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Uncertainties and controversies in neurology and medicine - with focus on stroke and TIAs.

Part 1 of 4. This 4-part series focuses on controversies in the area of strokes and TIAs. Future Rife with Strife series will focus on controversies in other areas of neurology.

Hear these reports:

The Role Of Controversies In The Advancement Of Medicine: medical controversies, with criticism and debates, are the way that optimal medical therapies crystallize.

TIA and Stroke Admissions: a study on primary care physicians last year in the journal Stroke showed that even when strokes and TIAs were well recognized as medical emergencies by the PCPs, essentially 30% of them would not admit the TIA patients as a medical emergency.

Immediate Treatment of TIAs: the PROFESS trial is underway comparing clopidogrel (Plavix) with ASA/dipyridamole (Aggrenox) for secondary stroke prevention. Until those results are available, which drug is best to use for the prevention of stroke in TIA patients? Or is Aspirin alone adequate ?

Carotid Stenting Versus Carotid Endarterectomy: Which do you recommend for your patients and why?

Intra-Arterial Thrombolytics for the Treatment of Acute Stroke: You may recall the “Lazarus phenomenon” from STAT episode #61. Dramatic improvement after intra-arterial thrombolytic occurred in twenty-five percent of the patients. Might this ‘emerging therapy’ someday take the place of IV infusions of thrombolytics?

Percutaneous Closure of Patent Foramen Ovales for Stroke Prevention: The relative risk of any thromboembolic event is 4-fold in patients with a PFO. A study in the New England Journal of Medicine 4 months ago support that PFOs and resulting paradoxical emboli are a cause of stroke in both older patients and younger patients. How about this proposition: the large-scale procedural intervention - percutaneous PFO closure - for the prevention of strokes (and migraines)? Now there’s a controversy that society is probably not quite ready to grapple with.

Next week’s show: Controversies about neuroprotection before or after acute ischemic stroke, and EDTA chelation therapy as a preventive and treatment for cerebrovascular and cardiovascular disease.

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.

Stroke-Struck: Medical and Surgical Advances for Neurovascular Disorders.

 

 #88: Stroke Struck, Installment #9 [24:40m]: Play Now | Play in Popup | Download (664)

Hear these reports:

• Failure To Admit Patients With Tia Ups Stroke Risk
• Reversing Trend - Hospitalizations For Stroke Decline In U.S Poststroke Costs Hit Young The Hardest
• Hispanic Stroke Awareness:
• Immune Response Genes Found Linked To Intracranial Aneurysm
• Reducing Post-Stroke Infections [And] Mortality From A Novel Caspase Inhibitor Drug.
• Ending Poststroke Therapy With Statins Too Soon May Raise Mortality Risk
• Hyperglycemia After Stroke Is Linked To Poor Outcomes
• Imaging, History Predict Early Post-Tia Stroke
• Intravenous Immunoglobulin For Acute Ischemic Stroke:
• Antidepressants May Improve Multiple Outcomes After Stroke

Weblinks:

• Activated Immune System Attacks The Brain After Stroke
• Glycosylated Proteins Have Increased BBB Penetration
• Increased Body Iron Stores Are Associated With Poor Outcome After Thrombolytic Treatment In Acute Stroke: Chelation Therapy May Hold Promise

Next week’s show: Our 6th installment of Policy for Neurology - Plans and strategies impacting your patients and your practice.

 

 #80: Defeating Dementia - Installment #7 [31:01m]: Play Now | Play in Popup | Download (965)

Installment #8 of Defeating Dementia - Promising news and approaches for progressive brain disorders.

Treat Alzheimer’s Early With Cholinesterase Inhibitors, Treat Long Term?

• At 1 year, patients on donepezil were significantly less likely to convert to Alzheimer’s disease. Over a year and a half, they did better on thinking, memory, and daily functioning measures, but by 3 years, there was no difference in the rate of conversion to Alzheimer?s signs and symptoms.
• Listeners are reminded of the potential importance of the likely neuroborreliosis etiology of Alzheimer’s; also the free CSF testing for evidence of the bug, being offered by Dr. Alan MacDonald in his research. Contact Dr. MacDonald via his website www.molecularalzheimer.org
• We also reflect briefly on research focusing on the use of vitamin E to reduce Alzheimers. The National Guideline Clearinghouse says vitamin E should be considered - at 1000 I.U. PO BID - in an attempt to slow progression of Alzheimer’s disease. Not a cure, but maybe Alzheimer’s patients can live longer and have better health if they take vitamin E.

Rivastigmine Patch Gets Approval for Dementia: It?s the second patch approved for Parkinson’s disease. One of the researchers (a consultant for the manufacturer, Novartis) said the patch appears better tolerated than the pill.

Alzheimer’s Disease Affects 5 Million: The prevalence is projected to skyrocket in the next 40 years.

Money and Leadership Sought As Alzheimer’s Crisis Looms: The Center for Health Transformation is a health policy think tank founded by former Speaker of the House Newt Gingrich. The Center has a national financial-plus-leadership strategic plan intended to tackle the impending Alzheimer’s epidemic.

Race and Ethnicity Play Role in Alzheimer’s Treatment Delays: The survey found that essentially 70% of both African American and Hispanic caregivers were likely to dismiss the symptoms of Alzheimer’s as “old age” compared with just 50% of caregivers of other races. And African American caregivers were more likely to report that stigma of the diagnosis affected their decision to obtain a diagnosis for a family member.

CAIDE Dementia Risk Score Validated: This risk score predicts the likelihood of a middle-aged person developing dementia within 20 years. It has been independently validated in an ethnically diverse population.

Imaging Compound Pittsburgh B May Help Track Alzheimer’s: The investigational Pittsburgh B compound that binds to cerebral -amyloid and is visible on positron emission tomography — PET scans — maintains its promise as a way to distinguish the elderly patients presenting with memory problems who will go on to develop Alzheimer’s disease from those who won’t progress.

Stroke in Early Alzheimer’s Ups Dementia Risk: The interaction of cerebrovascular disease and Alzheimer’s disease pathology appears to significantly increase the risk of dementia from Alzheimer’s, even when only a small amount of Alzheimer’s pathology is present.

And Last but not least: Marijuana’s active ingredient, THC, acts as a cholinesterase inhibitor and may slow the progression of Alzheimer’s disease.

Next week’s show: Our 5th installment of Vulnerability in Neurology - Potential challenges for neurologists on the clinical front lines. Tune in as we discuss insights about the doctor shortage from the results of a large survey done on hospital CEOs. We’ll have other important vulnerability-related news too.

Weblink (other): Alzheimer’s is the 3rd most expensive medical condition in the US. The direct and indirect costs of Alzheimer’s disease add up to essentially $150 billion each year. That?s on the ?billions scale? the Iraq war is costing us each year. BTW: Click here for an interesting website showing a running total estimate of the ongoing costs of the Iraq war.

 

 #71: Stroke Struck, Installment #5 [25:07m]: Play Now | Play in Popup | Download (743)

Medical and surgical advances for neurovascular disorders. Installment #8

Publication Date: May 18th, 2007.

Focus: New AHA/ASA Stroke Guidelines - EMS emphasis.

1. New Stroke Guidelines Emphasize Role of EMS: The new Guidelines recommend that EMS personnel bypass a hospital that doesn’t have the resources or institutional commitment to treat stroke patients.
2. Two States’ Mandates Increased TPA Use in Stroke: In Massachusetts, for example, when ambulances with stroke patients were forced to take those patients to stroke centers, use of IV TPA increased from 30% to 50% after the law went into effect (an increase of 20 percentage points).
3. Metabolic Syndrome Found To Be Risk Factor for Stroke: According to data from the Northern Manhattan Stroke Study, metabolic syndrome is a significant risk factor for intracranial atherosclerosis-related stroke.

And last but not least: Give me the chocolate, and no one gets hurt!

Weblinks: www.stroke.ahajournals.org (to download latest Stroke Guidelines).

 

 #61: Stroke-Struck, Installment #7 [26:05m]: Play Now | Play in Popup | Download (592)

Medical and surgical advances for neurovascular disorders. This is the last of our three-part series of shows covering AHA’s International Stroke Meeting.

Publication Date: Mar 16th, 2007.

1. TPA is used in pediatric stroke despite lack of guidelines: Children have started the ‘clot-buster’ therapy at time intervals ranging from 20 minutes 52 hours.
2. Anticlotting drug use in children varies widely after stroke: What percent of children who”ve had arterial ischemic strokes do you think receive no anticoagulation therapy after the stroke? Listen and learn.
3. One in four acute ischemic stroke patients rapidly respond to intra-arterial treatment: The investigators referred to the rapid recovery from intra-arterial infusion of thrombolytic as the “Lazarus phenomenon.”
4. And last but not least: Contraceptive peace of mind now in convenient chewable form!

Links: http://stroke.ahajournals.org/cgi/content/full/36/9/1825 According to the Stroke report, the annual incidence of pediatric stroke is 4.3 per 100,000, and the majority of the stroke cases were hemorrhagic. The researchers projected that future studies of pediatric stroke would have to draw from a patient population of up to essentially 60 million children to complete a case-control study within 4 years.

 

 #60: Stroke-Struck, Installment #6 [27:12m]: Play Now | Play in Popup | Download (604)

Medical and surgical advances for neurovascular disorders. This is the second of three shows covering AHA’s International Stroke Meeting.

Publication Date: Mar 9th, 2007.

1. Tight glycemic control - does it help in acute stroke patients? Even in medicine, we make assumptions about what we think may result in best outcomes for our patients (like stabilizing glucose in stroke patients), but the research can prove us wrong!

2. Get with the guidelines: Diabetes is poorly addressed in acute stroke patients. Significant numbers of stroke patients with diabetes leave the hospital after a stroke without treatment plans that meet evidence-based guidelines.

3. Aspirin may be helpful for more than just pain, fever and thinning the blood. Even at low doses, it appears to prevent age-related declines in gray and white matter integrity.

4. And last but not least, the spirit of Seuss speaks: Call it the ‘bro,’ but into the dustbin, the boy-bras now go!

Links: Brain Awareness Week is coming up: Mar 12th to Mar 18th. It is an international program of public events to celebrate the brain. The campaign unites essentially 2000 partner organizations, including universities, medical and research organizations, patient advocacy groups, schools, government agencies, service groups, and professional organizations in 66 countries - all communicating the progress of brain research. For more information, go to www.dana.org.

 

 #59: Stroke-Struck, Installment #5 [22:56m]: Play Now | Play in Popup | Download (595)

Medical and surgical advances for neurovascular disorders. This is the first of 3 shows covering AHA’s International Stroke Meeting.

Publication Date: Mar 2nd, 2007.

1. Neurologist shortage hits stroke centers: There clearly aren’t enough neurologists to go around! It’s a major obstacle for hospitals to find neurologists available to consult 24 hours a day, 7 days a week.
2. The Neurological Emergencies Treatment Trials Network: The mission is to improve outcomes of patients with acute neurological problems - through innovative research.
3. NINDS gains new leadership: Neurologist and researcher Dr. Walter Koroshetz has been named deputy director.
4. The Stroke Treatment and Ongoing Prevention Act introduced again: The bill calls for public education efforts to increase awareness of the warning signs of stroke, and the need to treat acute ischemic stroke as a medical emergency.
5. And last but not least: Swoons of ’skinnies’ are stalling subways!

Links: Brain Awareness Week is coming up: Mar 12th to Mar 18th. It is an international program of public events to celebrate the brain. The campaign unites essentially 2000 partner organizations, including universities, medical and research organizations, patient advocacy groups, schools, government agencies, service groups, and professional organizations in 66 countries - all communicating the progress of brain research. For more information, go to www.dana.org.

 

 #37 - Stroke Struck [35:57m]: Play Now | Play in Popup | Download (541)

Advances for Neurovascular Disorders, Installment #3.

Publication Date: 09/29/06.

Show notes: We tackle costs associated with comprehensive stroke centers, and what it takes to run them. Also: new application for statins to minimize vasospasm after subarachnoid hemorrhage; CT perfusion score to predict risk from tPA-induced hemorrhage; APACHE score to predict stroke outcome after 1 year; increased cerebral emboli in dementia patients; and last but not least for the male neurology professionals listening: do you shave at least once daily? Find out why we ask!