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

Wednesday, April 25, 2018

Retinal Abnormalities Predictor of Some Types of Stroke

See if your doctor is checking this after your stroke. 
https://www.medpagetoday.com/meetingcoverage/aan/72509?


Retinal imaging may offer noninvasive tool to determine pathogenesis of cerebral small vessel disease

  • by Kristen Monaco,
Staff Writer, MedPage Today
LOS ANGELES -- Abnormal retinal microvasculature was tied to a higher risk of some types of stroke, researchers reported here.
People with abnormal retinal microvasculature -- including arteriovenous nicking, focal arteriolar narrowing, retinal micro-aneurysms, and retinal hemorrhage -- had a higher cumulative incidence of stroke within 15 years compared with those with normal microvasculature, according to Michelle Lin, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

In a subanalysis of the large Atherosclerosis Risk in Communities (ARIC) study cohort presented at the American Academy of Neurology annual meeting, over 4% of those with abnormal microvasculature reported a stroke compared with only 1.9% of those with normal retinas (P<0.001).
"This is not surprising at all," commented the discussant for the study, Valerie Biousse, MD, of Emory University in Atlanta. "It goes very well within the concept of small vessel disease -- small vessel disease in the eye, small vessel disease in the brain. This makes a lot of sense."
The prospective ARIC study included 10,468 individuals between the ages of 45 and 65, all of whom underwent baseline retinal photography. A total of 673 strokes were reported among the cohort -- 578 ischemic strokes and 95 hemorrhagic strokes. Among ischemic strokes, the most common subtype was nonlacunar (292), followed by cardioembolic (172), and lacunar (114).
All retinal photographs were read by trained staff at a single center, which Lin cited as a strength of the study. However, she noted that some images were ungradable and the photographs captured only a small area of the retina, which may have led to an underestimate of the prevalence of microvasculature abnormality.
Using an adjusted model, the researchers found a positive association specifically with ischemic stroke and retinal microvasculopathy. However, this relationship extended only to lacunar stroke (HR 1.8, 95% CI 1.2 to 2.7). A dose-dependent relationship was also identified, with a higher risk for both ischemic and lacunar stroke tied to a larger amount of abnormal retinal microvasculatures.

Other subtypes of stroke were not significantly tied to retinal microvasculature:
  • Nonlacunar: HR 1.3 (95% CI 0.9 to 1.6)
  • Cardioembolic: HR 1.2 (95% CI 0.8 to 1.6)
  • Hemorrhagic: HR 1.2 (95% CI 0.8 to 1.9)
"I believe that retinal imaging now allows direct visualization of the small vessel vasculature and neuronal tissues that may give insights into the pathogenesis of cerebrovascular disease, as well as the neurodegenerative disease," Lin said.
Biousse echoed this sentiment, highlighting that the findings are an important addition to everyday clinical practice, predicting that neurologists "will use this information."
"If this is really true, though, why are we not using it yet?" she questioned, explaining that the technology is still not widely available to many practicing neurologists. "The limiting factor remains this: which magic wand do we need to be able to measure and calculate the retinal microvasculature changes? We're almost there."
Lin said she was hopeful, given the rapid advancements in retinal imaging within the past decade -- for example, newer camera technology has allowed for greater mobility, even extending to smartphone applications that make it possible for more dissemination of retinal imaging to a wider group of patients across various settings, including underserved communities.
The study was supported by the National Heart, Lung, and Blood Institute.
Lin and co-authors reported having no relevant disclosures.
Biousse reported receiving personal compensation in an editorial capacity for UptoDate Neurology.
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