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Neuroscience (SNI) Blog

'stroke' Neuroscience (SNI) posts

Carotid Stenosis: What you need to know

Carotid stenosis is a build of up plaque in the large arteries that supply the brain with blood. This buildup of plaque increases the risk of transient ischemic attack (TIA) and stroke. Risk factors for carotid artery stenosis include hypertension, hyperlipidemia, obesity, and tobacco use. Symptoms of carotid artery stenosis include facial droop, weakness or numbness on one side of the face and body, slurred speech, garbled speech, gait instability, dizziness, and visual disturbances including blurred vision, loss of vision and double vision.

Carotid artery stenosis can be diagnosed with several diagnostic studies including carotid ultrasound, MR angiography (MRA), CT angiography (CTA), and cerebral angiogram.

Treatment options for carotid artery stenosis vary depending upon the severity of stenosis, history of TIA or stroke, and...

How do you know if you're having a stroke?

Hopefully, you won't have a stroke. But if you do, do you know what to do? Why is it important that you get to an emergency room quickly? Knowing the signs and symptoms of stroke could help save your life or the life of a loved one. How do you lessen your risk of having another stroke? Is your family at increased risk? Dr. William Likosky, director of Swedish Stroke and Telestroke programs, explains.

(Click here to see the entire playlist and other questions answered about stroke, including why follow up care is so important.)

Hugh Markus - 2011 Merrill P. Spencer Lecturer

Each spring, The Merrill P. Spencer, M.D. Endowed Lecture is presented in conjunction with the annual Swedish Neuroscience Institute Cerebrovascular Symposium. This year, we are pleased to welcome Dr. Hugh Markus, Professor of Neurology at St. George’s University of London.

Hugh Markus was educated in Medicine at Cambridge and Oxford Universities and then carried out medical jobs in Oxford, London and Nottingham before training in neurology in London. He was senior lecturer and subsequently, reader in neurology at Kings College London before moving to the chair of neurology at St George’s in 2000.

His clinical interests are in stroke, and he is clinical lead for stroke at St George’s Hospital. He is involved in both acute stroke care and outpatient stroke clinics, and runs specialist services for patients with sub cortical vascular disease and genetic forms of stroke.

Advances in thrombolysis

 Washington State has one of the high est stroke mortality rates in the nation. To improve this situation, acute intervention al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in farction following a stroke.

A recent European study demonstrat ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des moteplase.

Detection of Cerebral Microemboli by Transcranial Doppler

FROM BRAINWAVES: Since its introduction in 1982, transcranial doppler ultrasound (TCD) has evolved into a portable, multimodality, noninvasive method for real-time imaging of intracranial vasculature. The detection of cerebral microemboli is among the more remarkable capabilities of TCD. Emboli create countable signals in the ultrasound display due to the higher reflection of sound waves compared to the blood cells. Experimental models have shown a high sensitivity and specificity for detection of a variety of substrates, including thrombotic, platelet and atheromatous emboli.

Microembolic signals (MES) within the intracranial vasculature are most frequently identified in patients with large-vessel atherosclerotic disease, such as carotid stenosis. They have also been reported in intracranial arterial stenosis, arterial dissection, cardiac disease and atheroaortic plaque. Additionally, they have been seen in arteries distal to coiled aneurysms.

There is strong evidence that MES detection predicts future ipsilateral stroke risk in patients with symptomatic carotid stenosis (Markus HS, et al.; King A, et al.). A recent study of patients with asymptomatic carotid stenosis demonstrated that MES predicted subsequent ipsilateral stroke and TIA, and also ipsilateral stroke alone, and that it is helpful in selecting patients who will benefit from carotid endarterectomy.

Staying Fit to Prevent Stroke

A brisk walk for as little as 30 minutes a day can improve your health in many ways and may reduce your risk for stroke. Join me, and one of our exercise physiologists to learn how to stay fit and reduce your risk for stroke. Free blood pressure screening will also be available.

Cherry Hill - Pinard Foyer

Tuesday, Oct. 12, 11 a.m.-1 p.m

For more information, please contact Sherene Schlegel:

sherene.schlegel@swedish.org

Office: 206-320-3484

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