Hooman Kamel

Outcomes of Admitted vs. Discharged ED Patients with TIA

Transient ischemic attacks (TIAs) can lead to subsequent stroke within 90 days in an estimated 10% to 20% of cases. Current guidelines recommend prompt testing for stroke risk factors including hypercholesterolemia, carotid stenosis, and atrial fibrillation. Using data from the Ontario Stroke Registry for 8540 adult patients with an emergency department (ED) diagnosis of TIA or minor stroke, researchers compared outcomes and adherence to recommended care between those admitted …

Effect of Alteplase on Long-Term Survival After Ischemic Stroke

Numerous randomized trials have assessed thrombolytic therapy for the treatment of acute ischemic stroke. Pooled analyses from these trials indicate that alteplase treatment improves functional outcomes, but the effect on survival remains unclear. Investigators now report the results of long-term follow-up among a subset of participants in the Third International Stroke Trial (IST-3). Of the 3035 participants in IST-3, 1946 were enrolled in the …

Better Blood Pressure Control Associated with Lower Risk for ICH Recurrence

Treatment of hypertension reduces the risk for intracerebral hemorrhage (ICH). However, we do not know the optimal blood pressure target for patients

More Cautionary Data on Surgery for Brain Vascular Malformations

Cerebral cavernomas consist of thin-walled vascular channels that can provoke seizures or cause neurological deficits from hemorrhage. Recent data indicate a 25% risk for rebleeding during the 5 years after an initial hemorrhage into a cavernoma. To reduce seizure frequency or prevent rebleeding, many cavernomas are surgically excised, but little data support this practice. Investigators have therefore examined outcomes after surgical excision of cavernomas …

Endovascular Stroke Therapy Remains Unproven

Two research groups conducted randomized trials to assess the long-term effects of endovascular stroke treatment.Ciccone and colleagues randomized 362

Subclinical Atrial Fibrillation Is Common in Patients with Cryptogenic Stroke

One third of ischemic strokes remain cryptogenic even after thorough inpatient evaluation. Numerous studies suggest that some of these patients may have paroxysmal atrial fibrillation (AF) that remains undiagnosed during their stroke hospitalization. Failing to detect these cases of AF may result in suboptimal antithrombotic therapy. However, what type and duration of cardiac monitoring should be used to rule out subclinical AF remain unclear. To address this question, …

Prehospital Thrombolysis for Stroke Is Possible

Few patients receive intravenous tissue plasminogen activator (TPA) within the optimal period of 90 minutes after stroke. Most efforts to speed

The Complicated Natural History of Unruptured Intracranial Aneurysms

Widespread use of brain imaging has led to frequent identification of unruptured intracranial aneurysms. The patients and clinicians face a difficult

Amantadine Accelerates Recovery from Post-Traumatic Disorders of Consciousness

Traumatic brain injury (TBI) often causes disorders of consciousness such as minimally conscious or vegetative states. Psychotropic medications are

No Benefit from Early Aspirin After TPA for Ischemic Stroke

Tissue plasminogen activator (TPA) is an imperfect therapy for acute ischemic stroke, because it often fails to recanalize blocked vessels or prevent reocclusion after initial recanalization. Observational data suggest that patients already on antiplatelet therapy may have more recanalization and better outcomes after TPA, but current guidelines recommend withholding aspirin for 24 hours after TPA administration. To better assess the effect of …