Stroke is a common problem, affecting nearly 800,000 people annually in the United States and serving as a leading cause of significant long-term disability. This article begins with a brief discussion of stroke epidemiology and then provides an overview of the various stroke mechanisms, setting a framework for which to consider etiology-specific stroke management.
Stroke prevention is complex because of the varied stroke etiologies and the multifactorial approach necessary for optimal stroke prevention and risk factor management. Inevitably, primary care providers will be part of every aspect of stroke care and, with a thorough understanding of key aspects, can greatly assist in the management of these patients.
Twenty percent to 40% of ischemic strokes are classified as cryptogenic, meaning a specific cause cannot be identified. A subset of those have been classified by some investigators as embolic stroke of undetermined source. However, this remains a controversial category and classification.
The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) study was designed to test the hypothesis that 30-day treatment with ticagrelor and aspirin would be superior to aspirin alone in reducing the risk of subsequent stroke or death in patients who had a non-cardioembolic ischemic stroke or transient ischemic attack.
It is well documented that influenza epidemics are associated with an increased risk of ischemic stroke and myocardial infarction, as are all systemic inflammatory disorders. Investigators at Weill Cornell Medicine wanted to determine if coronavirus infection induced a higher risk of ischemic stroke than other viral infections, such as influenza.
Cilostazol is a phosphodiesterase 3 inhibitor widely used in Asia for secondary stroke prevention but approved for use in North America only for symptomatic peripheral vascular disease. It has been theorized that cilostazol might be beneficial in preventing the progression of small vessel disease in the brain and, therefore, may have a secondary effect in preventing vascular dementia.
Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy.
These reviews of studies presented at the 2020 International Stroke Conference were written by Neurology Alert's editor after personal attendance at the presentations, followed by review of the simultaneous publications in Stroke. All comments and opinions are solely those of the editor.
A prospective cohort study in the United Kingdom demonstrated that vegetarians have a 22% lower incidence of ischemic heart disease, but a 20% increased incidence of total stroke, mostly related to hemorrhagic stroke, when compared to meat eaters. No difference in ischemic stroke or acute myocardial infarction was found.