Cerebrovascular Diseases Extra最新文献

{"title":"Self-Efficacy Is a Modifiable Factor Associated with Frailty in Those with Minor Stroke: Secondary Analysis of 200 Cohort Respondents.","authors":"Abodunrin Quadri Aminu,&nbsp;Roderick Wondergem,&nbsp;Yvonne Van Zaalen,&nbsp;Martijn Pisters","doi":"10.1159/000519311","DOIUrl":"https://doi.org/10.1159/000519311","url":null,"abstract":"<p><strong>Background: </strong>Owing to the improvement in acute care, there has been an increase in the number of people surviving stroke and living with its impairments. Frailty is common in people with stroke and has a significant impact on the prognosis after stroke. To reduce frailty progression, potentially modifiable factors should be identified. Increasing levels of self-efficacy influence both behaviour and physical functioning, and therefore it could be a potential target to prevent frailty.</p><p><strong>Methods: </strong>This is a prospective cohort study that involved the secondary analysis of the RISE data to examine the relationship between self-efficacy and frailty. The RISE study is a longitudinal study that consists of 200 adults aged 18+ years after their first stroke event. Data were collected from the respondents at 3 weeks, 6 months, 12 months, and 24 months after their discharge from the hospital. Frailty was assessed using the multidimensional frailty index with scores ranging from 0 to 1, and self-efficacy was assessed using the SESx scale, which was dichotomized as low/moderate or high. Frailty trajectories were examined using the repeated linear model. The generalized estimating equation was used to examine the relationship between self-efficacy and frailty at baseline and in the future (6-24 months). The B coefficients were reported at 95% CI before and after adjusting for potential confounders (age, gender, stroke severity, education, and social support).</p><p><strong>Results: </strong>A total of 200 responses were analysed, and the mean age of the respondents was 67.78 ± 11.53. Females made up 64% of the sample, and the mean frailty score at baseline was 0.17 ± 0.09. After adjusting for confounders, respondents with low self-efficacy had an approximately 5% increase in their frailty scores at baseline and in the 24-month follow-up period compared to those with high self-efficacy.</p><p><strong>Conclusion: </strong>The result from this study showed that self-efficacy was significantly associated with frailty after stroke. Our findings suggest that self-efficacy may play a role in frailty progression among stroke survivors.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"99-105"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/60/cee-0011-0099.PMC8543288.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39501044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superb Microvascular Imaging Ultrasound for Cervical Carotid Artery Stenosis for Prediction of the Development of Microembolic Signals on Transcranial Doppler during Carotid Exposure in Endarterectomy.","authors":"Takayuki Chiba,&nbsp;Shunrou Fujiwara,&nbsp;Kazumasa Oura,&nbsp;Kohki Oikawa,&nbsp;Kokei Chida,&nbsp;Masakazu Kobayashi,&nbsp;Kenji Yoshida,&nbsp;Yoshitaka Kubo,&nbsp;Tetsuya Maeda,&nbsp;Ryo Itabashi,&nbsp;Kuniaki Ogasawara","doi":"10.1159/000516426","DOIUrl":"https://doi.org/10.1159/000516426","url":null,"abstract":"<p><strong>Introduction: </strong>During exposure of the carotid arteries, embolism from the surgical site is recognized as a primary cause of neurological deficits or new cerebral ischemic lesions following carotid endarterectomy (CEA), and associations have been reported between histological neovascularization in the carotid plaque and both plaque vulnerability and the development of artery-to-artery embolism. Superb microvascular imaging (SMI) enables accurate visualization of neovessels in the carotid plaque without the use of intravenous contrast. This study aimed to determine whether preoperative SMI ultrasound for cervical carotid artery stenosis predicts the development of microembolic signals (MES) on transcranial Doppler (TCD) during exposure of the carotid arteries in CEA.</p><p><strong>Methods: </strong>Preoperative cervical carotid artery SMI ultrasound followed by CEA under TCD monitoring of MES in the ipsilateral middle cerebral artery was conducted in 70 patients previously diagnosed with internal carotid artery stenosis (defined as ≥70%). First, observers visually identified intraplaque microvascular flow (IMVF) signals as moving enhancements located near the surface of the carotid plaque within the plaque on SMI ultrasonograms. Next, regions of interest (ROI) were manually placed at the identified IMVF signals (or at arbitrary places within the plaque when no IMVF signals were identified within the carotid plaque) and the carotid lumen, and time-intensity curves of the IMVF signal and lumen ROI were generated. Ten heartbeat cycles of both time-intensity curves were segmented into each heartbeat cycle based on gated electrocardiogram findings and averaged with respect to the IMVF signal and lumen ROI. The difference between the maximum and minimum intensities (ID) was calculated based on the averaged IMVF signal (IDIMVF) and lumen (IDl) curves. Finally, the ratio of IDIMVF to IDl was calculated.</p><p><strong>Results: </strong>MES during exposure of the carotid arteries were detected in 17 patients (24%). The incidence of identification of IMVF signals was significantly greater in patients with MES (94%) than in those without (57%; p = 0.0067). The IDIMVF/IDl ratio was significantly greater in patients with MES (0.108 ± 0.120) than in those without (0.017 ± 0.042; p < 0.0001). The specificity and positive predictive value for the IDIMVF/IDl ratio for prediction of the development of MES were significantly higher than those for the identification of IMVF signals. Logistic regression analysis revealed that only the IDIMVF/IDl ratio was significantly associated with the development of MES (95% CI 101.1-3,628.9; p = 0.0048).</p><p><strong>Conclusion: </strong>Preoperative cervical carotid artery SMI ultrasound predicts the development of MES on TCD during exposure of the carotid arteries in CEA.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"61-68"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000516426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38948135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Patients with Cranial Dural Arteriovenous Fistula and Secondary Parkinson&apos;s Syndrome: Comment.","authors":"Pinar Beyaz,&nbsp;Gerasimos Baltsavias","doi":"10.1159/000515629","DOIUrl":"https://doi.org/10.1159/000515629","url":null,"abstract":"With great interest, we read the paper “Management of Patients with Cranial Dural Arteriovenous Fistula and Secondary Parkinson’s Syndrome: Pathophysiology and Treatment Options” by Velz et al. [1]. The authors should be commended for drawing our attention to this particular presentation of dural fistulae and for their detailed description of the vascular shunt anatomy. However, there is a point that may cause confusion, which, I suppose went unnoticed by the authors. Although they classify correctly the presented arteriovenous fistula according to the DES scheme as a bridging vein shunt with direct, exclusive, and strained reflux, they describe the dural arteriovenous fistula as draining “through the straight sinus into the median tentorial sinus, supraculminal vein, superior vermian vein, and the system of the vein of Galen.” If the venous drainage of the shunt was through the straight sinus, then the shunt should be classified as a dural sinus shunt or isolated sinus shunt [2]. Then the reflux should be by definition nondirect. If we rely though on the provided figures, no opacification of the straight sinus is seen (unclear if one distinguishes a median tentorial sinus and we would very much guess that one does not), as it should be in a bridging vein shunt, where the shunt is located at the intradural segment of the bridging vein and its normal exit to the sinus is occluded [3]. Therefore, the venous drainage, consistent with the angiographic images and the above classification, should be described as “through the supraculminal vein, the superior vermian vein, and the system of the vein of Galen.”","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"45"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000515629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25585222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Feasibility of Mechanical Thrombectomy on Single-Plane Angiosuite: An In-Depth Analysis of Procedure Time.","authors":"Hiroyasu Inoue,&nbsp;Masahiro Oomura,&nbsp;Yusuke Nishikawa,&nbsp;Mitsuhito Mase,&nbsp;Noriyuki Matsukawa","doi":"10.1159/000519555","DOIUrl":"https://doi.org/10.1159/000519555","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical thrombectomy (MT) is usually performed on biplane (BP) angiosuites. When the BP angiosuite is not available, the single-plane (SP) angiosuite may be a substitute. However, the feasibility of MT performed on the SP angiosuite is yet to be elucidated. Therefore, we investigated the alternative effect of the SP angiosuite on the detailed division of procedure time, recanalization rate, and outcome in patients with anterior circulation infarction.</p><p><strong>Methods: </strong>The subjects included 80 consecutive patients with anterior circulation infarction who underwent MT at our hospital between May 2015 and December 2020. Demographics and characteristics of the BP and SP groups were assessed and compared. The time from puncture to guiding catheter placement (P-G), time from guiding catheter placement to recanalization (G-R), and time from puncture to recanalization (P-R) were also extracted. A good outcome was defined as a modified Rankin scale score ≤2 at 3 months.</p><p><strong>Results: </strong>Of the 80 patients, 67 and 13 were treated with BP and SP angiosuites, respectively. There were no differences in age, sex, complications, Alberta Stroke Program Early CT Score, National Institutes of Health Stroke Scale score at onset, occlusion site, rate of recombinant tissue-type plasminogen activator administration, stroke subtype, recanalization rate, and complications between the 2 groups. The rate of a good outcome was not different between the 2 groups. P-G was significantly longer in the SP group than in the BP group, whereas there was no significant difference in G-R and P-R between the 2 groups (P-G: BP 29.9 ± 21.8 vs. SP 48.5 ± 43.6 min, p = 0.04).</p><p><strong>Conclusion: </strong>MT performed on the SP angiosuite tended to prolong the time for guiding catheter placement. However, there was no difference in the overall procedure time, recanalization rate, or outcome between BP and SP angiosuites. Therefore, if the BP angiosuite is not available, the use of the SP angiosuite should be encouraged.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"112-117"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/cd/cee-0011-0112.PMC8613560.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39524141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment in Acute Ischemic Stroke Adoption and Practice: A Single-Center Indonesian Experience.","authors":"Taufik Mesiano,&nbsp;Mohammad Kurniawan,&nbsp;Kevin M Saputri,&nbsp;Rakhmad Hidayat,&nbsp;Affan P Permana,&nbsp;Al Rasyid,&nbsp;Salim Harris","doi":"10.1159/000517183","DOIUrl":"https://doi.org/10.1159/000517183","url":null,"abstract":"<p><p>Indonesia is facing increasing stroke prevalence in the past 5 years. Ischemic stroke imposes economic and productivity burden if it is not addressed properly. Endovascular treatment studies are conducted in developed countries where facilities and cost do not count in therapy consideration if it is indicated. Developing countries like Indonesia should work hard to provide the best hyperacute stroke care with protocol deviation and limitation. This is the first review on endovascular treatment practice in a top single-center hospital in Indonesia. Further improvement is needed to catch up with state-of-the-art hyperacute ischemic stroke treatment.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"72-76"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000517183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39201820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Biomarkers in Patients with Thrombotic Thrombocytopenic Purpura Presenting with Large and Small Ischemic Stroke.","authors":"Chen Lin,&nbsp;Raima Memon,&nbsp;Jingrui Sui,&nbsp;X Long Zheng","doi":"10.1159/000513574","DOIUrl":"https://doi.org/10.1159/000513574","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder resulting in organ damage including ischemic strokes. We sought to characterize the neuroimaging patterns of stroke in a large cohort of patients with immune-mediated TTP (iTTP) and determined their associations with clinical and laboratory parameters and outcomes.</p><p><strong>Methods: </strong>We analyzed the Alabama TTP Registry who had laboratory confirmation of acute iTTP. We reviewed the neuroimaging patterns of those with ischemic stroke on MRI, clinical information, and laboratory results. Small ischemic strokes were ≤20 mm in their maximum diameter in the axial plane. Large ischemic strokes were >20 mm. Student t test, Mann-Whitney U test, and χ2 test were all used for data analysis.</p><p><strong>Results: </strong>Of 108 iTTP patients, 21 had ischemic stroke on neuroimaging. The median platelet count in these patients was 12 × 109/L (interquartile range, IQR, 8.8-21 × 109/L), plasma ADAMTS13 activity 1.8 U/dL (IQR 0-4.5 U/dL), and the mean plasma level of anti-ADAMTS13 IgG was 6,595.8 U/mL (SD 3,448.9 U/mL). Comparison between patients with large ischemic strokes (n = 10) and small ischemic strokes (n = 11) revealed that patients with small stroke were older (p = 0.043) and had higher plasma levels of citrullinated histone 3 (p = 0.006) and histone/DNA complex (p = 0.014) than those with large strokes. There were no significant differences between 2 stroke groups in mortality or exacerbation.</p><p><strong>Conclusions: </strong>iTTP patients can present with large ischemic strokes and are usually younger. Further research should be performed in assessing different etiologies of iTTP-associated stroke based on neutrophil extracellular trap formation biomarkers (e.g., histone markers) seen in small ischemic stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"29-36"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000513574","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25380420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attack Interval Is the Key to the Likely Pathogenesis of Multiple Transient Ischemic Attacks.","authors":"Yoshinari Nagakane, Tomoyuki Ohara, Eijirou Tanaka, Takehiro Yamada, Shinji Ashida, Yuta Kojima, Keiko Maezono, Shiori Ogura, Daisuke Nakashima, Takamasa Kitaoji, Yasumasa Yamamoto","doi":"10.1159/000519105","DOIUrl":"10.1159/000519105","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to test the hypothesis that the attack interval of multiple transient ischemic attacks (TIAs) is correlated with the underlying pathogenesis of ischemia.</p><p><strong>Methods: </strong>Patients with multiple TIAs, defined as 2 or more motor deficits within 7 days, were studied. The attack interval between the last 2 episodes was classified into 3 groups: 2 episodes within an hour (Hour group), over hours within a day (Day group), and over days within a week (Week group). Patients with a lacunar syndrome, no cortical lesions, and no embolic sources were recognized as having a small vessel disease (SVD) etiology for their multiple events.</p><p><strong>Results: </strong>Of 312 TIA patients admitted over a 9-year period, 50 (37 males, 13 females, mean 67.6 years) had multiple TIAs. Twelve patients were classified as being within the Hour group, 23 within the Day group, and 15 within the Week group. Lacunar syndromes were observed in 30 (75%, 35%, and 67%), embolic sources were detected in 28 (25%, 65%, and 67%), and a high signal lesion on diffusion-weighted imaging was depicted in 30 (75%, 48%, and 67%) patients (18 cortical, 11 subcortical, and one cerebellar). Patients in the Hour group had a significantly higher prevalence of SVD etiology (75%) than those in the Day and Week groups (30%, p = 0.0165; 27%, p = 0.0213, respectively). Four patients had a subsequent stroke within 7 days.</p><p><strong>Conclusion: </strong>Attack intervals of multiple TIAs may be correlated with the underlying pathogenesis of ischemia. Two motor deficits within an hour are more likely to suggest a SVD etiology.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 3","pages":"92-98"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/3f/cee-0011-0092.PMC8543286.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39474151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Favorable Perfusion Imaging in Predicting the Outcome of Patients with Acute Ischemic Stroke due to Large Vessel Occlusion Undergoing Effective Thrombectomy: A Single-Center Study.","authors":"Riccardo Di Iorio,&nbsp;Fabio Pilato,&nbsp;Iacopo Valente,&nbsp;Andrea Laurienzo,&nbsp;Simona Gaudino,&nbsp;Giovanni Frisullo,&nbsp;Paolo Profice,&nbsp;Simone Cottonaro,&nbsp;Andrea Alexandre,&nbsp;Pietro Caliandro,&nbsp;Roberta Morosetti,&nbsp;Emilio Lozupone,&nbsp;Francesco D'Argento,&nbsp;Alessandro Pedicelli,&nbsp;Cesare Colosimo,&nbsp;Paolo Calabresi,&nbsp;Giacomo Della Marca,&nbsp;Aldobrando Broccolini","doi":"10.1159/000513025","DOIUrl":"https://doi.org/10.1159/000513025","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to verify the predicting role of a favorable profile on computed tomography perfusion (CTP) in the outcome of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) undergoing effective mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>We retrospectively enrolled 25 patients with AIS due to LVO and with a CTP study showing the presence of ischemic penumbra who underwent effective MT, regardless of the time of onset. The controls were 25 AIS patients with overlapping demographics and clinical and computed tomography angiography features at admission who had undergone successful MT within 6 h from onset and without a previous CTP study. The outcome measure was the modified Rankin Scale (mRS) score at 90 days.</p><p><strong>Results: </strong>Sixty-four percent of the study patients had an mRS score of 0-1 at 90 days versus 12% of the control patients (p < 0.001). Patients of the study group had a more favorable distribution of disability scores (median mRS [IQR] score of 0 [0-2] vs. 2 [2-3]). Multivariate analysis showed that the selection of patients based on a favorable CTP study was strongly associated (p < 0.001) with a better neurological outcome.</p><p><strong>Conclusions: </strong>In our small-sized and retrospective study, the presence of ischemic penumbra was associated with a better clinical outcome in patients with AIS due to LVO after MT. In the future, a larger and controlled study with similar criteria of enrollment is needed to further validate the role of CTP in patient selection for MT, regardless of the time from the onset of symptoms.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000513025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38826579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Warning Signs in the Era of Unruptured Intracranial Aneurysms: Report on 2 Cases of Fatal Aneurysmal Hemorrhage.","authors":"Katarzyna Wójtowicz,&nbsp;Przemysław Kunert,&nbsp;Łukasz Przepiórka,&nbsp;Andrzej Marchel","doi":"10.1159/000517421","DOIUrl":"https://doi.org/10.1159/000517421","url":null,"abstract":"<p><strong>Introduction: </strong>The timing of treatment remains unresolved for patients with unruptured intracranial aneurysms (UIAs) and headaches, particularly when the pain is short term, localized, and related to the aneurysm site. We lack evidence to support the notion that when a headache accompanies an aneurysm, it elevates the risk of rupture.</p><p><strong>Results: </strong>We describe 2 cases of fatal subarachnoid hemorrhage in patients with a history of headache and known aneurysms. Both of these patients had good indications for treatment: a young age and an aneurysm >7 mm, and both were qualified for elective surgery. However, both patients died of fatal aneurysm ruptures before the planned surgery.</p><p><strong>Conclusion: </strong>These cases suggested that treatment should be started as soon as possible, when a UIA is diagnosed based on a short-term period of severe headaches or when a UIA is observed and then severe headaches appear. There is no straightforward guideline for treatment timing in these patients. However, in this era of UIAs, the significance of sentinel headaches should be reevaluated. Given the incidence of headaches in the general population and the very low risk of aneurysm rupture, there may be a tendency to neglect the role of headache as a possible warning sign.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"11 2","pages":"77-80"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000517421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39286318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in Sri Lanka: How Can We Minimise the Burden?","authors":"Udaya K Ranawaka,&nbsp;Narayanaswamy Venketasubramanian","doi":"10.1159/000515890","DOIUrl":"https://doi.org/10.1159/000515890","url":null,"abstract":"<p><p>The burden of stroke in Sri Lanka is high and steadily increasing. Accurate estimation of the burden is hampered by a paucity of epidemiological data. More neurologists, stroke units, facilities for modern treatments and multi-disciplinary rehabilitation services are urgently needed. Essential drugs for risk factor control and secondary prevention are available in many hospitals. Aggressive preventive strategies and promoting stroke awareness are the best ways to minimise the stroke burden in Sri Lanka.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"46-48"},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000515890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38850254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}