Deans' stroke musings
Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,032 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Wednesday, May 13, 2026
Both Caffeinated & Decaf Coffee Improved Mood, Memory, & Stress by mindbodygreen
Arterial widening emerges as key driver of small vessel stroke
How will this change your competent? doctors' protocols on treating stroke? Oh, nothing will happen because there are NO protocols, since your doctor is guessing every step of the way, Hope the guesses are correct because your doctor gets paid regardless!
Arterial widening emerges as key driver of small vessel stroke
A prospective study of 229 patients with lacunar or mild non-lacunar stroke found that large-artery stenosis was not associated with cerebral small-vessel disease (cSVD) or incident infarcts, whereas arterial widening and basilar artery dolichoectasia were strongly linked to lacunar stroke, higher cSVD burden, and progression of brain lesions over 1 year.
The findings, published in Circulation, challenge traditional atherosclerotic paradigms and suggest that intrinsic microvascular pathology plays a central role in cSVD, underscoring the need for mechanism-specific diagnostic and therapeutic strategies in stroke care.
“This study provides strong evidence that lacunar stroke is not caused by fatty blockage of larger arteries, but by disease of the small vessels within the brain itself,” said Joanna Wardlaw, University of Edinburgh’s Institute for Neuroscience and Cardiovascular Disease, Edinburgh, United Kingdom. “Recognising this distinction is crucial, because it explains why conventional treatments like antiplatelet drugs are not as effective for this type of stroke and highlights the urgent need to develop new therapies that target the underlying microvascular damage.”
For the study, the researchers followed 229 patients (mean age, 65.9 years; 57% with lacunar stroke) with serial clinical and MRI assessments over 1 year to evaluate the impact of large-artery stenosis and arterial widening on stroke subtype and cSVD. Large-artery stenosis (≥50%) was present in 20.5% of patients and basilar artery dolichoectasia in 15.7%, with multivariable analyses adjusting for demographic and vascular risk factors.
Results showed that large-artery stenosis was not associated with cSVD markers or incident infarcts and was instead linked to lower odds of lacunar versus non-lacunar stroke (odds ratio [OR] = 0.49), whereas basilar artery dolichoectasia was strongly associated with lacunar stroke (OR = 4.67), higher small-vessel disease burden (OR = 2.57), increased risk of incident infarcts (OR = 2.29; 75% subcortical), and greater progression of white matter hyperintensities over 1 year (β 0.15 per log10 volume increase).
The researchers said that future treatments should target the underlying small vessel damage. Trials such as LACI-3 are now testing whether existing drugs, including cilostazol and isosorbide mononitrate, can protect the brain, reduce further strokes, and help prevent problems with memory, mobility, and dementia after lacunar stroke.
Reference: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079493
SOURCE: University of Edinburgh
Researchers develop ‘breakthrough’ nasay[sic] spray for stroke
Ask your competent? doctor EXACTLY what this contains and the method of action. This said absolutely nothing useful!
So quiz your doctor on all this other nasal research! NO knowledge is grounds for termination!
- nasal delivery
(10 posts to December 2017)
- intranasal delivery
(8 posts to June 2022)
- dihydroergotamine nasal powder
(2 posts to May 2025)
- 13 nasal delivery options
(6 posts to April 2014)
Researchers develop ‘breakthrough’ nasay[sic] spray for stroke
A nasal spray designed to protect brain cells after stroke could offer a new prehospital emergency option, researchers say.
Researchers say the approach could help slow brain cell death and buy time for clot-removing or clot-busting treatment.
The spray has been developed by scientists at the University of Hong Kong, who describe it as the world’s first nasal spray designed to protect brain cells immediately after stroke.
Stroke is a leading cause of death and disability, with researchers citing an annual global healthcare burden of more than US$890bn.
Current stroke treatment usually begins after hospital admission and can involve clot-breaking drugs or reperfusion therapies, which aim to restore blood flow through arteries going to the brain.
The window for effective treatment is narrow, meaning more than 85 per cent of patients are unable to receive treatment quickly enough.
Researchers said many brain-targeting drugs also fail in trials because they cannot cross the blood-brain barrier.
The blood-brain barrier is the brain’s protective filter. It helps keep harmful substances out of the brain, but can also stop medicines reaching the area where they are needed.
Aviva Chow Shing-fung, from the University of Hong Kong, said: “The failure rate of drug candidates targeting the central nervous system in clinical trials exceeds 90 per cent, largely because these drugs cannot cross the blood-brain barrier, and thus fail to reach the brain to exert their therapeutic effects.”
To address this, the team developed a “Nanopowder” nasal spray containing brain-protective drugs(What are they?) in ultra-small inhalable powders.
The spray is inhaled into the nasal cavity, where it settles in the target area and separates into nanoparticles.
These tiny particles then travel through the nose-to-brain pathway, bypassing the blood-brain barrier.
Researchers said this could deliver the drug directly to the brain and provide early protection while a patient is being taken to hospital.
They reported that giving the nasal spray within 30 minutes of stroke onset reduced brain tissue death by more than 80 per cent in their tests.
They also said the spray protected neurological and body movement functions, reduced inflammation, helped prevent cell death and supported the integrity of the blood-brain barrier.
Neurological functions are abilities controlled by the brain and nervous system, such as movement, speech, memory and coordination.
Shao Zitong, a postdoctoral fellow at the University of Hong Kong, said: “After a stroke, every second matters.
“Even an additional 10 minutes of brain protection might determine whether a patient can walk or speak in the future.
“The key breakthrough of this technology lies in shifting stroke treatment from the ‘in-hospital’ setting to the ‘prehospital’ stage, enabling neuroprotection rather than merely clot dissolution or thrombectomy.”
Recognized for Results: Sutter’s Stroke Care Stands Out
I wouldn't go there for stroke; they refer to 'care; NOT RECOVERY! Survivors want 100% recovery; this center does nothing of the sort! YOU are going to have to scream at them for not showing these three results:
There is no quality here if you don't measure the right things.
- tPA full recovery? Better than 12%?
- 30 day deaths? Better than competitors?
- rehab full recovery? Better than 10%?
You'll want to know results so call that hospital president(whomever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.
Recognized for Results: Sutter’s Stroke Care Stands Out
Stroke remains a leading cause of death in California and across the U.S. — even as new data from the American Heart Association show a slight decline in cardiovascular deaths since 2023. Too many strokes remain preventable, and too many patients aren’t getting care(NOT RECOVERY!) fast enough.
That’s the gap California-based not-for-profit Sutter Health is working to close.
Building a faster stroke system
Across the communities it serves, Sutter is scaling a stroke system built for prevention, speed and impact. As tens of thousands of Californians experience a stroke each year, the goals are simple: to help more people reduce their risk and ensure fast, coordinated care(NOT RECOVERY!) when a stroke occurs.
Sutter’s advanced neuroscience services include more than 150 neurologists and neurointerventional surgeons across 17 stroke-certified stroke centers, spanning the full continuum of care(NOT RECOVERY!): from early detection and risk management to emergency treatment, rehabilitation and recovery. The differentiator is how quickly that care(NOT RECOVERY!) activates.
Sutter pairs bedside expertise with real-time technology. This includes 24/7 telestroke consults that connect emergency teams to board-certified specialists within minutes, a Mobile Stroke Unit equipped for on-the-spot CT imaging, as well as advanced AI-enabled triage tools that accelerate diagnosis and treatment. For patients who need it, access to minimally invasive procedures that treat blood vessels from the inside like thrombectomy — which removes a blood clot from a blocked artery in the brain — can mean the difference between long-term disability and recovery.
Results that deliver for patients
Sutter’s systemwide focus on speed and coordination is translating into measurable outcomes.
Last year, the American Heart Association recognized 16 Sutter hospital campuses with the Get With The Guidelines® – Stroke Gold Plus quality achievement award — the highest level of recognition possible. Additionally, Becker’s Hospital Review named Sutter among its “100 Great Neuro and Spine Programs.”
“Improving outcomes extends far beyond the hospital walls,” said Dr. Nobl Barazangi, a vascular neurologist with Sutter West Bay Medical Group and the Sutter Advanced Neuroscience Service Line Chief of Stroke. “We’re caring for patients every step of the way — helping them lower their risk, reaching them quickly when a stroke occurs and surrounding them with the support they need to recover.”
In 2026, multiple Sutter hospitals were recognized for excellence in stroke care(NOT RECOVERY!) by Healthgrades — honors that reflect the consistency, expertise and teamwork required to deliver life-saving care(NOT RECOVERY!) on the clock.
Sutter’s Alta Bates Summit Medical Center – Alta Bates Campus
- Stroke Care(NOT RECOVERY!) Excellence Award™ for 16 consecutive years
- Top 10% in the Nation for Treatment of Stroke for 16 consecutive years
- Five-Star Recipient for Treatment of Stroke for 23 consecutive years
Sutter’s Alta Bates Summit Medical Center – Summit Campus
- Five-Star Recipient for Treatment of Stroke for 16 consecutive years
Sutter’s CPMC – Davies Campus
- Five-Star Recipient for Cranial Neurosurgery for four consecutive years
Sutter Davis Hospital
- Five-Star Recipient for Treatment of Stroke for four consecutive years
Sutter’s Eden Medical Center
- Five-Star Recipient for Treatment of Stroke for 20 consecutive years
Sutter Medical Center, Sacramento
- 2026 Stroke Care(NOT RECOVERY!) Excellence Award™
- Top 10% in the Nation for Treatment of Stroke
- Five-Star Recipient for Treatment of Stroke for two consecutive years
Sutter’s Memorial Medical Center
- Five-Star Recipient for Treatment of Stroke
Sutter’s Mills-Peninsula Medical Center
- Stroke Care(NOT RECOVERY!) Excellence Award™ for seven consecutive years
- Top 10% in the Nation for Treatment of Stroke for seven consecutive years
- Five-Star Recipient for Treatment of Stroke for seven consecutive years
Learn more about Sutter’s advanced neuroscience services.
Factors associated with exercise adherence among stroke survivors: a cross-sectional study using the COM-B model
It's fuckingly simple, with NO EXACT 100% RECOVERY PROTOCOLS there really is NO incentive to follow whatever shitworthy guidelines are given!
You're that fucking clueless that you UNDERSTAND NOTHING ABOUT SURVIVOR MOTIVATION! My god, I'd have you all fired for stupidity!
My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION/DEMORALIZATION, DO YOU? You create EXACT 100% recovery protocols, and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. I'd fire all of you for absurd incompetence! GET THERE!
Factors associated with exercise adherence among stroke survivors: a cross-sectional study using the COM-B model
Scientific Reports (2026) Cite this article
We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.Abstract
Exercise adherence plays a critical role in lowering physical disability and mortality rates among stroke survivors. Previous research indicates that exercise adherence among stroke survivors is generally low, influenced by various factors, the mechanisms of which remain not yet fully understood(Then you don't have enough functioning brain cells to even be working in stroke!). This study aimed to explore the factors affecting exercise adherence in stroke survivors using the Capability, Opportunity, Motivation, and Behavior (COM-B) model in a cross-sectional study. Using convenience sampling, 359 participants were recruited from a tertiary hospital, and they filled out the demographic questionnaire, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale, Stroke Rehabilitation Motivation Scale, and Stroke Functional Exercise Adherence Questionnaire Scale. Structural equation modeling (SEM) was used for data analysis. The average scores for psychological resilience, social support, rehabilitation motivation and exercise adherence were 67.86 ± 16.26, 36.60 ± 6.17, 107.70 ± 15.18, and 41.76 ± 6.13, respectively. The SEM showed a satisfactory fit (χ2/df = 2.097 < 3, RMSEA = 0.055, SRMR = 0.0376, CFI = 0.979, TLI = 0.974, IFI = 0.980, GFI = 0.933, AGFI = 0.902, and NFI = 0.951). Direct path analyses revealed that psychological resilience (β = 0.174, p < 0.01), social support (β = 0.184, p < 0.01), and rehabilitation motivation (β = 0.517, p < 0.001) significantly affected exercise adherence. Furthermore, both psychological resilience (β = 0.142, p < 0.001) and social support (β = 0.218, p < 0.001) exerted indirect effects on exercise adherence through their impact on rehabilitation motivation. Enhancing exercise adherence among stroke survivors requires attention to psychological resilience, social support, and particularly, rehabilitation motivation. The mediating influence of rehabilitation motivation in linking psychological resilience and social support to adherence is especially noteworthy. Interventions targeting these factors may effectively improve exercise adherence and optimize post-stroke recovery outcomes.(You really are that fucking dumb!)
Once Daily, 10 Minute Rehab Maybe Be Enough in Mild Stroke
You are truly going to have to scream at anyone who suggests this! In no way will this guarantee 100% recovery! This is absolutely appalling! And Julie Bernhardt is a rock star stroke researcher, which shows you that even rock stars can be completely wrong!
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling your supposedly smart stroke medical 'professionals' they know nothing about stroke is a no-no even if it is true.
Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.
Once Daily, 10 Minute Rehab Maybe Be Enough in Mild Stroke
A new clinical trial has produced the most reliable information to date on the optimum level of early rehabilitation appropriate for patients with acute stroke.
The AVERT DOSE trial has suggested that in the initial days after an acute stroke, just 10 minutes of active training per day is sufficient for patients with mild stroke, while patients with moderate stroke could benefit from slightly higher levels of exercise training split into two separate sessions.
“The AVERT DOSE trial, while underpowered, provides current best available evidence to guide early training after an acute stroke,” said lead investigator, professor Julie Bernhardt, PhD, The Florey Institute, Melbourne, Australia.
“Our trial shows that the protocolized training tested can feasibly be delivered in multiple settings and is safe(And you blithering idiots think that 'safe is what survivors want? THEY WANT 100% RECOVERY and 10 minutes won't do that!),” she added.
The findings suggest that for patients with mild stroke (National Institutes of Health Stroke Scale [NIHSS] 0-7), a single 10-minute session of active, task-specific training supported by nurses during upright daily activities may be sufficient for most patients, with no clear evidence that higher-intensity training provides additional benefit, Bernhardt said.(You're totally ignoring survivor requirements of 100% recovery!)
For patients with moderate stroke severity (NIHSS, 8-16), the findings suggest that two separate 10-minute sessions of active, task-specific training supported by nurses during upright daily activities provided clinically meaningful benefits compared with a single session.
In both cases the 10 minutes of active training refers to only the active practice time and does not include preparation or rest periods in between activity, so the session itself would take significantly longer than 10 minutes.
The trial results were presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.
A Vital Early Poststroke Goal
Bernhardt explained that regaining movement is a vital early goal after stroke, but important questions remain about how soon rehabilitation should begin and how much training is beneficial. Those uncertainties have persisted since the first AVERT trial, reported in 2015, showed that very early intensive mobilization — initiated within 24 hours of stroke onset — worsened outcomes(You absolute fucking idiots ignored the neuronal cascade of death
in the first week killing off hundreds of millions to billions of neurons. Of course, you are going to worsen, neurons are dying by the score early on!) compared with lower-dose usual care, with the greatest adverse effects seen in patients with intracerebral hemorrhage (ICH) and severe stroke.
“This very early intensive therapy appeared to be too much, too soon and but there has remained a lack of clear evidence on the optimal timing and intensity for rehabilitation training,” Bernhardt noted
To address this issue the researchers conducted the AVERT DOSE trial.
For the study, the researchers analyzed data from the original AVERT trial to identify intervention doses with the most favorable safety and efficacy profiles, then evaluated those dosing strategies in the new trial that excluded patients with ICH and severe stroke.
The study enrolled 1000 patients across 50 hospitals in seven countries, including Australia, Brazil, India, Ireland, Malaysia, Singapore, and the UK.
Participants were stratified by stroke severity, with 631 patients in the mild stroke group and 366 in the moderate stroke group and randomly assigned to one of four mobility training regimens.
All interventions were initiated within 48 hours of stroke onset (mean, 38 hours) and continued for 14 days or until hospital discharge. The interventions focused on functional, task-specific upright movement tailored to each patient and delivered by trained physiotherapists.
Participants were stratified by stroke severity, with 631 patients in the mild stroke group and 366 in the moderate stroke group and randomized to one of four mobility training regimens. All interventions were initiated within 48 hours of stroke onset (mean, 38 hours) and continued for 14 days or until hospital discharge.
BP Targets After Stroke Thrombectomy: Individualization Needed?
Your doctor obviously hasn't though through blood pressure at all. Lowering too much means the penumbra will die quicker because of lack of oxygenated blood. Can your competent? doctor think at all about how to get you recovered? Ask him/her FOR EXACT SPECIFICS, doesn't have them is a sign of gross incompetence!
BP Targets After Stroke Thrombectomy: Individualization Needed?
Results of a new trial have re-awakened the possibility that blood pressure (BP) reduction following thrombectomy in patients with acute ischemic stroke (AIS) can be beneficial but with the caveat that BP targets may have to be individualized depending on patient-specific characteristics.
The HOPE trial showed that BP management intervention, with different targets for various levels of reperfusion achieved, improved functional outcomes after successful endovascular therapy.
This is the first clinical trial to demonstrate a benefit from BP reduction after thrombectomy; previous studies of intensive BP lowering — most conducted in Asia — showed either no benefit or even potential harm.
“Our trial reopens the debate about blood pressure lowering post-thrombectomy,” said lead investigator Pol Camps-Renom, MD, PhD, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
However, he cautioned that the findings should be considered hypothesis-generating rather than practice-changing, noting that other studies reinforcing the point that other trials have failed to show benefit with intensive BP lowering after thrombectomy but added that the results “definitely give information about key factors that can be incorporated into future trials.”
“I think the idea that one size will not fit all patients is probably the way forward and that blood pressures will be individualized based on patient characteristics in future. But it is too premature to act on these data at present,” he added.
The study was presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.
Hazard if Not Fully Reperfused?
Compared with previous trials of intensive BP lowering after thrombectomy, the HOPE trial used different BP targets according to the degree of reperfusion achieved at the end of the procedure.
“We did this because we were concerned about blood circulation in patients with incomplete reperfusion,” Camps-Renom noted.
He cited data suggesting that patients with incomplete reperfusion after thrombectomy rely more heavily on collateral circulation to maintain cerebral blood flow, raising concerns that overly aggressive BP lowering in these patients could compromise collateral perfusion and prove harmful.
The trial was therefore designed with two different BP treatment targets. Conducted at 11 stroke centres in Spain, the HOPE trial enrolled patients with anterior circulation AIS due to intracranial large vessel occlusion within 24 hours of symptom onset who achieved successful recanalization after endovascular thrombectomy, defined as modified treatment in cerebral infarction (mTICI) 2b or higher.
A total of 440 patients were randomized to receive either protocol-driven or guideline-recommended BP management. In the intervention arm, systolic BP targets were individualized according to final reperfusion status.
For participants with good reperfusion after thrombectomy (mTICI 2c/3, equating to reperfusion of 90%-100%), a systolic BP target of 100-140 mg Hg was recommended. In contrast, those with incomplete reperfusion (mTICI 2b flow, indicating a reperfusion of 50%-90%), a target of 140-160 mm Hg was advised.
Randomization to the trial BP intervention protocol or standard guideline-based management began 1 hour after the final angiographic series, followed by an additional hour to achieve the assigned systolic BP target.
The intervention was then maintained for 72 hours and included antihypertensive therapy or vasopressor support, as needed.
Why HOPE Succeeded
Results showed that the primary endpoint — a favorable functional outcome (modified Rankin Scale score of 0-2 at 90 days) was achieved in 60.0% of patients in the intervention group vs 46.7% in the control group (OR, 1.71; 95% CI, 1.17-2.50; P = .005).
Post-stroke headache: a review of epidemiology, pathophysiology, and clinical management
Your competent? doctor implemented this aneurysm identification a long time ago, right! Oh NO! Your doctor is incompetent; what are YOU going to do about that?
Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!
New Tool Identifies Patients With Headache Who Are at Risk of Aneurysms November 2017
The latest here:
Post-stroke headache: a review of epidemiology, pathophysiology, and clinical management
- D
Dabao Yao
- L
Luwei Nie
Danyang Chen
- S
Shiling Chen
- X
Xuan Wu
Chao Pan
- Y
Yingxin Tang
Na Liu *
Zhouping Tang *
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
Abstract
Post-stroke headache (PSH) and its chronic counterpart, persistent post-stroke headache (PPSH), represent significant but frequently overlooked complications of cerebrovascular disease that adversely affect rehabilitation and quality of life. This review provides an updated synthesis of PSH, following its formal classification in the International Classification of Headache Disorders, 3rd edition (ICHD-3). We examine the epidemiology of PSH, noting a prevalence range of 6–44% in ischemic stroke survivors, with risk factors including younger age, female sex, and posterior circulation lesions. The pathophysiology is explored as a complex interplay involving the trigeminovascular system, neurogenic inflammation, and central sensitization, often exacerbated by structural factors such as edema and stroke topography. Clinical phenotypes vary, predominantly presenting as tension-type, though migraine-like features occur. Furthermore, this review highlights the critical role of headache as a sentinel symptom in the differential diagnosis of distinct stroke etiologies such as cervical artery dissection, reversible cerebral vasoconstriction syndrome, and cerebral venous thrombosis. A major finding is the significant gap in evidence-based management; current therapeutic strategies often rely on extrapolating data from primary headache disorders, with unverified safety profiles for newer agents such as triptans and calcitonin gene-related peptide (CGRP) antagonists in the post-stroke population. We conclude by emphasizing the urgent need for randomized controlled trials to establish safe, effective pharmacological and non-pharmacological interventions for this disabling condition.