ˛đđ˛đť đđśđđľđźđđ đżđ˛đđ˛đżđđŽđš đźđż đšđ˛đđ˛đš đ°đľđ˛đ°đ¸
⢠đŚđśđşđśđšđŽđż đđđđ đżđŽđđ˛đ: đśđąđŽđżđđ°đśđđđşđŽđŻ (đ.đŽ%) đđ đťđź đżđ˛đđ˛đżđđŽđš (đŻ.đ%)
đŹ đđťđđ˛đżđ˝đżđ˛đđŽđđśđźđť:
IV thrombolysis after recent DOAC use đŽđ˝đ˝đ˛đŽđżđ đđŽđłđ˛ đđľđ˛đť đ˝đŽđđśđ˛đťđđ đŽđżđ˛ đ°đŽđżđ˛đłđđšđšđ đđ˛đšđ˛đ°đđ˛đą.
đĄ đđšđśđťđśđ°đŽđš đŁđ˛đŽđżđš:
Weâre moving from âđŽđđđźđşđŽđđśđ° đ˛đ
đ°đšđđđśđźđťâ â âđşđ˛đŽđđđżđ˛đą đśđťđ°đšđđđśđźđť.â
𩺠đđźđđđźđş đđśđťđ˛:
đđđśđąđ˛đťđ°đ˛ đśđ đ´đżđźđđśđťđ´ đđľđŽđ đđ˘đđ đđđ˛ â đŽđŻđđźđšđđđ˛ đ°đźđťđđżđŽđśđťđąđśđ°đŽđđśđźđť đłđźđż đđľđżđźđşđŻđźđšđđđśđ.
Stroke codes now ask: âđŞđľđ˛đť đđŽđ đđľđ˛ đšđŽđđ đąđźđđ˛?â â not âđ˘đť đđ˘đđ = đťđź đđŁđ.â
#Stroke #DOAC #tPA #TNK #Thrombolysis #VascularNeurology #EvidenceBasedMedicine #DOIT #DOACIVT
đ§ đđ¨đŽđĽđ đđ¨đŽ đđĽđđđŹđ đđŽđ đđ§ đđ¨đŽđŤ đđ˘đ đŤđđ˘đ§đ đđĽđđŹđŹđđŹ ??
Have you heard the parable of the đđĽđ˘đ§đ đŚđđ§ đđđŹđđŤđ˘đđ˘đ§đ đđ§ đđĽđđŠđĄđđ§đ?
Each touches a different part â one feels the leg and says itâs a tree, another the trunk and says itâs a snake, another the tail and calls it a rope.
Each is partly right, but all are missing the bigger picture.
đđ˘đ đŤđđ˘đ§đ đđđ§ đđ đđĄđđ đđĽđđŠđĄđđ§đ.
A đŚđ˘đ đŤđđ˘đ§đ đŠđđđ˘đđ§đ presented with đđŤđŚ đđ˘đ§đ đĽđ˘đ§đ đđĄđđ§ đ§đŽđŚđđ§đđŹđŹÂ and was called đđđ/đđđâđ§đđ đđđ˘đŻđ đŹđđŤđ¨đ¤đ.
Then presented to cardiology with đđĄđđŹđ đŠđđ˘đ§Â and was diagnosed with đđ§đ đ˘đ¨đ đŤđđŠđĄđ˛âđ§đđ đđđ˘đŻđ đđ¨đŤđ¨đ§đđŤđ˛ đđ˘đŹđđđŹđ.
Then presented to GI with đ˘đ§đđđŤđŚđ˘đđđđ§đ đđđđ¨đŚđ˘đ§đđĽ đŠđđ˘đ§, đđ˘đđŤđŤđĄđđ/đđ¨đ§đŹđđ˘đŠđđđ˘đ¨đ§Â and was told it is đđđ.
Then presented to primary care with đđĽđđŹđĄđđŹ đ¨đ đĽđ˘đ đĄđ đđ¨đĽđĽđ¨đ°đđ đđ˛ đđŤđđ§đŹđ˘đđ§đ đŻđ˘đŹđ˘đ¨đ§ đĽđ¨đŹđŹÂ and was diagnosed with đđŚđđŽđŤđ¨đŹđ˘đŹ đđŽđ đđą.
From time to time, we see patients who have undergone đđąđĄđđŽđŹđđ˘đŻđ đ°đ¨đŤđ¤đŽđŠđŹ â đđđŹ, đđđđŹ, đđ§đđ¨đŹđđ¨đŠđ˘đđŹ, đđđŤđđ˘đđ đđđŹđđŹ â đđĽđĽ đ§đđ đđđ˘đŻđ.
But if you put on your âđŚđ˘đ đŤđđ˘đ§đ đ đĽđđŹđŹđđŹ,â the diagnosis becomes clear in seconds.
I still remember when đđŤ. đđđŻđ˘đ đđđ đđ¨đŤđđ¨đ§Â once helped me put on those đŚđ˘đ đŤđđ˘đ§đ đ đĽđđŹđŹđđŹÂ đ â it completely changed how I see these patients.
đđ˘đ đŤđđ˘đ§đ đ˘đŹ đŚđ¨đŤđ đđĄđđ§ đ đĄđđđđđđĄđ â đ˘đâđŹ đ đ§đđŽđŤđ¨đŻđđŹđđŽđĽđđŤ đđ˘đŹđ¨đŤđđđŤ đ°đ˘đđĄ đŹđđ§đŹđ¨đŤđ˛, đđŽđđ¨đ§đ¨đŚđ˘đ, đđ§đ đŹđ˛đŹđđđŚđ˘đ đđąđŠđŤđđŹđŹđ˘đ¨đ§đŹ.
Sometimes, recognizing the đ°đĄđ¨đĽđ đđĽđđŠđĄđđ§đ changes everything.
#Neurology #Headache #Migraine #ClinicalReasoning #Neuroeducation #Stroke #Neurovascular #MedicalEducation #CME
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