Malpractice Risks in Neurology: Lessons From a $4.5 Million Stroke Verdict

 Maybe this will finally get ACTUAL PROTOCOLS IN PLACE and remove the too good to treat bullshit!

I personally think the only way we're ever going to get stroke solved is financial penalties like; $1000 a dead neuron after tPA is delivered or the clot is pulled out. That is the only way we will ever get the neuronal cascade of death solved in the first week!

Malpractice Risks in Neurology: Lessons From a $4.5 Million Stroke Verdict

Medical malpractice claims in neurology often arise from diagnostic errors, particularly missed or delayed identification of conditions such as stroke, intracranial aneurysm, or subdural hematoma, which can result in severe patient harm. As with many medical specialties, communication breakdowns and inadequate documentation are also common contributing factors. The case discussed here highlights several of these issues, including delayed diagnosis as well as deficiencies in communication and documentation.

 

During an acute stroke, every second counts.

Facts of the Case

Mr B was a 57-year-old White man with no significant medical history. He worked as a master electrician and owned his own company. One morning, he woke up with a headache, noticed a slight weakness in his left arm, and his speech was a bit slurred. While speaking to him, his girlfriend noticed that he seemed confused and had a tremor in his left arm. Concerned, his girlfriend convinced him to go to the emergency department (ED) of the local hospital to get examined.

In the ED, Mr B was seen by Dr E, the attending emergency physician, who recognized that the patient’s symptoms were consistent with a stroke. Dr E ordered a non-contrast head CT at around noon, which showed no acute abnormalities. He assigned the patient a National Institutes of Health (NIH) Stroke Scale score of 2.

Dr N was the on-call neurologist at the hospital that day. Dr E contacted the neurologist after examining the patient to discuss whether to administer tissue plasminogen activator (tPA). After the 2 physicians spoke, it was decided that Mr B was outside the time frame for tPA, and that he was not a candidate for intervention at that point due to his symptoms, duration of onset, and low NIH Stroke Scale score. Instead, Dr E started the patient on aspirin, admitted him for observation, and asked Dr N to evaluate the patient.

Dr N eventually arrived to evaluate the patient several hours after admission. Dr N noted acute gait instability, ataxia, headache, right mouth droop, impaired repetition, and a left arm tremor. The physician ordered a magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) to assess for infarct or vascular occlusion; however, he failed to write ‘stat’ on the order to note the urgency and instead gave it routine priority. Dr N was also unaware that the hospital’s MRI/MRA machine was currently not working and the hospital was waiting for a service call. Hours passed without the tests being performed. In all that time, Dr N did not follow up to find out why the MRI/MRA had not been completed. The rest of the day and night passed without Mr B receiving the MRI/MRA.

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The next morning, approximately 24 hours after the onset of symptoms, Mr B was found unresponsive, with labored breathing and significant neurologic decline. His NIH Stroke Scale score had risen to 13. A repeat CT revealed a basilar artery thrombus. Mr B was transferred to another hospital, where an MRI revealed acute infarcts in both cerebellar hemispheres, the left mesial temporal lobe, bilateral thalami, and thrombi in the basilar and left posterior cerebral arteries. Although he underwent a mechanical thrombectomy at the second hospital, the intervention came too late to reverse the damage. As a result, the patient suffered “locked-in syndrome,” where he was aware but unable to speak or move for 5 days before he finally died from the damage caused by the severe stroke.

The Trial

After Mr B’s death, his family consulted with a plaintiff’s attorney, who reviewed the medical records and agreed to take the case. The attorney filed a lawsuit against Dr N, alleging that his failure to order the imaging on a ‘stat’ basis, failure to follow up on the order, and failure to send the patient to another hospital with a working MRI machine resulted in Mr B’s severe and life-ending stroke.

Dr N was assigned an attorney from his malpractice insurance company. After several years, the case went to trial. At trial, the defense attorney argued that the severe stroke that occurred the morning after Mr B was admitted was an entirely new and unpredictable event. The plaintiff’s attorney argued that the original stroke did exactly what it was at risk of doing: causing significant harm. The plaintiff’s attorney described the horror of “locked-in syndrome” and elicited testimony from the defense’s expert that he had previously described it as “a terrifying experience for the patient” and “a fate worse than death.”

The testimony lasted for 2 weeks, and the jury deliberated for 5 hours before returning a verdict for the plaintiff and awarding his family over $4.5 million.

Keep Reading | “Don’t Call Us, We’ll Call You”: How MRI Follow-Up Failure Led to Court

Protecting Yourself

We all know that time is of the essence when diagnosing a stroke, which makes it all the more shocking that Dr N did not order the test ‘stat’. Worse still, when the test wasn’t done in the ensuing hours, Dr N did not follow up to find out why. Had the physician known that the MRI machine was down, he could have had the patient transferred to another hospital where the tests could have been conducted. With the information gained from an MRI/MRA, Mr B could have been treated.

The jury’s high monetary award indicated that they were sympathetic to the patient, were swayed by the expert’s description of “locked-in syndrome” as a “fate worse than death,” and found fault with the neurologist for failing to order tests with the proper urgency and to follow up on his own orders.

During an acute stroke, every second counts. Quick diagnosis and treatment are vital to a good outcome. Rapid intervention is essential, and tests and imaging should always be ordered on a stat basis to protect your patient… and yourself.

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Stroke Recovery: How Patients and Caregivers Can Improve Quality of Life

 First of all you SCREAM at all your stroke providers FOR NOT HAVING  100% RECOVERY PROTOCOLS!  And don't stop screaming until the president AND board of directors gets called in! Then ask how fucking long they will continue incompetence in not having 100% recovery protocols! Suggest a lawsuit for $1000 a dead neuron past the clot buster treatment or stopping of the hemorrhage! Their complacency in accepting recovery failure as a matter of course is PURE INCOMPETENCE!

Notice the word 'care' NOT RECOVERY! That is accepting failure in recovery as a normal matter! Which is why screaming is required if you want change and have your children and grandchildren recover completely from their strokes!

Stroke Recovery: How Patients and Caregivers Can Improve Quality of Life

Recovering from a stroke can be a long and challenging journey. Many survivors work hard to rebuild strength, mobility, speech, and independence. But physical recovery is only one part of the process.

“There’s a whole other side of stroke recovery that people don’t see,” says Alexandra Terrill, PhD, a licensed clinical psychologist and co‑director of the Center for Quality of Life After Stroke at University of Utah Health. “Cognitive changes, communication challenges, and especially mental health concerns are incredibly common, yet often misunderstood.”

The Mental Health Challenges of Stroke Recovery

Many people focus on physical recovery after a stroke, but emotional recovery plays a major role in long‑term well‑being.

Post‑stroke depression affects about one‑third of survivors. Symptoms can appear months after the stroke and may include:

• Withdrawal
• Low motivation
• A sense of “blah”
• Difficulty engaging in therapy

Terrill notes that many survivors downplay their symptoms while speaking with doctors, so family members often become the ones who speak up.

“The best thing you can do is say something,” Terrill says. “Use language that’s caring, not stigmatizing—like, ‘I’m worried about you,’ or ‘It seems like you’re having a hard time.’ It’s also a good idea to join them at their medical appointments to help their doctors see the full picture.”

Caregivers Need Support Too

Every year, more than 795,000 Americans experience a stroke. Behind many of those survivors is a caregiver helping them navigate the recovery process. 

Research led by Terrill highlights often-overlooked realties, including:

• Caregivers are at equal or higher risk of depression and anxiety compared to survivors
• Relationships often change as partners take on caregiving responsibilities, sometimes resulting in strain
• Small, shared moments can help couples reconnect, such as holding hands while taking a short walk

“Sometimes couples tell us, ‘These aren’t new ideas, we just forgot to do them,” Terrill says. “They were so lost in the medical side of stroke recovery that they forgot how to be a couple. These simple moments help rebuild closeness and improve depression and anxiety for both partners.”

Quality of Life Isn’t One‑Size‑Fits‑All

Measuring quality of life after stroke is complex because it’s deeply personal. What feels like progress or comfort is, as the saying goes, in the eye of the beholder.

“You can have two people with the exact same stroke, and one might feel like their life is over, while the other finds new meaning and purpose,” Terrill says. mental health is vital. Terrill urges partners to prioritize their own well‑being, too, because recovery is a shared journey.

“There’s so much resilience in these couples,” Terrill says. “Sometimes they just need a reminder of how to reconnect, and permission to take care of themselves as well.”

A Whole-Person Approach to Stroke Recovery

At University of Utah Health, care(NOT RECOVERY!) teams focus on long‑term, whole‑person care(NOT RECOVERY!). 

Their approach includes:

• Supporting survivors beyond the crisis moment
• Addressing emotional, cognitive, and relational needs
• Helping families navigate the months and years after a stroke
• Providing tools to rebuild confidence, connection, and independence

Recovery doesn’t happen alone. Lean on your health care(NOT RECOVERY!) team, connect with support groups, and ask for help when you need it. Taking care of both physical and emotional health can make a meaningful difference for stroke survivors and the people who care for them.

Targeted Brain Cooling Boosts LVO Recovery After Thrombectomy

 Have your competent? doctor and hospital initiate research that finishes the job and delivers 100% recovery protocols! Why can't that be done?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

Targeted Brain Cooling Boosts LVO Recovery After Thrombectomy

Targeted cooling to the brain during endovascular thrombectomy significantly improved functional outcomes in patients with large-vessel occlusion ischemic stroke.

Results of the CHILL-ART trial showed that cooling the brain by infusion of saline chilled to 4 °C led to a substantial increase in the number of patients who achieved a favorable functional outcome at 90 days.(Favorable to survivors is 100% RECOVERY; not your tyranny of low expectations where failure is considered success!)

“Even when we successfully remove the clot, many patients do not regain independence because of ongoing brain injury after blood flow is restored,” said principal investigator Zhi-Xin Huang, MD, Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.(Yeah, that's called the neuronal cascade of death and will kill off hundreds of millions of neurons in the first week! I'd suggest billing your doctors and hospital $1000 a dead neuron, that would concentrate their minds!)

“Our findings show that targeted cooling delivered directly into the brain at the moment of reperfusion can meaningfully improve recovery without adding risk,” he noted.

Article Key Points

Targeted brain cooling during thrombectomy significantly improved recovery in ischemic stroke patients, with a 15% increase in functional independence at 90 days. The CHILL-ART trial suggests this approach is safe, effective, and easily implementable.

A second trial of a similar technique, FOCUS, also conducted in China, did not show a significant benefit, but functional outcomes trended in a positive direction in the intervention group, and there was a safety benefit with a reduction of any intracerebral hemorrhage (ICH) incidence at 24 hours.

“These findings validate the feasibility of selective intra-arterial cooling as an adjunctive therapy during endovascular thrombectomy. The marked decrease in any intracerebral hemorrhage indicates a potential protective effect on the blood-brain barrier and microvasculature, which may translate into clinical benefits,” FOCUS investigator, Shen Li, MD, Beijing Shijitan Hospital, Beijing, China, said.

The findings from both studies were presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.

A Novel Approach

The CHILL-ART trial investigator, Raul Nogueira, MD, University of Pittsburgh School of Medicine, Pittsburgh, explained that hypothermia is known to be an effective neuroprotectant.

He noted that substantial data support the concept, but implementation has remained challenging. Systemic hypothermia has been associated with several drawbacks: It takes time to induce, can disrupt endovascular treatment workflows, and has been linked to significant adverse effects, including higher rates of pulmonary infection, potential coagulopathy and bleeding complications, and refractory shivering. As a result, this approach has not been widely pursued.

The CHILL-ART and FOCUS trials investigated a novel approach of inducing regional hypothermia by infusing chilled saline intra-arterially directly into the brain at the end of the thrombectomy procedure.

The intervention uses standard thrombectomy equipment and refrigerated saline, making it readily scalable in routine clinical practice without requiring specialized devices or additional training.

The CHILL-ART trial enrolled 262 patients across 26 comprehensive stroke centers. Participants within 24 hours of stroke onset were randomized to receive either thrombectomy plus intra-arterial infusion of 350 ml of cold saline (hypothermia group) or thrombectomy with room-temperature saline (control group). The saline was administered at 50ml pre-reperfusion and 300 ml directly after reperfusion.

The median patient age was 70 years, and the median National Institutes of Health Stroke Scale score was 14. The trial imposed no exclusion criteria based on baseline ASPECTS, and patients could be enrolled up to 24 hours after stroke onset. However, the median ASPECTS was high at 8, and treatment was initiated fairly early, at a median of between 5 and 6 hours after stroke onset, Nogueira reported.

15% Absolute Increase in Functional Independence

The study’s primary outcome, functional independence defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days, was achieved in 54.7% of patients in the hypothermia group compared with 39.8% in the control group (adjusted risk ratio, 1.36; 95% CI, 1.05 1.76; P =.018). This gives a number need to treat for one additional favorable outcome of 7.

Safety outcomes were comparable between groups, with no significant increase in symptomatic ICH (7.0% vs 9.0%) or 90-day mortality (13.3% vs 18.0%).

By combining reperfusion with targeted neuroprotection, the study introduces a promising new approach into acute stroke treatment, and these findings support broader adoption of intra-arterial hypothermia as an accessible, cost-effective strategy to reduce disability after stroke, the CHILL-ART trial investigators concluded.

However, the FOCUS trial results were not as favorable. The trial, conducted at 12 hospitals, enrolled 258 patients with anterior circulation large-vessel occlusion stroke who presented within 24 hours of symptom onset. Participants were randomized to receive either selective intra-arterial cooling plus endovascular thrombectomy or standard thrombectomy alone.

Results showed no significant difference in functional outcomes at 90 days between the two groups, with an adjusted common odds ratio of 1.16 (95% CI, 0.75-1.79; P = .51).

However, the safety results were encouraging, with a reduction in ICH rates in the cooling group with an adjusted risk difference of -0.174 (95% CI, -0.288 to -0.059; P = .003). There was no difference in the occurrence of symptomatic ICH or mortality between groups.

Easy and Inexpensive

Noguera pointed out that this approach is easy and inexpensive.

“We can use the typical neurovascular thrombectomy equipment, and it’s very easy to implement. You just need cold saline at 4 degrees,” he said.

Nogueira added that the results of the two studies were not necessarily contradictory, noting that both were only moderately sized trials. He suggested that the benefit seen in the CHILL-ART trial — a 15% absolute improvement in functional independence — was larger than expected, whereas the FOCUS trial produced more modest results than investigators had hoped for.

However, he noted that the mRS shift analyses from the two studies were actually similar, suggesting the apparent discrepancy may reflect differences in statistical power and sample size rather than fundamentally different findings.

“We are going to need more trials, larger numbers, and potentially meta-analyses, to really answer this question,” he said.

Still, Nogueira argued that the studies together provide important validation of the concept. “While we are going to need more data before changing guidelines, I think we have validated this concept here, and it is definitely a big step in the right direction,” he commented.

He added that regional brain cooling should now become a major focus of thrombectomy research because of its simplicity and apparent promise.

“I would say this regional cooling approach should be the biggest priority in thrombectomy research now because it’s so easy to implement, and we have a very strong signal of effectiveness,” Nogueira said.

Large Therapeutic Effect

Commenting on the CHILL-ART trial, Marieta Peycheva, MD, Medical University of Plovdiv, Plovdiv, Bulgaria, characterized the findings as “really amazing.”

She asked about safety, noting that there appeared to be slight increase in pneumonia in the intervention group.

Nogueira replied that the safety appears very good. He pointed out that rates of symptomatic ICH and mortality were numerically lower in the hypothermia groups in both trials, which he said was encouraging from a neurologic safety perspective.

Although pneumonia occurred slightly more often among patients receiving hypothermia, he emphasized that the cooling strategy produced minimal systemic effects because it was delivered over only a brief period rather than inducing prolonged whole-body hypothermia.

“Of course we need to look at that carefully in the future, but I think overall, in both trials we saw the same direction towards a benefit and very good safety.”

Commenting on the CHILL-ART trial, Peter Kelly, MD, University College Dublin, Dublin, Ireland, said the study really stood out.

“It showed a big therapeutic effect — a 15% absolute benefit in terms of 90-day functional independence, it looked very safe, and it involved just cooling a bag of saline to 4 °C.”

“This should certainly kick off a whole collection of new trials to try to confirm those really interesting results,” he added.

Both trials were investigator initiated. The authors reported having no relevant disclosures.

May is American Stroke Month: University Hospitals Offers Free Screenings and Educational Events

 The only awareness needed is that NOBODY KNOWS ANYTHING CONCRETE ABOUT RECOVERY! You'll get useless guidelines hoping you think that is getting you recovered and not blame your doctor/hospital for failure to fully recover! BLAME YOUR DOCTOR and charge them $1000 a dead neuron past your blockage opening or your hemorrhage closed. That might concentrate their mind on recovery.

May is American Stroke Month: University Hospitals Offers Free Screenings and Educational Events

After Stroke, Rehabilitation Therapy Determines the Quality of Life of Patients

 With only 10% full recovery, that rehabilitation therapy IS A COMPLETE FUCKING FAILURE! There is NO DEFENSE against that! The tyranny of low expectations excuse will result in immediate firings!

After Stroke, Rehabilitation Therapy Determines the Quality of Life of Patients

JAKARTA - Stroke management does not stop when the patient passes the critical phase. After the initial attack is handled, the therapy process continues in an effort to restore body functions while preventing wider brain damage.

At this stage, support for the function of nerve cells becomes crucial, because brain cells are still in a vulnerable condition due to disruptions in the supply of oxygen and energy.(Yeah, during the first week, hundreds of millions to billions of neurons continue to die! And your fuckingly incompetent? doctor IS DOING NOTHING TO STOP THAT! I'd suggest charging $1000 a dead neuron, that might concentrate their minds!)

In Indonesia, stroke is still one of the leading causes of death and disability, with a prevalence of 8.3 per 1,000 population based on the Indonesian Health Survey (SKI) 2023.

In addition to emergency treatment, the next challenge is to minimize the subsequent neurological damage that can affect the quality of life of patients in the long term.

To answer this need, PT Pyridam Farma Tbk presents a neuroprotective therapy called Cytoflavin. This therapy is designed to help maintain cell metabolism function and support cellular respiration processes, especially when the brain condition experiences oxygen deficiency.

In the condition of ischemic stroke, mitochondrial dysfunction causes decreased energy production, thereby accelerating brain tissue damage. An approach to therapy that supports the utilization of oxygen and the formation of energy at the cellular level is considered important for maintaining the viability of nerve cells during the critical phase until the beginning of recovery.

This approach is increasingly relevant given the high rate of post-stroke disability which impacts the patient's daily activities. Appropriate interventions from the early to subacute phases are considered to play a major role in determining long-term recovery outcomes.

Throughout 2025, the company was also involved in various scientific forums in the field of neurology as part of education for medical personnel. This therapy has reportedly been used in hundreds of hospitals in Indonesia, including stroke referral facilities.

Specialist neurologist from National Hospital Dr. Cipto Mangunkusumo, Mohammad Kurniawan, conveyed his views regarding the development of this therapy.

"Seeing the manufacturing process and cutting-edge technology of Cytoflavin in Russia makes me amazed. The standards they apply are very good in ensuring the efficiency of production and the efficacy of pharmacological products. This kind of pharmaceutical innovation with precision is what is needed to provide the best support for patients who need intensive treatment such as stroke in the acute phase," he said.

Meanwhile, the Director of PT Pyridam Farma Tbk, Antes Eko Prasetyo, highlighted the trend of increasing stroke cases at productive age as a challenge in itself.

"We are committed to continuing to provide health solutions that are relevant to the needs of the community and hospitals today. Through the distribution of Cytoflavin, we want to ensure that health workers in Indonesia have access to the right therapeutic options to support the optimal recovery process for stroke patients," he said.

Through the development of neuroprotective therapy, it is hoped that stroke treatment in Indonesia can be more comprehensive, not only saving lives, but also helping patients achieve better quality of life after the recovery period.(Quality of life is NOT the survivors goal; FULL RECOVERY IS! GET THERE!)

Brain Adapts to Neuron Loss Through Rapid Rewiring

 Ask your competent? doctor EXACTLY HOW TO ENGAGE THIS post stroke!

This is what your doctor is up against, I'd suggest charging your hospital $1000 a dead neuron, that might get them to solve stroke, nothing else gets them off their asses!

 In each  untreated minute,

1.9 million neurons die

14 billion synapses die

12 km (7.5 miles) of myelinated fibers die

brain ages 3.6 years each hour without treatment

If Pedro Bach-y-Rita can recover you can solve most stroke problems.

Pedro Bach-y-Rita had a stroke in 1958, it destroyed a large portion of his brain stem and yet over the last 7 years of his life he recovered most of his faculties.  We have the methods he used, your doctor should be able to modify them to help you. If you have a competent doctor!

Brainstem stroke recovery How Pedro recovered in here.

And negative Nellie here, don't listen to her, she knows nothing!

Brain can't rewire itself: A new study on brain damage and recovery

The latest here:

Brain Adapts to Neuron Loss Through Rapid Rewiring

Summary: New research shows that the brain’s cortex can rapidly reorganize itself after losing neurons, allowing other nerve cells to take over lost functions. Scientists studied neural networks in the auditory cortex and found that although sound-processing patterns were briefly disrupted, the brain formed nearly identical patterns within days.

Neurons previously uninvolved in processing stimuli stepped in to compensate for the loss. This adaptive mechanism could help explain how the brain maintains function during aging or in diseases like Alzheimer’s and Parkinson’s.

Key Facts:

• Rapid Reorganization: Neural networks re-establish activity patterns just days after neuron loss.
• Functional Compensation: Unused neurons can adapt to take over the roles of lost cells.
• Clinical Implication: May explain brain resilience in aging and neurodegenerative conditions.

Source: Johannes Gutenberg University Mainz

How the brain largely maintains its function when neurons are lost—this is what researchers at the University Medical Center Mainz, the Frankfurt Institute for Advanced Studies (FIAS) and Hebrew University (Jerusalem) have deciphered.

They show that neuronal networks in the cerebral cortex reorganize within a short period of time, with other nerve cells taking over the tasks of the lost neurons.

Nerve cells (neurons) are the most important building blocks of the brain. Credit: Neuroscience News

These findings could form the basis for future research into natural aging processes and neurodegenerative diseases such as Alzheimer’s or Parkinson’s.

The study is published in the journal Nature Neuroscience.

Nerve cells (neurons) are the most important building blocks of the brain.

They form the basis for all mental and physical functions such as thinking, feeling, movement, and perception. In the course of life, nerve cells in the brain can be lost for various reasons: They die off due to age-related processes, are damaged by toxins such as alcohol, or neurodegenerative diseases such as Alzheimer’s and Parkinson’s lead to a more rapid progressive loss of neurons.

While most body organs regularly replace old or damaged cells with new ones in order to maintain their organ function, new neurons only form in certain regions of the brain. In the cerebral cortex, which is responsible for complex thought processes and perception, the ability to form new neurons is very limited in adulthood.

“Nevertheless, clinical studies have shown that cortical brain function is often surprisingly resistant to the loss of neurons that occurs in the course of aging or neurodegenerative diseases,” explains Simon Rumpel, head of the Systems Neurophysiology research group at the Institute of Physiology at the University Medical Center Mainz.

Until now, it was not known how the brain can compensate for the loss of nerve cells and maintain its function. To find this out, the research team used an animal model to investigate the neuronal networks in the auditory cortex, which is responsible for processing acoustic stimuli.

The perception of sounds is based on activity patterns that are triggered in the brain by acoustic stimuli. These patterns are very complex. Ph.D. student Bastian Eppler and Senior Fellow Matthias Kaschube at FIAS contributed significantly to the analysis of these data and the interpretation of the results with their expertise.

The researchers found that the activity patterns initially destabilize when the loss of a few specific nerve cells is deliberately induced. This indicates that the neuronal network responsible for sound perception is in a delicate balance.

After just a few days, very similar activity patterns form again. The nerve cells that were not previously activated by the acoustic stimuli now acquire the ability to take the place of the lost neurons.

“We assume that this newly discovered neuronal mechanism plays an important role in the loss of nerve cells in natural aging processes as well as in neurodegenerative diseases,” says Rumpel. Future research efforts could aim to support this neuronal reorganization.

About this neuroscience research news

Author: Simon Rumpel
Source: Johannes Gutenberg University Mainz
Contact: Simon Rumpel – Johannes Gutenberg University Mainz
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Homeostasis of a representational map in the neocortex” by Simon Rumpel et al. Nature Neuroscience

St. Luke’s Magic Valley adds new role to help stroke patients

 So you finally admit you're a complete failure at getting patients to 100% recovery! Are you paying them $1000 a dead neuron past the tPA administration or hemorrhage fix? Why not? You failed at your job of getting survivors recovered!

St. Luke’s Magic Valley adds new role to help stroke patients

TWIN FALLS, Idaho (KMVT/KSVT) — It is National Stroke Awareness Month, and St. Luke’s Magic Valley has added a new position to help stroke patients.

That’s the focus of this week’s Fit and Well Idaho report.

The stroke nurse navigator helps with rehabilitation after a patient is discharged.

One in four stroke survivors will suffer another one, according to the American Stroke Association.

St. Luke’s said the primary goal of the stroke nurse navigator is to help prevent that from happening.

“Health care is incredibly complex, and patients are in the hospital for such a short amount of time, and we can only give so much information in the two or three days that they’re in the hospital,” said Maggie Gaynor, the stroke nurse navigator at St. Luke’s Magic Valley. “The benefit of this role is to really be a support person. Once the patient gets out to make sure that they understand all of the information that we flooded them with and then to help them, walk through things that come.”

St. Luke’s encourages people to get in contact with their primary care provider to discuss any risks that increase their risk of having a stroke.

Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage

 

Because our incompetent stroke medical 'professionals' still haven't figured out an EXACT BLOOD PRESSURE MANAGEMENT PROTOCOL post stroke! And YOU bear the failure of that! Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid! Pay for performance would solve that problem pretty fast.

For stroke this is incredibly simple. Once the bleed is stopped or the clot removed any additional neurons that die, the hospital pays the patient $1000 a dead neuron and the doctors don't get paid at all. If the patient doesn't get 100% recovered the doctors and therapists don't get paid. Pay for performance will work! Painful at first but survivors don't care about your financial pain since you didn't care about their recovery since you got out of medical school. 

Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage

Ken S. Butcher, MD, PhD¹; Brian Buck, MD, PhD²; Dar Dowlatshahi, MD^3,4; et al Laura C. Gioia, MD, MSc⁵; Mahesh Kate, MD, MSc²; Ana C. Klahr, PhD⁶; Ashwin Sivasubramaniam, MBBS¹; Ashfaq Shuaib, MBBS²; Alan Wilman, PhD⁷; Vijay K. Sharma, MD⁸; Georgios Tsivgoulis, MD, PhD⁹; Christos Krogias, MD¹⁰; Ashkan Shoamanesh, MD¹¹

Author Affiliations Article Information

JAMA Neurol. Published online April 21, 2025. doi:10.1001/jamaneurol.2025.0586

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Editorial

Comment

• Editorial
  Do the Benefits of Blood Pressure Control in ICH Outweigh the Risks?
  Jessica Magid-Bernstein, MD, PhD; Santosh B. Murthy, MD, MPH
  JAMA Neurology

Key Points

Question  Does acute blood pressure (BP) reduction increase the incidence of subacute ischemic lesions in spontaneous intracerebral hemorrhage (ICH)?

Findings  The frequency of ischemic lesions detected with diffusion-weighted magnetic resonance imaging at 48 hours did not increase in patients with ICH randomized to an intensive systolic BP target of less than 140 mm Hg within 6 hours of onset, compared with those with a target of less than 180 mm Hg.

Meaning  Study findings support the safety of systolic BP reduction to a target of less than 140 mm Hg in patients with acute ICH.

Abstract

Importance  Diffusion-weighted imaging (DWI) lesions have been demonstrated in patients with subacute intracerebral hemorrhage (ICH), suggesting ischemic injury, which may be related to blood pressure (BP) reduction.

Objective  To test the hypothesis that acute intensive BP lowering is associated with DWI lesions after ICH.

Design, Setting, and Participants  The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2 (ICHADAPT-2) was a multicenter, randomized, open-label, blinded–end point trial. Between November 2012 and August 2022, patients with ICH presenting within 6 hours of onset were randomized to a systolic BP (SBP) target of less than 140 mm Hg or less than 180 mm Hg. The trial was conducted at 3 comprehensive stroke centers in Canada and Australia, including 1 telestroke referral hub and 1 community stroke hospital. A total of 162 patients with acute ICH were randomized. The primary analysis population was restricted to those undergoing DWI at 48 hours.

Intervention  Patients were randomly assigned to an acute SBP target of less than 140 mm Hg or less than 180 mm Hg.

Main Outcome and Measure  The primary end point was the incidence of acute DWI lesions on brain magnetic resonance imaging obtained 48 ± 12 hours after randomization.

Results  DWI was obtained in 79 (48% female) patients with a mean (SD) age of 71 (13) years and median baseline ICH volume of 11.2 (range, 0.5-122.2) mL. The median times from onset to randomization and DWI were 3.17 (range, 0.7-14.6) hours and 51.6 (range, 17.0-121.4) hours, respectively. Mean (SD) baseline SBP was 183 (22) mm Hg in the less than 140 mm Hg target group and 181 (28) mm Hg in the less than 180 mm Hg target group. Mean SBP was lower over the 48-hour period after randomization in the less than 140 mm Hg group (mean difference, 18.9 mm Hg [95% CI, 17.6-20.2]; P < .001). DWI lesions were detected in 13 of 42 patients (31%) in the less than 140 mm Hg group and 14 of 37 patients (38%) in the less than 180 mm Hg group (odds ratio, 0.74 [95% CI, 0.12-4.64]; P = .32). The median number of DWI lesions (1 [95% CI, 1-10] vs 1.5 [95% CI, 1-10]; P = .26) and total DWI lesion volume (0.1 [95% CI, 0.01-41.3] mL vs 0.3 [95% CI, 0.02-2.03] mL; P = .17) were not different in the less than 140 mm Hg and less than 180 mm Hg groups.

Conclusions and Relevance  DWI lesion frequency and volume were unaffected by intensive antihypertensive therapy. These results support the safety of early BP reduction in acute ICH.

(So, YOU INCOMPETENTLY STILL DIDN'T CREATE A PROTOCOL ON THIS! Or created a protocol delivery mechanism to get the protocol to all stroke hospitals!)

Do the Benefits of Blood Pressure Control in ICH Outweigh the Risks?

 

Because our incompetent stroke medical 'professionals' still haven't figured out an EXACT BLOOD PRESSURE MANAGEMENT PROTOCOL post stroke! And YOU bear the failure of that! Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid! Pay for performance would solve that problem pretty fast.

For stroke this is incredibly simple. Once the bleed is stopped or the clot removed any additional neurons that die, the hospital pays the patient $1000 a dead neuron and the doctors don't get paid at all. If the patient doesn't get 100% recovered the doctors and therapists don't get paid. Pay for performance will work! Painful at first but survivors don't care about your financial pain since you didn't care about their recovery since you got out of medical school. 

Do the Benefits of Blood Pressure Control in ICH Outweigh the Risks?

Jessica Magid-Bernstein, MD, PhD¹; Santosh B. Murthy, MD, MPH²

Author Affiliations

JAMA Neurol. Published online April 21, 2025. doi:10.1001/jamaneurol.2025.0238

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Articles

• Original Investigation
  Blood Pressure Lowering and Risk of Ischemic Lesions After Intracerebral Hemorrhage
  Ken S. Butcher, MD, PhD; Brian Buck, MD, PhD; Dar Dowlatshahi, MD; Laura C. Gioia, MD, MSc; Mahesh Kate, MD, MSc; Ana C. Klahr, PhD; Ashwin Sivasubramaniam, MBBS; Ashfaq Shuaib, MBBS; Alan Wilman, PhD; Vijay K. Sharma, MD; Georgios Tsivgoulis, MD, PhD; Christos Krogias, MD; Ashkan Shoamanesh, MD
  JAMA Neurology

Full Text

Nearly one-third of patients with intracerebral hemorrhage (ICH) have acute punctate infarcts on the diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging (MRI) scans in the first week after symptom onset.¹ These DWI lesions portend poor long-term prognoses and are independently associated with 2-fold higher odds of major disability or death.² From a mechanistic standpoint, underlying cerebral small-vessel disease is purported to cause DWI lesions.² Whether intensive blood pressure (BP) lowering contributes to these lesions is highly contested. Several prior studies have shown a significant relationship between the magnitude of BP reduction in the first 24 hours and the occurrence of DWI lesions.³ In contrast, a pooled, individual patient–level meta-analysis of 1750 patients showed that admission BP, and not change in BP, was independently associated with DWI lesions.⁴ More recently, intensive systolic BP (SBP) control did not result in DWI lesions compared with liberal SBP management in a post hoc analysis of the INTERACT2 trial (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial).⁵ Additionally, in the ICHADAPT trial (Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial), intensive (SBP <150 mm Hg) vs liberal (SBP <180 mm Hg) BP control did not lead to significant reduction in blood flow in the perihematomal or watershed border zones in patients with an acute ICH, indicating that acute BP reduction does not result in ischemia in these patients.⁶ Given these conflicting findings, the role of BP management after acute ICH, particularly in the context of incident DWI lesions, remains poorly understood.

Brain Blood Flow Issues Linked to Mild Cognitive Impairment

 And I bet your competent? doctor DID NOTHING immediately post stroke to improve your cerebral blood flow and oxygen delivery to try and save those neurons about to die from the neuronal cascade of death in the first week.  

Maybe these, why isn't your incompetent doctor already delivering these to you?

cerebral blood flow (36 posts to July 2016)

oxygen delivery (31 posts to January 2020)

I'd suggest charging your doctor $1000 a neuron that died in the first week. 

Here are the calculations I put together:

My calculation is that my doctors let 

5.4 billion neurons die. 

21,600 miles dead myelinated fibers 

2.8 trillion dead synapses 

All in the first week!

Day 1: first 90 minutes:
171 million dead neurons 
1.260 trillion dead synapses
675 miles of dead myelinated fibers
Brain aged 5.4 years

----------------------------------------------------------------------------
Days 2-3:
So 1440 minutes a day * 2days * 950000 = 2,736,000,000  or 2.7 billion  dead neurons
  1440 minutes a day *2days * 7,000,000,000syn = 20,160,000,000,000     20.2 trillion        dead synapses
1440 * 2days * 3.75mi = 10800 mi  dead myelinated fibers
Brain aged - 2 years, a guess
------------------------------------------------------------------------------
Days 4-7:
So 1440 minutes a day * 4days * 475000 = 2,736,000,000  or 2.7 billion dead neurons
  1440 minutes a day *4days * 3,500,000,000syn = 20,160,000,000,000 20.2 trillion    dead synapses
1440 * 4days * 1.875mi = 10800 mi  dead myelinated fibers
Brain aged - 2 years, a guess 

-------------------------------------------------------------------------
This is one hell of a lot of damage to recover from. Especially since we don't know how to move functions from dead locations to new ones.  Or know how to usefully get neurogenesis to work.

-----------------------------------------------------------------------------
Totals:
5.571 billion dead neurons
4.041260 trillion dead synapses
 22,275 miles dead myelinated fibers
Brain aged -  9.4 years

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The brain contains 80 billion neurons, I only lost 6.96375% of my brain.  
My charge would be $5.57100000E+15, whatever that is in real terms, beyond my calculators capacity. 

Damn hard to recover from all that with no stroke protocols.    

Brain Blood Flow Issues Linked to Mild Cognitive Impairment

Summary: Older adults with mild cognitive impairment (MCI) face higher cerebrovascular impedance, or resistance in brain blood flow, according to a new study. Researchers found this increased resistance leads to hypoperfusion, or reduced blood flow in the brain, which may contribute to cognitive difficulties in aging adults.

By using ultrasound and blood pressure tools, scientists analyzed brain blood flow in 58 older adults with MCI and 25 without, discovering a significant difference in cerebrovascular health between the two groups.

This finding suggests vascular function plays a vital role in maintaining cognitive health. The study opens new avenues for exploring interventions to improve blood flow and support cognitive function in older adults at risk of Alzheimer’s.

Key Facts

• Increased cerebrovascular impedance in MCI patients lowers brain blood flow.
• Hypoperfusion from blood flow resistance may worsen cognitive symptoms.
• The study suggests vascular health is crucial for cognitive function in aging.

Source: American Physiological Society

Older adults with mild cognitive impairment showed greater resistance to brain blood flow compared to those without cognitive impediments.

The first-of-its-kind study is published in the Journal of Applied Physiology and has been chosen as an APSselect article for October.  

The research team found the volunteers with mild cognitive impairment had higher cerebrovascular impedance and, in turn, decreased blood flow (hypoperfusion) through the brain. Credit: Neuroscience News

Brain blood flow resistance (also called cerebrovascular impedance) is linked to cognitive problems, which can manifest in several ways, including:

• Difficulty remembering recent events.
• Difficulty finding the right word or remembering a name.
• Difficulty focusing on a task.
• Disorientation in time and space. 

The purpose of the study was to determine if mild cognitive impairment affects the brain’s blood vessels’ ability to transport blood.

Using blood pressure instruments and ultrasonogram imaging to measure impedance in the brain’s blood vessels, the research team studied 58 older adults with mild cognitive impairment who have a higher risk for developing Alzheimer’s disease.

The researchers compared these participants to 25 age-matched volunteers with normal cognition.

The research team found the volunteers with mild cognitive impairment had higher cerebrovascular impedance and, in turn, decreased blood flow (hypoperfusion) through the brain.

Hypoperfusion can lead to cognitive problems in older adults.

“These findings shed light on the pathophysiological mechanisms of brain hypoperfusion in older adults who have a high risk of [Alzheimer’s disease],” the researchers wrote.

“This study highlights the importance of brain vascular function in brain health in older adults,” said Rong Zhang, PhD, a professor of neurology and senior author of the study.

About this cognition and aging research news

Author: Erica Roth
Source: American Physiological Society
Contact: Erica Roth – American Physiological Society
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Patients with amnestic mild cognitive impairment have higher cerebrovascular impedance than cognitively normal older adults” by Rong Zhang et al. Journal of Applied Physiology