Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Monday, September 30, 2013

Using Neuroplasticity to Help You Now

A 30 page slide show purporting to tell you how important it is for you to take the Interactive Metronome class from them.  Ask your doctor for advice.
http://braintime.co.nz/wp-content/uploads/2013/09/Hillary-Village-Presentation.pdf

Cannabinoid receptor signaling in progenitor/stem cell proliferation and differentiation

So ask your doctor what cannabinoids have to do with stem cell creation in your brain. Do not take 'I don't know' for an answer,  if it can help your recovery demand to know how you can get cannabinoids.  I would go to Italy or Spain to help my recovery. Why doesn't your doctor know anything?
http://www.sciencedirect.com/science/article/pii/S0163782713000544
  • a Department of Biochemistry and Molecular Biology I, School of Biology, Complutense University, IUIN, CIBERNED and IRYCIS, 28040 Madrid, Spain
  • b Department of Biomedical Sciences, University of Teramo, 64100 Teramo, Italy
  • c European Center for Brain Research (CERC)/Santa Lucia Foundation, 00143 Rome, Italy
  • d Department of Experimental Medicine & Surgery, Tor Vergata University of Rome, 00133 Rome, Italy
  • e Center of Integrated Research, Campus Bio-Medico University of Rome, 00128 Rome, Italy

Abstract

Cannabinoids, the active components of cannabis (Cannabis sativa) extracts, have attracted the attention of human civilizations for centuries, much earlier than the discovery and characterization of their substrate of action, the endocannabinoid system (ECS). The latter is an ensemble of endogenous lipids, their receptors [in particular type-1 (CB1) and type-2 (CB2) cannabinoid receptors] and metabolic enzymes. Cannabinoid signaling regulates cell proliferation, differentiation and survival, with different outcomes depending on the molecular targets and cellular context involved. Cannabinoid receptors are expressed and functional from the very early developmental stages, when they regulate embryonic and trophoblast stem cell survival and differentiation, and thus may affect the formation of manifold adult specialized tissues derived from the three different germ layers (ectoderm, mesoderm and endoderm). In the ectoderm-derived nervous system, both CB1 and CB2 receptors are present in neural progenitor/stem cells and control their self-renewal, proliferation and differentiation. CB1 and CB2 show opposite patterns of expression, the former increasing and the latter decreasing along neuronal differentiation. Recently, endocannabinoid (eCB) signaling has also been shown to regulate proliferation and differentiation of mesoderm-derived hematopoietic and mesenchymal stem cells, with a key role in determining the formation of several cell types in peripheral tissues, including blood cells, adipocytes, osteoblasts/osteoclasts and epithelial cells. Here, we will review these new findings, which unveil the involvement of eCB signaling in the regulation of progenitor/stem cell fate in the nervous system and in the periphery. The developmental regulation of cannabinoid receptor expression and cellular/subcellular localization, together with their role in progenitor/stem cell biology, may have important implications in human health and disease.

Abbreviations

  • 2-AG, 2-arachidonoylglycerol;
  • AEA, N-arachidonoylethanolamine;
  • BDNF, brain derived neurotrophic factor;
  • CBD, cannabidiol;
  • CBG, cannabigerol;
  • CFU-GEMM, colony-forming unit: granulocyte, erythrocyte, macrophage, megakaryocyte;
  • CREB, cAMP response element-binding protein;
  • CSF, colony-stimulating factors;
  • DAGL, diacylglycerol lipase;
  • ECB, endocannabinoid;
  • ERK, extracellular-signaling regulated protein kinase;
  • ES, embryonic stem;
  • ECS, endocannabinoid system;
  • FAAH, fatty acid amide hydrolase;
  • FGF, fibroblast growth factor;
  • GAD, glutamate decarboxylase;
  • GSK3β, glycogen synthase kina;
  • ICM, inner cell mass;
  • HSC, hematopoietic stem cells;
  • HPC, hematopoietic progenitor cells;
  • L1-CAM, L1-cell adhesion molecule;
  • MAGL, monoacylglycerol lipase;
  • mGluR, metabotropic glutamate receptors;
  • mTORC1, mammalian target of rapamycin complex 1;
  • NCAM, neural cell adhesion molecule;
  • NGF, nerve growth factor;
  • NP, neural progenitor/stem cell;
  • OEA, N-oleoylethanolamine;
  • PEA, N-palmitoylethanolamine;
  • PI3K, phosphoinositol 3-kinase;
  • PKA, protein kinase-A;
  • PPARγ, peroxisome proliferator activated receptors;
  • RANKL, receptor activator of nuclear factor kappa-B ligand;
  • SVZ, subventricular zone;
  • THC, Δ9-tetrahydrocannabinol;
  • vGlut, vesicular glutamate transporter;
  • VZ, ventricular zone

Stroke victim paid £350K after warfarin withdrawn

And what exactly is your standard of care during the first week when neurons are dying off by the millions due to the neuronal cascade of death? Are the doctors just sitting on their asses not doing anything at all? Do they even know there is a neuronal cascade of death? Demand an answer from your hospital. Apologies will not bring back dead neurons so sue the hell out of them. Maybe money will change behavior, nothing else seems to work to get the stroke world to solve their problems with saving neurons from dying.
http://www.bbc.co.uk/news/uk-england-manchester-24341286
A Greater Manchester woman who had a stroke after she was taken off blood-thinning drugs has been awarded £350,000 compensation from a hospital trust.
Anne Olliver, 66, from Altrincham, was taken off the drug warfarin while at Wythenshawe Hospital in 2007.
The former librarian suffered a stroke in November 2010 when a blood clot travelled from a chamber in her heart to her brain.
Mrs Olliver said she had been left so incapacitated by the stroke she was now unable to carry out "even the simplest of tasks".
A statement from the University Hospital of South Manchester Trust said: "The trust accepts that there were failings in the standard of care provided to Mrs Olliver, and apologises unreservedly."

Aspirin ineffective in many heart patients

Has your doctor warned you about this ineffectiveness?
http://www.irishhealth.com/article.html?id=22668
"The profile of the patients who are not adequately protected are typically men with high blood pressure, overweight and with a high alcohol intake. This group, who are at high risk of recurrent heart attack, are not getting the benefit of a cheap and generally effective therapy," explained lead researcher, Prof Dermot Kenny, of the Royal College of Surgeons in Ireland.
He said that the findings indicate that about 20% of the 700 people in the study ‘are not protected by their existing therapy'.

More at link.
You probably have to bring this to your doctors attention.

Apraxia and action disorganisation syndrome (AADS)

At least the Stroke Association of the UK is getting involved in research and hands on work.
http://www.theguardian.com/lifeandstyle/2013/sep/29/stroke-survivors-retraining-the-brain-aads
Stephen Manning was head chef at a French restaurant in Notting Hill for 25 years. Today, he struggles to make a cup of tea. His wife Joanne intervenes when he pours water into a cup without a tea bag or forgets to add milk to his cereal. But when she is not around, life can be very difficult. It is not that Stephen doesn't understand what he is trying to do. He knows what a cup of tea looks like. The problem is that he often struggles to remember the steps to make the perfect brew.
Last year, Stephen was one of the 150,000 people in the UK who suffered a stroke, caused by a lack of blood getting to parts of the brain. The classic symptoms associated with having a stroke are physical. Patients can end up with paralysed limbs and problems with speech. But for Stephen, something much more subtle underlies his problems – and he is not alone.
Of stroke patients, 68% go on to develop apraxia and action disorganisation syndrome (AADS). Sufferers have difficulty in sequencing previously automatic actions, from washing themselves to making the bed. Although the patient's movement is affected, AADS is primarily a disorder of the mind. Naturally people want to cure what they can see. AADS is hard to identify and although it is common, it has been overlooked in favour of physical stroke rehabilitation.
Improved brain-scanning techniques mean it is easier to identify AADS. And now, psychologists and engineers have joined forces in a project that aims to help improve the lives of the thousands of people who suffer from this condition.
"Patients may have done basic tea-making tasks in hospital, but there is nothing to aid cognitive rehabilitation after that," says Amy Arnold, a PhD researcher at Birmingham University who is working on the project, called Cogwatch. It aims to restore patients' independence by developing personalised rehabilitation systems that can be installed into their homes.
These systems will silently monitor patients as they go about their daily lives and provide advice to guide them when they make errors. It is hoped that patients will learn to sequence tasks correctly as a consequence.
But designing this rehabilitation system has proved a challenge. Ultimately, patients will wear a watch that will monitor their movements. Electronic devices will be installed into everyday objects in their homes, such as a toothbrush or a vest. These will transmit information wirelessly to a central system. This will guide patients if they make errors, through sounds, vibrations or a visual screen.
Manish Parekh, a PhD student who is part of the project, explains: "We are incorporating sensors that monitor grip strength or motion into everyday objects. This is the same technology used in mobile phones that detect which way up they are being held."
Another challenge is combining technology with the research carried out by the project's psychologists. "We are trying to learn how healthy people normally behave and the kind of errors that occur in stroke patients," explains Amy.
To monitor how tasks are normally undertaken, the team has studied healthy participants. Sensors that can monitor complex movements were used to examine how they completed several tasks. This information can then be used as a comparison to AADS behaviour.
Brin Helliwell, who had a stroke a year ago, is participating in the research: "I benefitted hugely, psychologically, in terms of motivation and coming to understand what had happened to me," he said.
Not everyone will welcome the new technology with open arms. Many stroke patients are above the age of 65 and may struggle to integrate technology into their everyday lives. "It has to be friendly enough to make patients want to use it," explains Amy. "They don't want lots of gadgetry and to press lots of buttons, or for it to take over their lives."
This is the reason Cogwatch is working closely with the Stroke Association. "It is great that they are addressing this problem but a system like this will only succeed if it is usable by patients," explains Dr Clare Walton, the Stroke Association's Research Communication Officer. "One of the concerns with this project is that the tech group will go nuts, developing all this amazing technology, but that it will be unusable – like developing a vibrating watch for a patient with sensation problems."
With the focus still on physical rehabilitation, this project, though still in its infancy, is quietly tackling AADS head-on for the first time. The disorder affects a massive percentage of stroke survivors, and for people like Stephen Manning that fight could not have come soon enough.

Ballet dancers' brains 'adapt to spins'


And if dancers can do this neuroplastically your doctor needs to start a clinical trial for all the cerebellum stroke survivors who experience dizziness and figure out how to stop their dizziness. But that won't occur, give it to your great stroke association to figure out.
BBC article here;
Ballet dancers' brains 'adapt to spins'

The Neurologica blog writing about it here;
Why Isn’t the Spinning Dancer Dizzy?

The abstract and article this is based on is here: 
The Neuroanatomical Correlates of Training-Related Perceptuo-Reflex Uncoupling in Dancers

Researchers Find Early Success in New Treatment for Stroke Recovery

Ask your doctor for the protocol and how this might help you.
http://www.utdallas.edu/news/2013/10/1-26531_Researchers-Find-Early-Success-in-New-Treatment-fo_story-wide.html?WT.mc_id=NewsHomePage
Researchers at The University of Texas at Dallas have taken a step toward developing a new treatment to aid the recovery of limb function after strokes.
In a study published online in the journal Neurobiology of Disease, researchers report the full recovery of forelimb strength in animals receiving vagus nerve stimulation.
“Stroke is a leading cause of disability worldwide,” said Dr. Navid Khodaparast, a postdoctoral researcher in the School of Behavioral and Brain Sciences and lead author of the study. “Every 40 seconds, someone in the U.S. has a stroke. Our results mark a major step in the development of a possible treatment.”
Vagus nerve stimulation (VNS) is an FDA-approved method for treating various illnesses, such as depression and epilepsy. It involves sending a mild electric pulse through the vagus nerve, which relays information about the state of the body to the brain.
Khodaparast and his colleagues used vagus nerve stimulation precisely timed to coincide with rehabilitative movements in rats. Each of the animals had previously experienced a stroke that impaired their ability to pull a handle.


Stimulation of the vagus nerve causes the release of chemicals in the brain known to enhance learning and memory called neurotransmitters, specifically acetylcholine and norepinephrine. Pairing this stimulation with rehabilitative training allowed Khodaparast and colleagues to improve recovery.
Many rehabilitative interventions try to enhance neuroplasticity (the brain’s ability to change) in conjunction with physical rehabilitation to drive the recovery of lost functions, according to Khodaparast. Unfortunately, up to 70 percent of stroke patients still display long-term impairment in arm function after traditional rehabilitation.
“For years, the majority of stroke patients have received treatment with various drugs and/or physical rehabilitation,” Khodaparast said. “Medications can have widespread effects in the brain and the effects can last for long periods of time. In some cases the side effects outweigh the benefits. Through the use of VNS, we are able to use the brain’s natural way of changing its neural circuitry and provide specific and long lasting effects.”

Khodaparast acknowledged the study has some limitations. For example, the animals were young and lacked some of the other illnesses that accompany an aged human population, such as diabetes or hypertension. But Khodaparast and his colleagues said they are optimistic about vagus nerve stimulation as a future tool. They will continue testing in chronically impaired animals with the hopes of translating the technique for stroke patients. Working with MicroTransponder Inc., a partner company in the current study, researchers at the University of Glasgow in Scotland have begun a small-scale trial in humans.
“There is strong evidence that VNS can be used safely in stroke patients because of its extensive use in the treatment of other neurological conditions,” said Dr. Michael Kilgard, professor in neuroscience at UT Dallas and senior author of the study.
Kilgard is also conducting clinical trials using vagus nerve stimulation to treat tinnitus, the medical condition of unexplained ringing in the ears. Kilgard’s lab first demonstrated the ability of vagus nerve stimulation to enhance brain adaptability in a 2011 Nature paper.
Other UT Dallas researchers involved in the study are: postdoctoral fellows Dr. Seth Hays and Dr. Andrew Sloan; graduate student Daniel Hulsey; undergraduate students Andi Ruiz and Maritza Pantoja; and Dr. Robert Rennaker II, associate professor in neuroscience, director of the Texas Biomedical Device Center and head of the Department of Bioengineering.

Sunday, September 29, 2013

Frequent orgasms may protect against heart attacks

All the news about your brain health all the time, no censoring.  Ok, it doesn't directly mention stroke but close enough.    Enjoy.
I'm sure that the faked orgasm that Sally had in When Harry Met Sally does not count.
You do expect your doctor to know all about this and prescribe appropriate measures right after your stroke?
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And another reason to have sex;
Sex 4 Days Per Week Will Raise Your Salary Up To 5%

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An orgasm a day keeps the doctor away!
There is also evidence that frequent orgasms may protect against heart attacks and keep our brains healthy. “Functional MRI images show that women’s brains utilize much more oxygen during orgasm than usual, similar to the effects of exercise,” says Barry Komisaruk, PhD, coauthor of The Science of Orgasm.
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Why Bad Sex Is Shortening Your Life

There is also evidence that frequent orgasms may protect against heart attacks and keep our brains healthy.

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Health benefits of the 'Big O'

According to sex and health experts, it is quite beneficial to both a man and woman's overall health if they have an orgasm three to five times per week - be it through sexual intercourse or masturbation. In fact, due to circumstances beyond your control, you may not always find a willing partner to achieve that 'Big O' that frequently, so, according to the experts, there is nothing wrong with 'self-service', and, as a matter of fact, you may be healthier for it in the end.

 

 

Mercury astronaut Scott Carpenter suffers stroke; full recovery expected

You need to have your doctor contact the doctor making this statement because s/he obviously knows a hell of a lot more than all the other doctors combined. Predicting recovery from what information?
http://www.nbcnews.com/science/mercury-astronaut-scott-carpenter-suffers-stroke-full-recovery-expected-8C11273378
He reportedly experienced some paralysis and is having trouble speaking, but is expected to make a full recovery.

Dan Pallotta: The way we think about charity is dead wrong

This pretty much explains what is totally wrong with our stroke organizations. They do not think big. Thinking big would involve significant risks but significant rewards. No they think very small, lets just put out press releases that put all the responsibility about preventing stroke damage on the public by telling them generic ways not to have a stroke. How stupid and ineffective can you get? The bold goal a great stroke association would have is 100% recovery for all survivors. That would bring in donations and brilliant persons to tackle the problem.
http://www.ted.com/talks/dan_pallotta_the_way_we_think_about_charity_is_dead_wrong.html
Activist and fundraiser Dan Pallotta calls out the double standard that drives our broken relationship to charities. Too many nonprofits, he says, are rewarded for how little they spend -- not for what they get done. Instead of equating frugality with morality, he asks us to start rewarding charities for their big goals and big accomplishments (even if that comes with big expenses). In this bold talk, he says: Let's change the way we think about changing the world.

World's First Thought-Controlled Bionic Leg Unveiled by Rehabilitation Institute of Chicago

And with just a little bit more research it should be easily able to be adapted to send signals to stop the spastic muscles and fire the correct ones in sequence. But don't expect any of our ineffective stroke organizations to take on that challenge. That would require brains, innovation and hard work.
http://www.sacbee.com/2013/09/25/5768318/worlds-first-thought-controlled.html
The science of bionics helped the more than 1 million Americans1 with leg amputations take a giant step forward, as the Rehabilitation Institute of Chicago (RIC) revealed clinical applications for the world's first thought-controlled bionic leg in this week's New England Journal of Medicine. This innovative technology represents a significant milestone in the rapidly-growing field of bionics. Until now, only thought-controlled bionic arms were available to amputees.
To view the multimedia assets associated with this release, please click: http://www.multivu.com/mnr/63339-rehabilitation-institute-of-chicago-first-thought-controlled-bionic-leg
(Photo: http://photos.prnewswire.com/prnh/20130925/MM85148)
Levi Hargrove, PhD, the lead scientist of this research at RIC's Center for Bionic Medicine, developed a system to use neural signals to safely improve limb control of a bionic leg.
"This new bionic leg features incredibly intelligent engineering," said Hargrove. "It learns and performs activities unprecedented for any leg amputee, including seamless transitions between sitting, walking, ascending and descending stairs and ramps and repositioning the leg while seated."
This method improves upon prosthetic legs that only use robotic sensors and remote controls and do not allow for intuitive thought control of the prosthetic.
The case study focuses on RIC research subject Zac Vawter, a lower-limb amputee who underwent targeted muscle reinnervation surgery – a procedure developed at RIC and Northwestern University – in 2009 to redirect nerves from damaged muscle in his amputated limb to healthy hamstring muscle above his knee. When the redirected nerves instruct the muscles to contract, sensors on the patient's leg detect tiny electrical signals from the muscles. A specially-designed computer program analyzes these signals and data from sensors in the robotic leg. It instantaneously decodes the type of movement the patient is trying to perform and then sends those commands to the robotic leg. Using muscle signals, instead of robotic sensors, makes the system safer and more intuitive.
"The bionic leg is a big improvement compared to my regular prosthetic leg," stated Vawter. "The bionic leg responds quickly and more appropriately, allowing me to interact with my environment in a way that is similar to how I moved before my amputation. For the first time since my injury, the bionic leg allows me to seamlessly walk up and down stairs and even reposition the prosthetic by thinking about the movement I want to perform. This is a huge milestone for me and for all leg amputees."
Army Funding More than 1,200 leg amputees in the United States are recently injured servicemen and women.2
The US Army's Telemedicine and Advanced Technology Research Center (TATRC) funded the RIC study with an $8 million grant to improve the control of advanced robotic leg prostheses by adding neural information to the control system. Due to this unusually large TATRC grant for the rehabilitation field and a multi-disciplinary team, RIC was able to accomplish these breakthrough innovations in only four years.
"We are pleased to partner with the RIC Center for Bionic Medicine in the development of user intent controlled bionic limbs," said Col. John Scherer, director of the Clinical and Rehabilitative Medicine Program at the U.S. Army Medical Research and Materiel Command.  "We appreciate the opportunity to sponsor this life-changing effort to provide military amputees with as much physical functionality as possible, as soon as possible."
This partnership aims to make these bionic legs available for in-home testing for both the military and civilian populations within the next five years.
About The Rehabilitation Institute of Chicago The Rehabilitation Institute of Chicago (RIC) is the nation's leading provider of comprehensive physical medicine and rehabilitation care to patients from around the world. Ranked No. 1 by both U.S. News and World Report and the U.S. National Institutes of Health, RIC holds an unparalleled market distinction.
With a record six multi-year, multi-million dollar federal research designations awarded and funded by the National Institutes of Health and the Department of Education's National Institute of Disability and Rehabilitation Research in the areas of spinal cord injury, brain injury, stroke, neurological rehabilitation, outcomes research, bionic medicine/rehabilitation engineering research, and pediatric orthopedics, RIC operates the largest rehabilitation research enterprise in the world. RIC also operates its 182-bed, flagship hospital in downtown Chicago, as well as a network of more than 40 sites of care distributed throughout the Midwest, through which it delivers inpatient, day rehabilitation, and outpatient services.
The Center for Bionic Medicine at RIC is one of the world's largest prosthetics and orthotic research centers; it focuses on developing bionic legs, bionic arms, and other innovative rehabilitation technologies.
Founded in 1954, RIC has been designated the "No. 1 Rehabilitation Hospital in America" by U.S. News & World Report every year since 1991. RIC sets the standard of care in the post-acute market through its innovative applied research and discovery programs, particularly in the areas of neuroscience, bionic medicine, musculoskeletal medicine and technology transfer. For more information, go to www.ric.org.
About the Telemedicine and Advanced Technology Research Center The Telemedicine and Advanced Technology Research Center (TATRC) explores, innovates and manages medical technologies that advance military medicine. TATRC serves as the primary execution manager for Defense Health Programs research while exploring science and engineering technologies leveraging other programs to maximize benefits to military health care.
TATRC's vision is to be the Department of Defense (DoD) model for enablement of transformational medical research. TATRC is the science and technology scout for military medicine and the center of gravity for Army telemedicine initiatives. TATRC initiates, sponsors, promotes, and oversees programs and partnerships in medical science and engineering that support military medical programs. With the strategic application of funding from small business innovation research/small business technology transfer, Army Medical Department advanced medical technology initiatives, and other sources, TATRC accelerates the implementation of novel science and engineering technology applications through validation studies, translational research, and demonstration projects. As a result, TATRC is a network of experts and capabilities positioned to rapidly address urgent DoD needs. For more information about TATRC, please visit:  www.tatrc.org

Read more here: http://www.sacbee.com/2013/09/25/5768318/worlds-first-thought-controlled.html#storylink=cpy

Saturday, September 28, 2013

Amy

Had lunch with Amy today. Intelligent discussions with intelligent people, great fun. I'm crazy enough to drive for hours just for a couple hour discussion. Got to see Amy show off her intention tremor and I'm jealous of her walking ability. Couldn't even tell that the bangs were ever a problem.
Had my own self-inflicted problem on the way down, I buy large cups of coffee and use straws to drink with. My second cup had a smaller straw and it took 3 powerful draws in a row to get coffee into my mouth.  Like an idiot I keep trying until I finally pull the straw out and find out that I had kinked the bottom 2 inches cutting off the flow.
Don't you dare complain about the picture of your wonderful face.

Friday, September 27, 2013

Janice needs more

Another press release email from the National Stroke Association. Janice would have much less disability if the NSA would find out how to stop the neuronal cascade of death.
Mr. Baranski, Why don't you talk to all the stroke bloggers out there that know exactly what is needed to prevent disability rather than reacting to it after the fact. I will never support your organization until you change your focus to preventing disability by stopping the neuronal cascade of death.
Mr. Baranski if you really want to do something useful for the stroke world, this would be a great starting place;
If I could do anything as a Health Activist - stroke rehab 
I dare you Mr. Baranski.

Are you afraid of us?
Be a Part of the Change

Dear dean,
Get startedRecently, I had a conversation with a stroke survivor, Janice. She has shared with us, many times, her desire to more effectively provide hope and resources to her support group. We’ve provided her access to webinars, educational tools on our website, and information on how to get involved with our Stroke Advocacy Network.
But, like many stroke survivors, Janice needs more.
Janice shared, “New stroke survivors need to know that there is life at the end of the tunnel. There are resources, but we need more.”
I couldn’t agree with Janice more. The stroke community needs more support to build hope and regain their dignity. National Stroke Association is committed to not only providing hope, but also creating the tools to help survivors take the next step in recovery.
But we need your help. We need you to help raise more dollars for the creation and implementation of the support that the survivor community is asking for. We know the stroke community is facing issues with finances, insurance navigation, returning to work and many other hurdles.
With your help, we can continue to increase post-stroke support to those in need. It’s easy to get started today by creating a personal fundraising page. Let us help you share you story and make a significant impact on long-term support for the stroke community.
Thank you for joining this fight with us.
Jim Baranski Signature
Jim Baranski
Chief Executive Officer
PS. Every dollar makes a difference, so please join us today in raising much-needed funds to support the vast needs of the stroke community.

Effects of Interactive Metronome Therapy on Cognitive Functioning After Blast-Related Brain Injury: A Randomized Controlled Pilot Trial

Whom is going to study this and see how to apply it to stroke? It's going to fall thru the cracks because we have no great stroke association.
http://atattentionfund.org/images/TBI/pdf/Nelson_et_al._Neuropsychology_Sep_23_2013.pdf
Lonnie A. Nelson, Margaret MacDonald, Christina Stall, and Renee Pazdan
Defense and Veterans Brain Injury Center, Fort Carson, Colorado
Objective:
We report preliminary findings on the efficacy of interactive metronome (IM) therapy for the remediation of cognitive difficulties in soldiers with persisting cognitive complaints following blast-related mild-to-moderate traumatic brain injury (TBI).
Method:
Forty-six of a planned sample of 50 active duty soldiers with persistent cognitive complaints following a documented history of blast-related TBI of mild-to-moderate severity were randomly assigned to receive either standard rehabilitation care (SRC) or SRC plus a 15-session standardized course of IM therapy. Primary outcome measures were Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Index Scores. Secondary outcome measures included selected subtests from the Delis–Kaplan Executive Functioning System (Trail Making Test and Color–Word Interference) and the Wechsler Adult Intelligence Scale–Fourth Edition (Symbol Search, Digit–Symbol Coding, Digit Span, and Letter–Number Sequencing) as well as the Integrated Visual and Auditory Continuous Performance Test.
Results:
Significant group differences (SRC vs. IM) were observed for RBANS Attention (p=.044), Immediate Memory (p=.019), and Delayed Memory (p=.031) indices in unadjusted analyses, with the IM group showing significantly greaterimprovement at Time 2 than the SRC group, with effect sizes in the medium-to-large range in the adjusted analyses for each outcome (Cohen’s d=0.511, 0.768, and 0.527, respectively). Though not all were statistically significant, effects in 21 of 26 cognitive outcome measures were consistently in favor of the IM treatment group (binomial probability=.00098).
Conclusion:
The addition of IM therapy to SRC appears to have a positive effect on neuropsychological outcomes for soldiers who have sustained mild-to-moderate TBI and have persistent cognitive complaints after the period for expected recovery has passed.

‘Stroke common among patients from Qatar’

Where the hell does this doctor get 9 out of 10 patients to full recovery? Have your doctor contact him for the secret. That's Nobel prize winning stuff.
http://www.gulf-times.com/qatar/178/details/366914/%E2%80%98stroke-common-among-patients-from-qatar%E2%80%99
A short nap during daytime and not being angry all the time may save you from life threatening medical conditions such as a paralysing stroke, a Swiss doctor recommends.
Dr Daniel Zutter, a specialist in neurology and internal medicine at the Centre for Neurological Rehabilitation in Switzerland, was in Doha recently as part of a Swiss health delegation.
Speaking to Gulf Times, Dr Zutter said that he frequently dealt with cases of stroke, brain injuries and Parkinson’s from Qatar and other GCC countries. He attributed these illnesses to poor lifestyles and unhealthy habits such as smoking.
“I’ve been treating patients from Qatar for the past four years now. Mostly I treat patients who suffer from stroke, brain injuries due to accidents or chronic neurological diseases like Parkinson’s or multiple cirrhosis,” Zutter said.
The risk factors for heart diseases such as hypertension, diabetes and smoking are exactly the same for the human brain. The doctor said that he observed that among his patients from GCC countries, people suffering from stroke were mostly middle-aged. The youth generally were treated for injuries suffered in car accidents, while the elderly have Parkinson’s, a degenerative disorder of the central nervous system characterised by tremor and impaired muscular co-ordination.
According to the doctor, 25 years ago when a patient suffered from a condition such as a stroke, he would be told that there was nothing much that a doctor could do and recommendations would be made to shift the patient to a nursing home. “But today due to new methods and technology, nine out of 10 people make complete recovery and are able to go home to lead an independent life,” the doctor said.
Dr Zutter gave the example of one of his Qatari patients, who was 55 years old and weighed over 100kg. He had suffered a massive stroke and his right side was completely paralysed. “With traditional physiotherapy methods, the patient could hardly make any significant recovery because it was very difficult to lift him. But with our robotic technology, we saw him make a full recovery within weeks,” he said.
The Swiss delegation that visited Qatar comprised three doctors who were specialists in neurosurgery, orthopaedics, spinal surgery and oncology.
The delegation also met HE the Minister of Health Abdullah bin Khalid al-Qahtani to discuss how to facilitate the exchange of visits between doctors of both countries; treatment of patients in Switzerland and explore points for a future agreement between the Ministry of Health and Swiss hospitals. They also met top officials of Hamad Medical Corporation  during their stay in Qatar.
Swiss Ambassador to Qatar Martin Aeschbacher said that Switzerland was known world over for its expertise in the field of medical treatment, especially neuroscience.
“We want to explore this potential to further develop the relations between our two countries,” Ambassador Martin said.

Toward a Theory of Neuroplasticity

This book tells us that the term is meaningless because everyone has their own definition.
http://books.google.com/books?id=cbeY_fm0YPgC&lpg=PP1&dq=neuroplasticity&pg=PA3#v=onepage&q&f=false

From the first chapter is this paragraph.
Given the central important of neuroplasticity, an outsider would be forgiven for assuming that it was a well defined and that a basic and universal framework served to direct current and future hypotheses and experimentation. Sadly, however, this is not the case. While many neuroscientists use the word neuroplasticity as an umbrella term it means different things to different researchers in different subfields… In brief, a mutually agreed upon framework does not appear to exist.


The Mind Hacks blogger has this as a post title. Read it all because your doctor and therapists don't understand what they are referring to when they say you need to neuroplastically rewire your brain. They know it occurs but can not give you a specific protocol that will accomplish that.

Neuroplasticity is a dirty word

Aphasia and bilingualism: Using one language to relearn another

Your speech therapist might find this useful in creating your stroke protocol.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=134867&CultureCode=en
In the era of globalization, bilingualism is becoming more and more frequent, and it is considered a plus. However, can this skill turn into a disadvantage, when someone acquires aphasia? More precisely, if a bilingual person suffers brain damage (i.e. stroke, head trauma, dementia) and this results in a language impairment called aphasia, then the two languages can be disrupted, thus increasing the challenge of language rehabilitation. According to Dr. Ana Inés Ansaldo,  researcher at the Research Centre of the Institut universitaire de gériatrie de Montréal (IUGM),  and a professor at the School of Speech Therapy and Audiology at Université de Montréal, research evidence suggests that bilingualism can be a lever—and not an obstacle—to aphasia recovery.

A recent critical literature review conducted by Ana Inés Ansaldo and Ladan Ghazi Saidi -Ph.D student- points to three interventional avenues to promote cross-linguistic effects of language therapy (the natural transfer effects that relearning one language has on the other language).
It is important for speech-language pathologists to clearly identify a patient's mastery of either language before and after aphasia onset, in order to decide which language to stimulate to achieve better results. Overall, the studies reviewed show that training the less proficient language (before or after aphasia onset)—and not the dominant language—results in bigger transfer effects on the untreated language.

Moreover, similarities between the two languages, at the levels of syntax, phonology, vocabulary, and meaning, will also facilitate language transfer. Specifically, working on “cognates,” or similar words in both languages, facilitates cross-linguistic transfer of therapy effects. For example, stimulating the word “table” in French will also help the retrieval of  the word “table” in English, as these words have the same meaning and similar sounds in French and English. However, training “non-cognates” (words that sound alike,  but do not share the same meanings) can be confusing for the bilingual person with aphasia.

In general, semantic therapy approaches, based on stimulating word meanings, facilitate transfer of therapy effects from the treated language to the untreated one.  In other words, drilling based on the word's semantic properties can help recovering both the target word and  its cross-linguistic equivalent. For example, when the speech-language pathologist cues the patient to associate the word “dog” to the ideas of  “pet,” “four legs” and “bark,”, the French word “chien is as well activated, and will be more easily retrieved than by simply repeating the word “dog”.
“In the past, therapists would ask patients to repress or stifle one of their two languages, and focus on the target language.  Today, we have a better understanding of how to use both languages, as one can support the other. This is a more complex approach, but it gives better results and respects the inherent abilities of bilingual people. Considering that bilinguals may soon represent the majority of our clients, this is definitely a therapeutic avenue we need to pursue,” explained Ana Inés Ansaldo, who herself is quadrilingual.

A Phase III Failure at Eli Lilly. Yes, Again.

We need an analysis like this for stroke drugs.
From Derek Lowe atIn the Pipeline blog.
There are 1000 stroke failures that Dr. Michael Tymianski has referred to that need this type of analysis. A great stroke association would already have a database of all the failures and use that to create a forward looking plan to get to success. But we have crap for stroke survivor support and prevention of disability.
http://pipeline.corante.com/archives/2013/09/27/a_phase_iii_failure_at_eli_lilly_yes_again.php

New centralised stroke unit already making a difference, say health chiefs - Worcestershire Royal Hospital

Before you allow them too much back-patting. Ask what the 30-day death rate looks like. Ask what they are doing to stop the neuronal cascade of death. Do not let them rest on their laurels, there is tons of work yet to do to reach 100% recovery. That is the metric they need to reach, and only you can force them to even try for it.
Sorry about the rant, but only survivors can tell when the stroke unit is doing its job. Its not there yet, not even close.
http://www.tewkesburyadmag.co.uk/news/evesham/10701953.New_centralised_stroke_unit_already_making_a_difference__say_health_chiefs/
THE centralisation of county stroke services in Worcester is providing better care to patients, according to the latest statistics.
The change came into effect in late July, when stroke beds in the north of the county were closed down in favour of an enhanced operation at Worcestershire Royal Hospital.
Centralising stroke care has produced significant improvements when it has taken place elsewhere in the country and it is a practice backed by the Stroke Association.
And early figures now suggest that the move is having the intended impact for patients in Worcestershire.
During August, more than 95 per cent of patients were admitted directly to the new unit. The figure for June, before stroke services were centralised, was 85 per cent – while the national target is 70 per cent.
In the same month more than 95 per cent of patients spent more than 90 per cent of their time in a specialist stroke bed. The national target is 80 per cent while Worcestershire Acute Hospitals Trust’s overall figure for 2012-13 was 79 per cent.
As part of the centralisation, the stroke unit at Worcester has been expanded to provide an acute stroke ward, two additional specialised consultants, a dedicated nursing team and consolidated support from physiotherapists, dieticians, occupational therapists and speech and language therapists.
Jane Schofield, interim director of emergency care at the acute trust, said feedback from patients and carers had supported what the statistics are saying.
“This is all part of a bigger journey to make a modern stroke centre in Worcester,” she said. “Centralising services in this way has been trialled nationally and it is proven to save more lives. “I’m pleased to say that this move has been a success for our patients.”
Chairman Harry Turner put a vote of thanks to stroke staff on the record at a trust board meeting.
“In just two months we have seen a 10-point increase in both the metrics, which I think is incredible,” he said.
Chief operating officer Stewart Messer said: “The whole point of centralising stroke services was that it is a proven strategy for improving outcomes for patients. But to achieve that in the first two months is absolutely a huge success.”

Thursday, September 26, 2013

Why I hope every neurologist, PMR doctor for stroke hates me

Because doing the best for their patients is not occurring right now. If it was they would be having their doctor associations, Joint Commission and the WSO on high alert to get stroke research and rehab breathlessly talked about in any health discussion. And the way to do that is to have every single stroke survivor demand a protocol to get to 100% recovery. And threaten to not pay them until they do. Altruism hasn't worked, time to bring out the big guns.  Standard of care. Use all the links I've provided to prove they are not paying attention and thus failing in their standard of care responsibilities. Quote me liberally, I want Dean to be a swear word in the stroke medical world.
This may take 50 years but you have to start some time.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” -- Margaret Mead


DAMN YOU DEAN

How do you get to 100% stroke recovery?

First of all you don't ask your doctor, they have no clue.
This is the million dollar question that no one is willing to answer, your doctor, the ASA,NSA and WSO all punt on this question. They are all naked emperors.
The best way is to have a very small stroke. These people are probably the ones listed in the statistics of 10% fully recovering.
Then you look at those who seem to have succeeded in spite of the medical establishment.
Like Pedro Bach-y-rita with his massive brain stem stroke
http://oc1dean.blogspot.com/2011/05/brainstem-stroke-recovery.html
or
Michelle Mack born with half a brain due to stroke
http://www.pbs.org/saf/1101/segments/1101-6.htm 

or Jill Bolte-Taylor whom it is impossible to tell how bad her stroke was
http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html
Or
Kathy with 26 months of hard work.
http://www.youtube.com/watch?feature=player_embedded&v=71WEEn-bU9c

Neuroscience of Sports: Concussions

A blog posting from the Dana Foundation, read it all.
http://danapress.typepad.com/weblog/2013/09/neuroscience-of-sports-concussions.html?
This paragraph needs to be brought to your doctors attention, do not leave the office until your Alzheimers risk is reduced to 0% from the stroke.  Replace the word concussion with stroke/TBI.
I'm sure your doctor doesn't know about  your 33% chance of developing Dementia/Alzheimers after a stroke.
---------------------------------------------------------------------------------------------------------
Who is going to develop Alzheimer’s among the concussion(stroke) population? The APOE gene may hold the answer. Depending on which variant of the gene you have, you may be more or less at risk for long-term brain degeneration. In the future, perhaps people with a particular (higher risk) variant would be advised not to play contact sports.

2014 Neuro Film Festival

I think mine is going to contain one word - 10% flashing over and over.

2013 Neuro Film Festival
   
Enter Another Story For a Chance to Win Up To $1,000!
Thank you for your past submission to the Neuro Film Festival®! Do you have another compelling story to tell that makes the case for why more research is needed to cure brain diseases such as Alzheimer’s disease, stroke, brain injury, Parkinson’s disease, and others?
Submit a short video, no more than five minutes in length, to the American Brain Foundation’s 2014 Neuro Film Festival® and you could win up to $1,000 and a trip to Philadelphia to see your video premiered during the world’s largest gathering of neurologists and neurology professionals at the American Academy of Neurology's Annual Meeting.
Video submission deadline is February 26, 2014. See complete contest rules and submission guidelines.
The American Brain Foundation funds research to find better treatments and cures for brain disease. Please consider making a gift.
© 2013 American Brain Foundation
This email was sent by: American Brain Foundation
201 Chicago Avenue, Minneapolis, MN 55415 (800) 879-1960
To remove your name from these types of emails, please click here.

Wednesday, September 25, 2013

Managing executive dysfunction following acquired brain injury and stroke using an ecologically valid rehabilitation approach: a study protocol for a randomized, controlled trial

A protocol!!! Fire off the fireworks, your doctor needs to see what a protocol looks like, ask for one for every phase of your recovery. 100% recovery and nothing less. Give your doctor a heart attack when s/he realizes you are serious about full recovery. And expect him/her to know how to get there.
http://www.trialsjournal.com/content/pdf/1745-6215-14-306.pdf

Abstract
Background
We have been investigating an ecologically valid strategy-training approach to enable adults
with executive dysfunction to attain everyday life goals. Here, we report the protocol of a
randomized controlled trial of the effects of this training compared to conventional therapy in
a sample of community-dwelling adults with acquired brain injury and/or stroke.
Methods/design
We will recruit 100 community-dwelling survivors at least six months post-acquired brain
injury or stroke who report executive dysfunction during a telephone interview, confirmed in
pre-training testing. Following pre-training testing, participants will be randomized to the
ecologically valid strategy training or conventional therapy and receive two one-hour
sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur
immediately following the training and three months later. The primary outcome is self-
reported change in performance on everyday life activities measured using the Canadian
Occupational Performance Measure, a standardized, semi-structured interview. Secondary
outcomes are objective measurement of performance change from video tapes of treatment
session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural
Rating Inventory of Executive Function – Adult; participation in everyday life, Mayo-
Portland Adaptability Inventory Participation Index; and ability to solve novel problems,
Instrumental Activities of Daily Living Profile.
Discussion
This study is of a novel approach to promoting improvements in attainment of everyday life
goals through managing executive dysfunction using an ecologically valid strategy training
approach, the Cognitive Orientation to daily Occupational Performance
. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke.
Trial registration
Clinical Trials.gov, Trial Identification Number: NCT01414348

Rule Aids in Subarachnoid Bleed Diagnosis

But is it possible to have a completely objective diagnosis without the need for specialized knowledge? Like maybe one of these 17 ways.
Do you people ever use your brains at all?
http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/41837?
A highly sensitive clinical decision rule -- dubbed the Ottawa Subarachnoid Hemorrhage, Ottawa SAH, rule -- has been developed to help clinicians diagnose subarachnoid hemorrhage, a group of Canadian researchers reported.
The rule, which specifies that patients with any one of six clinical features should undergo diagnostic testing beginning with a CT scan of the head and, if necessary, a lumbar puncture, had a sensitivity of 100% (95% CI 97.2-100) and a specificity of 15.3% (95% CI 13.8-16.9), according to Jeffrey J. Perry, MD, of Ottawa Hospital in Ontario, and colleagues.
The features included in the rule were age 40 or higher, thunderclap headache, pain or stiffness in the neck, limited neck flexion, a witnessed loss of consciousness, and onset during exertion, Perry and colleagues reported in the Sept. 25 issue of the Journal of the American Medical Association.

More at link.

Statins Tied to Cataract Risk

I only have 27 other posts on statin side effects that your doctor will be able to refute.
http://well.blogs.nytimes.com/2013/09/25/statins-tied-to-cataract-risk/?_r=0

Why Size Matters: Differences in Brain Volume Account for Apparent Sex Differences in Callosal Anatomy

Stump your doctor and ask what differences in brain size and sex  will have in the stroke protocol given you. After you pick them off the floor muttering, 'What stroke protocol? What is a protocol?, you can then proceed to finding a different doctor.
http://www.sciencedirect.com/science/article/pii/S1053811913009762
  • Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles

Abstract

Numerous studies have demonstrated a sexual dimorphism of the human corpus callosum. However, the question remains if sex differences in brain size, which typically is larger in men than in women, or biological sex per se account for the apparent sex differences in callosal morphology. Comparing callosal dimensions between men and women matched for overall brain size may clarify the true contribution of biological sex, as any observed group difference should indicate pure sex effects. We thus examined callosal morphology in 24 male and 24 female brains carefully matched for overall size. In addition, we selected 24 extremely large male brains and 24 extremely small female brains to explore if observed sex effects might vary depending on the degree to which male and female groups differed in brain size. Using the individual T1-weighted brain images (n = 96), we delineated the corpus callosum at midline and applied a well-validated surface-based mesh-modeling approach to compare callosal thickness at 100 equidistant points between groups determined by brain size and sex. The corpus callosum was always thicker in men than in women. However, this callosal sex difference was strongly determined by the cerebral sex difference overall. That is, the larger the discrepancy in brain size between men and women, the more pronounced the sex difference in callosal thickness, with hardly any callosal differences remaining between brain-size matched men and women. Altogether, these findings suggest that individual differences in brain size account for apparent sex differences in the anatomy of the corpus callosum.

Caffeine consumption slows down brain development

So you really young stroke survivors you might want to lay off the caffeine.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=134758&CultureCode=en
Humans and other mammals show particularly intensive sleeping patterns during puberty. The brain also matures fastest in this period. But when pubescent rats are administered caffeine, the maturing processes in their brains are delayed. This is the result of a study supported by the Swiss National Science Foundation (SNSF).
Children’s and young adults’ average caffeine consumption has increased by more than 70 per cent over the past 30 years, and an end to this rise is not in sight: the drinks industry is posting its fastest-growing sales in the segment of caffeine-laden energy drinks. Not everybody is pleased about this development. Some people are worried about possible health risks caused in young consumers by the pick-me-up.
Researchers led by Reto Huber of the University Children’s Hospital Zurich are now adding new arguments to the debate. In their recently published study conducted on rats (*), the conclusions call for caution: in pubescent rodents, caffeine intake equating to three to four cups of coffee per day in humans results in reduced deep sleep and a delayed brain development.
Peak level during puberty
Both in humans and in rats, the duration and intensity of deep sleep as well as the number of synapses or connections in the brain increase during childhood, reaching their highest level during puberty and dropping again in adult age. “The brain of children is extremely plastic due to the many connections,” says Huber. When the brain then begins to mature during puberty, a large number of these connections are lost. “This optimisation presumably occurs during deep sleep. Key synapses extend, others are reduced; this makes the network more efficient and the brain more powerful,” says Huber.
Timid instead of curious
Huber’s group of researchers administered moderate quantities of caffeine to 30-day-old rats over five days and measured the electrical current generated by their brains. The deep sleep periods, which are characterised by slow waves, were reduced from day 31 until day 42, i.e. well beyond the end of administering caffeine. Compared to the rats being given pure drinking water, the researchers found far more neural connections in the brains of the caffeine-drinking animals at the end of the study. The slower maturing process in the brain also had an impact on behaviour: rats normally become more curious with age, but the rats consuming caffeine remained timid and cautious.
The brain goes through a delicate maturing phase in puberty, during which many mental diseases can break out. And even if the rat brain differs clearly from that of humans, the many parallels in how the brains develop raise the question as to whether children’s and young adults’ caffeine intake really is harmless or whether it might be wiser to abstain from consuming the pick-me-up. “There is still need for research in this area,” says Huber.
http://www.snsf.ch

Society to Improve Diagnosis in Medicine

Every single stroke and ER doctor should have already contacted them to get them working on improving stroke diagnosis. But you could ask every doctor you know and they won't have done anything yet. This is precisely why we need a great stroke association.
Society to Improve Diagnosis in Medicine

Tuesday, September 24, 2013

'Clot Picker' Rescues tPA Stroke Failures

Well, tPA is a failure most of the time anyway, only a 12% full success rate. So who the hell is finding something better?
Maybe these fourteen.
1. liposome-encapsulated hemoglobin written in Feb. 2010
2. bat saliva - Draculin  written in May, 2011, up to 9 hours
3. cardiac glycosides written in Feb. 2006 - up to 6 hours
4.inhalation of nitric oxide written in March, 2012 - 48 hours to 7 days
5. Nitric oxide written in 2006, to be tested in humans yet.
6. xenon gas written in Feb. 2006, to be tested yet
7. caffeinol irish coffee injection written in April 2003 to be tested in humans
8. Docosahexaenoic acid (DHA), a component of fish oil written in Nov. 2010, up to 5 hours
9. nicotine written in July 2005, to be tested in humans
10. Viagra written in 2002, to be tested in humans,  for 7 days
11.
11. Enzogenol  written in Nov. 2011 for New Zealand
12 edaravone approved in Japan since 2001
13. nitroglycerin instructions
14. benzodiazepine inverse agonist  written in Nov. 2010 

Don't they have any understanding that even if the clot is blown out via tPA or picked out that the neuronal cascade of death still occurs?
Is everyone stupid?
http://www.medpagetoday.com/MeetingCoverage/WCN/41792 
Treating ischemic stroke patients with endovascular therapy when initial tPA thrombolysis was unsuccessful led to good 3-month outcomes in most cases, a researcher said here.
Among 23 stroke patients in a prospective multicenter study, 15 were rated with modified Rankin scores of 2 or less when evaluated 3 months after failed thrombolysis followed by mechanical thrombectomy, according to Philippe Desfontaines, MD, of CHC St.-Joseph in Liege, Belgium.

More at link.