CONTINUUM Lifelong Learning in Neurology最新文献_第5页

Sex Differences in Stroke Diagnosis, Treatment, and Outcome. 脑卒中诊断、治疗和结果的性别差异。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001709

Cheryl E Carcel

{"title":"Sex Differences in Stroke Diagnosis, Treatment, and Outcome.","authors":"Cheryl E Carcel","doi":"10.1212/cont.0000000000001709","DOIUrl":"10.1212/cont.0000000000001709","url":null,"abstract":"Objective: This article examines how sex and gender differences affect stroke recognition, treatment, and outcomes and identifies strategies to advance equity across the stroke care continuum.Latest developments: Recent evidence highlights persistent sex-based and gender-based disparities in stroke care. Women are less likely to be identified by emergency services as having a stroke, largely because they have more frequent nonfocal presentations (eg, diffuse weakness, confusion). Standard prehospital tools often miss these signs. Although sex disparities in the administration of acute treatments such as IV thrombolysis and mechanical thrombectomy have narrowed, historical underuse in women contributed to worse outcomes. Anticoagulation in atrial fibrillation has improved with the inclusion of female sex in risk scores, although some gaps remain. Long-term, women have higher rates of poststroke disability, institutionalization, and reduced quality of life. Biological differences, health care bias, and underrepresentation in clinical trials contribute to these inequities.Essential points: Women often present with underrecognized stroke symptoms, which can lead to diagnostic delays and missed opportunities for timely intervention. Despite evidence showing equal benefit, women have historically received less reperfusion therapy than men. Poststroke outcomes are generally worse for women, particularly among older patients and racially minoritized groups. To address these disparities, targeted strategies are essential, such as implementing sex-sensitive stroke scales, providing training to reduce diagnostic bias, conducting routine sex-disaggregated audits, and improving the inclusion of women in clinical trials. Multidisciplinary care should also prioritize management of anxiety, depression, and fatigue, which disproportionately affect women after stroke. Closing these gaps is critical to achieving equitable and effective stroke care for all patients, regardless of sex or gender.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"32 3","pages":"819-835"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes. 健康的社会决定因素及其对中风预防和结果的影响。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001708

Nneka L Ifejika

{"title":"Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes.","authors":"Nneka L Ifejika","doi":"10.1212/cont.0000000000001708","DOIUrl":"10.1212/cont.0000000000001708","url":null,"abstract":"Objective: Often unrecognized and frequently overlooked, the inclusion of social determinants of health in stroke management is critical to improving outcomes. Using the National Institute of Neurological Disorders and Stroke working group Determinants of Inequities in Neurological Disease, Health, and Well-being framework, this article reviews structural, social status, intermediate, intrapersonal, and biological determinants of health inequities and their impact on equity in neurologic health after stroke.Latest developments: It is imperative that social determinants of health are evaluated as a requirement for effective stroke prevention and rehabilitation.Essential points: To optimize secondary stroke prevention and improve stroke outcomes, it is critical to include social determinants of health as components of poststroke management, starting during the acute hospitalization and continuing through outpatient management. Interdisciplinary services, such as social work, care coordination, behavioral health, physical and occupational therapy, speech and language pathology, and chaplaincy, provide additional resources to help stroke survivors and their caregivers.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"32 3","pages":"694-715"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevention of Stroke. 预防中风。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001705

Mitchell S V Elkind

{"title":"Prevention of Stroke.","authors":"Mitchell S V Elkind","doi":"10.1212/cont.0000000000001705","DOIUrl":"10.1212/cont.0000000000001705","url":null,"abstract":"Objective: This article provides an overview of the principles of stroke prevention, including the distinctions among primordial, primary, secondary, and tertiary prevention. The relationship between stroke prevention and preservation of brain health is considered, and recent guidelines for primary stroke prevention are emphasized.Latest developments: The current standard for the reduction in risk of stroke focuses on public-facing educational tools and clinical risk prediction algorithms that incorporate demographic, lifestyle, and health factors. Newly developed and validated prediction algorithms include social determinants of health, remove racial biases, and include cardiometabolic and kidney disease. Secondary stroke prevention increasingly accounts for presumed causal mechanisms of stroke while managing risk factors. Long-term monitoring for atrial fibrillation, remote patient monitoring of blood pressure, and increased use of glucagon peptide-like protein-1 receptor agonists are recent developments that may reduce disparities in risk. Vascular risk factor control before and after stroke may help mitigate cognitive decline and dementia by preserving brain health.Essential points: Social and environmental determinants, or drivers, of health are increasingly recognized contributors to stroke risk, and they may be amenable to policy and population solutions. Primary stroke prevention usually falls to the primary care physician, but neurologists may be involved as well, particularly for patients who present for other reasons or who are incidentally discovered to have cerebral infarcts in the course of evaluation for other conditions. Efforts to prevent stroke will also improve brain health more broadly, including reducing risk of cognitive decline, dementia, and late-life depression.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"32 3","pages":"716-745"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Key Considerations in Telestroke Program Management. 远程中风项目管理的关键考虑因素。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001699

Amy K Guzik

引用次数: 0

Unruptured Intracranial Aneurysms and Arteriovenous Malformations. 未破裂颅内动脉瘤及动静脉畸形。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001700

Edgar A Samaniego

{"title":"Unruptured Intracranial Aneurysms and Arteriovenous Malformations.","authors":"Edgar A Samaniego","doi":"10.1212/cont.0000000000001700","DOIUrl":"10.1212/cont.0000000000001700","url":null,"abstract":"Objective: Unruptured intracranial aneurysms and arteriovenous malformations (AVMs) are commonly detected with noninvasive imaging techniques. This article examines the various diagnostic imaging modalities used to characterize these vascular lesions, outlines their classification, and discusses the treatment options and decision-making processes involved in their management.Latest developments: Refined imaging techniques such as CT angiography (CTA) and magnetic resonance angiography (MRA) enable noninvasive characterization of both unruptured intracranial aneurysms and AVMs. In parallel, new artificial intelligence tools now assist radiologists in automated detection of unruptured intracranial aneurysms and intracerebral hemorrhages, potentially increasing the overall detection rate as these tools become routinely integrated into clinical workflows. The decision to manage unruptured intracranial aneurysms and AVMs with either periodic surveillance or treatment is increasingly personalized, guided by high-resolution CTA and MRI protocols that provide precise anatomic characterization. These imaging advances, combined with clinical information, help determine the necessity for intervention. Meanwhile, endovascular treatment for unruptured intracranial aneurysms continues to improve with the development of novel technologies that enhance clinical outcomes.Essential points: Although CTA and MRA are essential for characterizing unruptured intracranial aneurysms and AVMs, digital subtraction angiography remains the definitive modality for vascular lesion assessment. The decision to observe or treat an unruptured intracranial aneurysm or AVM should be made by a multidisciplinary team.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"32 3","pages":"902-932"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Erratum. 勘误表。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001720

N Jacoby, J Lynn

引用次数: 0

Postreading Self-Assessment and CME Test-Preferred Responses. 阅读后自我评估和CME测试偏好反应。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001704

Douglas J Gelb, Allyson R Zazulia

引用次数: 0

Postreading Self-Assessment and CME Test. 阅读后自我评估和CME测试。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001703

Douglas J Gelb, Allyson R Zazulia

引用次数: 0

SELF-ASSESSMENT AND CME. 自我评估和继续教育。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001702

引用次数: 0

Stroke in Children and Younger Adults. 儿童和年轻人中风。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2026-06-01 Epub Date: 2026-06-03 DOI: 10.1212/cont.0000000000001711

Thalia S Field, Thiviya Selvanathan

{"title":"Stroke in Children and Younger Adults.","authors":"Thalia S Field, Thiviya Selvanathan","doi":"10.1212/cont.0000000000001711","DOIUrl":"10.1212/cont.0000000000001711","url":null,"abstract":"Objective: This article reviews distinct acquired and congenital etiologies, age-specific and sex-specific risks, and lifelong implications of cerebrovascular conditions in children and young adults.Latest developments: Stroke incidence is rising among younger adults. An increased burden of vascular risk factors, particularly in adults older than 35 years, may play a role, as well as a confluence of underlying predisposing nonatherosclerotic risks and inciting triggers. New data and American Heart Association/American Stroke Association scientific statements are informing antithrombotic management in the setting of cervical artery dissection and cerebral venous thrombosis. Young people with chronic conditions affecting cerebrovascular health, including moyamoya arteriopathy, sickle cell disease, and congenital heart disease, may face accumulating and modulating risks for stroke as they age. Facilitating access to follow-up with specialized multidisciplinary care is important in optimally managing these complex diseases.Essential points: Stroke in young patients can result from nonatherosclerotic mechanisms such as dissection, arteriopathies, cardiac shunts, or systemic disease. Conventional vascular risk factors play a larger role in stroke risk in patients older than 35 years. Chronic conditions such as sickle cell disease, congenital heart disease, and moyamoya arteriopathy require lifelong cerebrovascular surveillance and individualized risk reduction strategies. Sex-specific factors, including menstruation, contraception, and pregnancy, can complicate management and amplify risks in younger patients, underscoring the need to promote awareness among neurologists who treat cerebrovascular disease in these individuals.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"32 3","pages":"791-818"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0