A Case–Control Study of the Effects of Chimarrão (Ilex paraguariensis) and Coffee on Parkinson's Disease

 With your risk of Parkinsons, you better hope your doctor has prevention protocols for that. I haven't seen any so I'm doing a pot of coffee(now decaf) a day hoping that my guess works. 

Parkinson’s Disease May Have Link to Stroke March 2017 

How coffee protects against Parkinson’s Aug. 2014  

The latest here:

 

A Case–Control Study of the Effects of Chimarrão (Ilex paraguariensis) and Coffee on Parkinson's Disease

Márcio Schneider Medeiros^1*, Artur Francisco Schumacher-Schuh^1,2, Vivian Altmann³ and Carlos Roberto de Mello Rieder³

• ¹Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
• ²Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
• ³Departamento de Neurologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

Introduction: Coffee has been inversely associated with Parkinson's disease (PD) in many studies, and caffeine is the leading candidate to mediate this effect. Mate (Ilex paraguariensis, IP), a caffeinated beverage rich in antioxidants consumed in South America, was also inversely associated with PD in one study from Argentina. Other varieties of IP infusion, such as chimarrão, were never studied in PD. Chimarrão is a common caffeinated beverage consumed in Brazil made with the leaves and stems of IP.

Methods: A case–control study was conducted to evaluate the relationship between chimarrão ingestion and PD in southern Brazil. All subjects answered a questionnaire about the frequency of chimarrão and coffee intake. A multiple regression analysis adjusted for age and sex was performed to assess the association between PD and chimarrão consumption.

Results: We included 200 PD patients and 200 healthy controls. High consumption of chimarrão was inversely associated with PD (OR = 0.44, 95% CI = 0.24–0.81, P = 0.008). High consumption of coffee was also inversely associated with PD, as expected. Chimarrão remained associated when adjusted for coffee consumption, smoking history, and age (OR 0.46, 95% CI = 0.25–0.86, P = 0.014). These two exposures showed an additive effect.

Conclusion: Chimarrão consumption was inversely associated with PD, even after adjusting for coffee intake, suggesting a possible protective role. IP's effect can be mediated by caffeine and through its antioxidant components. Chimarrão has a lower concentration of caffeine compared with coffee and has numerous substances with antioxidative effects that may be important to PD protection. Further studies are needed to test this hypothesis.

Introduction

The etiology of Parkinson's disease (PD) is not fully understood, and different environmental factors have been associated with PD. These factors are thought to either enhance the risk of developing the disease or provide a protective effect. Coffee is inversely associated with PD, and this effect seems to be mediated by caffeine (1). Several studies have found this association, supporting the evidence of the protective effect of caffeine in PD (1, 2), with a more evident outcome in men (2). Other caffeinated beverages have also been studied, especially tea (3), corroborating the protective role hypothesis of caffeine on PD. Caffeine acts on adenosine A2 receptors on dopaminergic D2 neurons in the substantia nigra, a mechanism potentially implicated with a neuroprotective effect (4). By antagonizing these receptors, caffeine alters dopamine transmission, protects against glutamatergic excitotoxicity, and frees radicals such as nitric oxide (5).

Chimarrão, a hot infusion of Ilex paraguariensis (IP), is a common caffeinated beverage consumed in Brazil. IP is a native plant from South America, and chimarrão was first consumed by its indigenous people. In the Seventeenth century, it was adopted by Spanish and Portuguese colonizers, and nowadays, it is consumed daily by ~30% of the population in southern Brazil (6). It is also popular in Uruguay, Argentina, and Paraguay, where it is called mate. However, chimarrão contains both leaves and stems, different from the mate consumed in Argentina, which is usually free of stems. Mate was previously associated with lower PD risk in Argentina, and caffeine was considered the probable mediator of this effect (7). Previous studies have demonstrated a high content of antioxidants and substances with iron chelation properties in IP, which could elicit a potential protective effect on PD (8, 9). In a recent study by Bernardi et al. (10), they demonstrated that IP may have a strong neuroprotective activity on dopaminergic neurons, preventing their death with a dose-dependent effect (10).

The hypothesis of a neuroprotective effect of IP infusions on PD is understudied. Whether this effect is due to caffeine alone or in combination with antioxidants is yet to be demonstrated. We conducted a case–control study to further investigate the effect of IP on PD.

 

Intermittent Light Exposures in Humans: A Case for Dual Entrainment in the Treatment of Alzheimer's Disease

 Sounds like it could be useful for stroke survivors. DEMAND YOUR DOCTOR CREATE A STROKE PROTOCOL ON THIS.

Intermittent Light Exposures in Humans: A Case for Dual Entrainment in the Treatment of Alzheimer's Disease

Mariana G. Figueiro^1,2* and Sagan Leggett^2,3

• ¹Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ²Lighting Research Center, Rensselaer Polytechnic Institute, Troy, NY, United States
• ³Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY, United States

Circadian sleep disorders are common among American adults and can become especially acute among older adults, especially those living with Alzheimer's disease (AD) and mild cognitive impairment (MCI), leading to the exacerbation of symptoms and contributing to the development and advancement of the diseases. This review explores the connections between circadian sleep disorders, cognition, and neurodegenerative disease, offering insights on rapidly developing therapeutic interventions employing intermittent light stimuli for improving sleep and cognition in persons with AD and MCI. Light therapy has the potential to affect sleep and cognition via at least two pathways: (1) a regular and robust light-dark pattern reaching the retina that promotes circadian phase shifting, which can promote entrainment and (2) 40 Hz flickering light that promotes gamma-wave entrainment. While this is a new area of research, preliminary evidence shows the potential of dual circadian and gamma-wave entrainment as an important therapy not only for those with AD, but for others with cognitive impairment.

Introduction

Forty-five percent of Americans report sleep problems that affect their daily activities at least once per week, with 35% reporting poor or fair sleep quality and 20% reporting that they did not feel refreshed by sleep on any day of the past week (1, 2). Asynchrony between normal work and social schedules and the timing of the internal clock (3) can lead to sleep disorders and sleep deprivation, particularly if the asynchrony is prolonged for an extended period, which in turn can negatively affect task performance, cognition, and general health (4–6). Sleep disorders and their attendant decrements can become especially acute among older adults, especially those living with Alzheimer's disease (AD) and mild cognitive impairment (MCI), leading to the exacerbation of symptoms and contributing to the development and advancement of the diseases (7–9). In fact, of the estimated 5.8 million people in the United States living with AD and related dementias (ADRD) (10), at least one-third experience difficulty sleeping (11, 12) and approximately two-thirds of their estimated 18.5 million unpaid caregivers report sleep disturbances themselves (10, 13, 14).

This review explores the connections between circadian sleep disorders, cognition, and neurodegenerative disease, offering insights on rapidly developing therapeutic interventions employing entraining light stimuli (both continuous and intermittent) for the treatment of sleep disorders, including in those with AD and MCI. Light therapy has the potential to affect sleep and cognition via at least two pathways: (1) a regular and robust light-dark pattern reaching the retina that promotes circadian phase shifting and thus, entrainment and (2) 40 Hz flickering light that promotes gamma wave entrainment. Both are discussed below.

More at link.

 

What Is the “Optimal” Target Mismatch Criteria for Acute Ischemic Stroke?

So at the end of this there is still NO PROTOCOL. You can be thankful your doctor is completely guessing on what needs to be done.  Do you trust your doctor to GUESS CORRECTLY?

What Is the “Optimal” Target Mismatch Criteria for Acute Ischemic Stroke?

Chushuang Chen^1*, Mark W. Parsons², Christopher R. Levi^3,4, Neil J. Spratt^3,4, Longting Lin², Timothy Kleinig⁵, Kenneth Butcher⁶, Xin Cheng⁷, Qiang Dong⁷, Billy O'Brien⁸, Richard I. Avivi⁹, Martin Krause¹⁰, P. N. Sylaja¹¹, Philip Choi¹², Sandeep Bhuta¹³, Congguo Yin¹⁴, Jianhong Yang¹⁵, Peng Wang¹⁶, Weiwen Qiu¹⁷ and Andrew Bivard¹

• ¹Melbourne Brain Centre, University of Melbourne, Parkville, VIC, Australia
• ²Department of Neurology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia
• ³Department of Neurology, John Hunter Hospital, University of Newcastle, Callaghan, NSW, Australia
• ⁴Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
• ⁵Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
• ⁶Prince of Wales Medical School, University of New South Wales, Sydney, NSW, Australia
• ⁷Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
• ⁸Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
• ⁹Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
• ¹⁰Department of Neurology, Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
• ¹¹Department of Neurology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
• ¹²Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
• ¹³Department of Medical Imaging, Gold Coast University Hospital, Southport, QLD, Australia
• ¹⁴Department of Neurology, Hangzhou First Hospital, Zhejiang, China
• ¹⁵Department of Neurology, Ningbo First Hospital, Zhejiang, China
• ¹⁶Department of Neurology, Taizhou First People's Hospital, Zhejiang, China
• ¹⁷Department of Neurology, Lishui People's Hospital, Zhejiang, China

We aimed to compare Perfusion Imaging Mismatch (PIM) and Clinical Core Mismatch (CCM) criteria in ischemic stroke patients to identify the effect of these criteria on selected patient population characteristics and clinical outcomes. Patients from the INternational Stroke Perfusion Imaging REgistry (INSPIRE) who received reperfusion therapy, had pre-treatment multimodal CT, 24-h imaging, and 3 month outcomes were analyzed. Patients were divided into 3 cohorts: endovascular thrombectomy (EVT), intravenous thrombolysis alone with large vessel occlusion (IVT-LVO), and intravenous thrombolysis alone without LVO (IVT-nonLVO). Patients were classified using 6 separate mismatch criteria: PIM-using 3 different measures to define the perfusion deficit (Delay Time, Tmax, or Mean Transit Time); or CCM-mismatch between age-adjusted National Institutes of Health Stroke Scale and CT Perfusion core, defined as relative cerebral blood flow <30% within the perfusion deficit defined in three ways (as above). We assessed the eligibility rate for each mismatch criterion and its ability to identify patients likely to respond to treatment. There were 994 patients eligible for this study. PIM with delay time (PIM-DT) had the highest inclusion rate for both EVT (82.7%) and IVT-LVO (79.5%) cohorts. In PIM positive patients who received EVT, recanalization was strongly associated with achieving an excellent outcome at 90-days (e.g., PIM-DT: mRS 0-1, adjusted OR 4.27, P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p > 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization (P = 0.006).

Conclusion: PIM-DT was the optimal mismatch criterion in large vessel occlusion patients, combining a high eligibility rate with better clinical response to reperfusion. No mismatch criterion was useful to identify patients who are most likely response to reperfusion in non-large vessel occlusion patients.

Introduction

Selection of patients using target mismatch can identify acute ischemic stroke patients who are most likely to benefit from intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) in an extended time window (1–3). However, the exact patient selection criteria remain a controversial topic. The DEFUSE3 (3) and EXTEND IA (4) using Perfusion Imaging Mismatch (PIM), which preferentially enroll patients with a largely treatable penumbra and small ischemic core. The DAWN trial (1) applied a Clinical-Core Mismatch (CCM) where an age-adjusted National Institutes of Health Stroke Scale (NIHSS) score was used as a surrogate for the total perfusion deficit, in combination with a small age-adjusted ischemic core define mismatch. However, various thresholds calculated by different post-processing algorithms, defining penumbra and core, has been reported. The most common set of thresholds defining penumbra and core are time to peak of the residual function (Tmax) > 6 s and relative cerebral blood flow (rCBF) <30%, or delay time (DT) >3 s and rCBF <30% (5). When calculating Mean Transit Time (MTT), Tmax and CBF by singular value deconvolution (sSVD), the algorithm assumes no delay in blood flow from proximal arteries to the ischemic region, as, almost invariably in ischemic stroke, there is delay and dispersion of the contrast between the more proximal arterial input function (AIF) and the ischemic region (6). The sSVD is a delay-sensitive algorithm, resulting in underestimation of CBF and overestimation of MTT (6–8). This is highly clinically relevant as different definitions of the perfusion deficit may affect reperfusion treatment eligibility. It is a challenge to determine which mismatch criteria are superior to others in term of optimally identifying excellent reperfusion responders and excluding those who are either likely to be harmed or who have a good natural history regardless of treatment, in routine clinical practice.

Therefore, in this study we aimed to: (i) to compare the various PIM and CCM criteria using different definitions of perfusion deficit; and (ii) assess the ability of each criterion to identify acute stroke patients who are most likely to respond to reperfusion treatment in different subgroups of acute ischemic stroke patients. We hypothesized: (i) that there would be considerable differences in the proportion of patients selected with each mismatch criterion; and (ii) that the presence of PIM or CCM positivity may not uniformly predict response to reperfusion treatment in different sub-groups of acute ischemic stroke patients.

 

Early Venous Filling Following Thrombectomy: Association With Hemorrhagic Transformation and Functional Outcome

 Oh great, you described a problem but offered NO SOLUTION.  What the fuck good does that do for any survivor? It's a simple question, what's your answer?

Early Venous Filling Following Thrombectomy: Association With Hemorrhagic Transformation and Functional Outcome

Sophie Elands^1*, Pierre Casimir¹, Thomas Bonnet², Benjamin Mine², Boris Lubicz², Martin Sjøgård³, Noémie Ligot¹ and Gilles Naeije¹

• ¹Department of Neurology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
• ²Department of Interventional Neuroradiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
• ³Laboratoire de Cartographie Fonctionnelle du Cerveau, Neuroscience Institute (ULB-Neuroscience Institute), Université Libre de Bruxelles, Brussels, Belgium

Background and Purpose: Previous studies have noted the angiographic appearance of early venous filling (EVF) following recanalisation in acute ischemic stroke. However, the prognostic implications of EVF as a novel imaging biomarker remain unclear. We aimed to evaluate the correlation between EVF with (i) the risk of subsequent reperfusion hemorrhage (RPH) and (ii) the association of EVF on both the NIHSS score at 24 h and functional outcome as assessed with the Modified Rankin Scale (mRS) score at 90 days.(Nothing in this purpose is of any use to getting survivors recovered. Your mentors and senior researchers need to be fired.)

Methods: We conducted a retrospective cohort study of patients presenting with an acute ischemic stroke due to a proximal large-vessel occlusion of the anterior circulation treated by thrombectomy. Post-reperfusion digital subtraction angiography was reviewed to look for EVF as evidenced by the contrast opacification of any cerebral vein before the late arterial phase.

Results: EVF occurred in 22.4% of the 147 cases included. The presence of EVF significantly increased the risk of RPH (p = 0.0048), including the risk of symptomatic hemorrhage (p = 0.0052). The presence of EVF (p = 0.0016) and the absence of RPH (p = 0.0021) were independently associated with a better outcome as defined by the NIHSS difference at 24 h, most significantly in the EVF⁺RPH⁻ group. No significant relationship was however found between either EVF or RPH and a mRS score ≤ 2 at 90 days.

Conclusion: Early venous filling on angiographic imaging is a potential predictor of reperfusion hemorrhage. The absence of subsequent RPH in this sub-group is associated with better outcomes at 24 h post-thrombectomy than in those with RPH.

Introduction

Stroke is the second most common cause of death and the main cause of acquired disability worldwide (1). Over sixty percent of morbidity and mortality related to stroke is due to large vessel occlusion (LVO) (2), which in itself accounts for about 30% of all ischemic strokes (3). The primary therapeutic aim is to rapidly recanalize the occluded vessel in order to restore blood flow and salvage cerebral tissue so as to improve patient outcome. In that context, endovascular thrombectomy (EVT) with or without intravenous thrombolysis substantially reduces disability in selected cases of LVO (4). The benefit of recanalizing treatments must be balanced with procedural risks and LVO stroke complications such as hemorrhagic transformation and reperfusion hemorrhage (RPH), with hemorrhagic transformation occurring in up to 43% of patients (5). These hemorrhagic complications tend to be classified based on their radiological appearance according to the European Cooperative Acute Stroke Study (ECASS II) into parenchymal hematomas (PH) and hemorrhagic infarctions (HI). The incidence of PH after EVT was recently reported to be 6% (6), with PH strongly correlating with early neurological deterioration and poor clinical outcome (7).

Although time is of the essence in achieving recanalization, there has been a recent paradigm shift whereby neuroimaging is gaining center stage in EVT decision-making. It provides an invaluable insight that is both patient-specific and dynamic into the physiological effects of the vessel occlusion, the penumbra at stake and RPH risks. Neuroimaging thus plays a key role in providing a tailored-made risk-benefit calculation for recanalization intervention and prediction of treatment response (8).

Current pre-treatment evaluation techniques include perfusion imaging derived from either computer tomographic (CT) or magnetic resonance imaging (MRI), which allow a quantitative assessment of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). These measures help to evaluate the degree of salvageable “penumbra,” in other words the area of brain tissue surrounding the irreversibly damaged “infarcted core” that is at risk of infarction but may still be saved if reperfused. As such, the infarcted core is usually defined on CT as a CBF <30% of normal brain blood flow or on MRI as an apparent diffusion coefficient <620 μm²/s, whereas the area of critical hypoperfusion is identified as MTT of >6 s. The estimated penumbra, otherwise known as mismatch volume, is derived from the difference between these two values. However, in LVO, EVT decision currently relies on perfusion characteristics only when symptom onset exceeds 6 h. There, a favorable mismatch allows to extend the therapeutic window to as far as 24 h post-symptom onset (8). Similarly, perfusion imaging helps to assess the risk of bleeding following EVT, with an increased risk of hemorrhagic transformation in cases with a large ischemic core volume, severe blood flow restriction, blood-brain barrier disruption and poor collateral status (9).

However, within 6 h of symptoms onset in LVO, perfusion imaging is not warranted, preventing its use as prognostic tool for clinical outcome or complications in most of cases. In that context, digital subtraction angiography (DSA) could provide valuable information. As such, there is scarce evidence about the post-recanalization imaging biomarkers available on digital subtraction angiography (DSA). Prominent brain vascularity in the form of capillary blush, arteriovenous shunting and early venous filling (EVF) have been noted immediately after EVT (9). EVF, defined as the contrast opacification of any cerebral vein before the late arterial phase on post-reperfusion DSA, has previously been shown to be associated with an increased risk of subsequent infarction (10–12), a higher rate of reperfusion hemorrhage (RPH) and worse clinical outcomes (10, 13). However, these findings were limited by either outdated recanalisation techniques or small cohort size.

Here, we investigated the association between EVF and RPH, together with its impact on functional prognosis and physiopathological correlations by conducting a retrospective study on the largest cohort to date of patients undergoing thrombectomy for a proximal anterior circulation occlusion.

 

How Musical Training Shapes the Adult Brain: Predispositions and Neuroplasticity

 If your doctor hasn't been prescribing music and music training for a decade then s/he is hopeless and this research wouldn't help. 

• music (94 posts back to March 2011)

• music therapy (53 posts back to October 2014)  

• musical training (13 posts back to June 2014)

How Musical Training Shapes the Adult Brain: Predispositions and Neuroplasticity

Alicja M. Olszewska^1*, Maciej Gaca¹, Aleksandra M. Herman¹, Katarzyna Jednoróg² and Artur Marchewka^1*

• ¹Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland
• ²Laboratory of Language Neurobiology, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland

Learning to play a musical instrument is a complex task that integrates multiple sensory modalities and higher-order cognitive functions. Therefore, musical training is considered a useful framework for the research on training-induced neuroplasticity. However, the classical nature-or-nurture question remains, whether the differences observed between musicians and non-musicians are due to predispositions or result from the training itself. Here we present a review of recent publications with strong focus on experimental designs to better understand both brain reorganization and the neuronal markers of predispositions when learning to play a musical instrument. Cross-sectional studies identified structural and functional differences between the brains of musicians and non-musicians, especially in regions related to motor control and auditory processing. A few longitudinal studies showed functional changes related to training while listening to and producing music, in the motor network and its connectivity with the auditory system, in line with the outcomes of cross-sectional studies. Parallel changes within the motor system and between the motor and auditory systems were revealed for structural connectivity. In addition, potential predictors of musical learning success were found including increased brain activation in the auditory and motor systems during listening, the microstructure of the arcuate fasciculus, and the functional connectivity between the auditory and the motor systems. We show that “the musical brain” is a product of both the natural human neurodiversity and the training practice.

Introduction: What is Neuroplasticity? Why is it so Important to Study it?

The constantly changing environment, the drive for new knowledge and skills, all require behavioral flexibility. The brain, as the source of behavior, adapts its architecture and functions to perform new tasks through processes broadly defined as neuroplasticity. These processes include, among others, dynamic reconfiguration of neural connections, cell shape, size, myelination, synaptic strength and neurogenesis, the last one limited to the olfactory bulb and the hippocampus in adults (Tardif et al., 2016). In human neuroimaging studies, it is possible to indirectly measure macroscopic effects of the neuroplastic biological dynamics via functional and structural modalities (for the overview of the relationship between macroscopic measures and the underlying biology, see Tardif et al., 2016). Although usually measured separately, functional and structural neuroplasticity reflect various aspects of the same neuroplastic processes and are thus inherently intertwined in a complex manner.

We currently understand that the human brain is not shaped exclusively during critical periods of development. Neuroplastic changes occur in response to internal and external stimuli throughout the entire lifetime (Draganski and May, 2008). From a social perspective, neuroplasticity processes underlie such phenomena as education, neurological rehabilitation, or healthy aging.

Musical Training as a Framework for Studying Brain Plasticity

Generally, in studies on neuroplasticity, two questions arise: what are the structural and functional changes related to a particular behavioral need, and how do they occur over time. To effectively answer these questions, we first need to elicit a novel behavior. There is a wide spectrum of learning protocols which were employed so far to understand neuroplasticity. Simple ones engage only a single sensory modality, like auditory (Zatorre et al., 2012) or tactile (Hodzic, 2004). More complex ones utilize sensorimotor associations and higher-order cognitive functions tasks, like the acquisition of foreign languages or tactile reading (Li et al., 2014; Siuda-Krzywicka et al., 2016). The complexity of music performance requires a unique and multi-system involvement from the human brain (Münte et al., 2002; Herholz and Zatorre, 2012; Schlaug, 2015). Playing a musical instrument requires sensorimotor adaptations, as with the use of any tool, and more: a mapping of specific movements to the auditorily perceived outcomes, which follow a set of more or less intuitively understood rules of musical harmony, esthetics and pleasure. It comprises both feed-forward and feedback interactions between the integrated multisensory input (tactile, proprioceptive, auditory, and visual) with motor output, as well as higher-order cognitive functions such as memory, attention, emotion, and the processing of musical syntax (Zatorre et al., 2007; Brown et al., 2015). Additionally, as rewarding stimuli are learned better than non-rewarding ones (Schultz, 2000), it is likely that the highly rewarding nature of musical performance promotes learning and drives brain plasticity (Penhune, 2019). Therefore, learning to play a musical instrument provides a useful framework to study multimodal brain plasticity.

Secondly, the changes in brain structure and function have to be sampled frequently enough to capture the dynamics of the neuroplastic processes. Brain volume changes do not relate to practice in a monotonically increasing way (Lövdén et al., 2013; Wenger et al., 2017). Yet, we observe continuous behavioral improvement and the extent of behavioral and plastic changes correlate with training duration. The proposed model of neuroplasticity includes a period of initial growth, after which comes a renormalization phase, when the efficiency of brain circuits increases while cortical volume does not (Wenger et al., 2017). From a functional perspective, plastic changes can be reflected in increased functional activation of a brain area related to a function, its expansion on neighboring areas, or an involvement of novel, often distant, areas. Interestingly, cortical map plasticity may also follow a comparable pattern of expansion followed by retraction to pre-training levels during learning as seen in structural changes (for review see Wenger et al., 2017). Therefore, the functional (and structural) expansion temporarily increases the available pool of circuits to be used “exploratively” until the most efficient circuit to perform the task is determined. As learning continues, the selected circuitry is further stabilized through practice, the performance increasingly relies on that circuit and thus the cortical map renormalizes (Wenger et al., 2017).

Two experimental approaches are typically employed in cognitive neuroscience to understand brain reorganization following training, namely the cross-sectional and the longitudinal design. Comparing musically naive and proficient individuals in cross-sectional studies can provide important insights into the neuroplasticity of the human brain (Münte et al., 2002). Musicians practice musical performance regularly for most of their lives, often starting in early childhood and practising for many years. Juxtaposing musicians and non-musicians can show changes associated with very long training. However, while it might be tempting, the causal relationship between musical training and the observed differences cannot be inferred from correlational studies (Schellenberg, 2019). The cross-sectional study design does not reveal the time course of the plastic changes nor does it correct for any possible predispositions. To infer causality, a theoretical model needs to be constructed and validated against properly designed longitudinal studies. Longitudinal studies can account for the interindividual variability pre-training, but are costly, with costs increasing with the duration of the experiments.

Finally, advances in non-invasive neuroimaging methods gave scientists specific tools to non-invasively study brain plasticity in living humans. Structural and functional neuroimaging techniques were used to compare brain anatomy and function between groups of musicians and non-musicians, and, more recently, to study the plastic changes related to musical training in longitudinal studies.

This review aims to present the newest evidence for experience-related neuroplasticity in the context of musical training in adults, concentrating on neuroimaging and with an emphasis on longitudinal studies. Since the scope of this review is limited, and the focus is on musical training as a model for studying brain plasticity in neurotypical adults, studies of complex developmental and aging-related changes are not discussed. We particularly focus on experimental designs in order to better understand both brain reorganization and the neuronal markers of predispositions when learning to play a musical instrument. Since we include studies which use a multitude of functional as well as structural neuroimaging techniques, we also provided a brief overview of such methods highlighting the advantages and disadvantages of each method for neuroplasticity research (Table 1).

More at link.

 

Charity calls for urgent action to avoid a stroke crisis in Scotland

In case you missed it the crisis has existed for decades and your suggested solution is totally wrong. 'Timely access' is fucking useless unless you address the existing failures. Will you please put someone in charge who actually knows what needs to be done? It's appalling that you even have stroke in your name.

10% full recovery from rehab or 12% full recovery from tPA is complete failure. 'Timely access' does nothing to solve that.

The latest here:

Charity calls for urgent action to avoid a stroke crisis in Scotland

Scotland could be ­heading for a stroke crisis without urgent action, a leading ­support charity fears.

Research suggests 128,000 people in Scotland currently live with the after-effects of strokes but that could rise by 59% in over-45s to almost 175,000 by 2035 as the treatment and related costs reach £4.57 billion.

In the run-up to the Scottish parliamentary election in May, the Stroke Association is urging the next Scottish Government to establish a new, progressive service for stroke patients, in which every­one receives timely access to specialist treatment and rehabilitation support.

The charity’s public affairs officer, Colin Oliver, said: “The fallout from Covid-19 is going to pose challenges for everyone in health and social care.

“Our Recoveries At Risk report highlighted the real-life impact of the pandemic on people recovering from a stroke. Emerging evidence of links between Covid-19 and stroke means that now, more than ever, a renewed national focus on stroke is needed in Scotland.”

Strokes, which kill 4,000 people in Scotland every year, happen when the blood supply to part of the brain is cut off. The impact of the stroke depends on which part of the brain is affected.

Statistics show that almost two-thirds of survivors leave hospital with a disability. As well as a range of physical ­disabilities, stroke commonly affects speech and communication, thinking processes and vision. A third of survivors experience depression.

When a stroke happens, the absolute priority for the patient is timely access to stroke expertise. There is ­unequivocal evidence that high-quality acute services reduce deaths and disability.

The Stroke Association in Scotland’s manifesto highlights the impact of strokes and how to build on the current work to improve services. It says strokes must be treated as a priority but Covid has greatly impacted on patient care in the last year.

The charity’s latest report, published in September, suggests the pandemic has affected every aspect of stroke treatment, from delays calling 999, to hospital care and discharge.

Covid has also affected access to rehabilitation and support, resulting in significant challenges for stroke survivors trying to rebuild their lives, according to the report.

Respondents said they felt anxious and concerned about the future, while carers have felt the pressures of lockdown.

Further research suggests the coronavirus could put people at greater risk of having a stroke, due to an increased risk of blood clots brought by the illness.

Oliver added: “We look ­forward to seeing the draft model for improved Scottish stroke services in the next few months.

“Whatever the outcome of May’s election, we look forward to working with the government to see improvements delivered from hospital care through to rehabilitation and community support.

“The implementation of a new, improved stroke service across the entire pathway from prevention to hospital treatment, rehabilitation and support, in tandem with forthcoming changes nationally to delivery of social care presents an opportunity for the next government to make a profound difference to the lives of thousands of Scots families.”

---

The whole of my left side was paralysed. I was terrified

© Jamie Williamson

Louise Copland

Louise Copland had a stroke when she was just 31 – and found the recovery challenging.

Now, six years on, she is backing the Stroke Association’s manifesto in the hope she can help change the experience for others.

Six years ago, Louise’s partner noticed her speech was slurred. She was taken to hospital where doctors revealed she was suffering a mini stroke.

“It was a massive haemorrhagic stroke. The whole of my left side was paralysed. I couldn’t walk or feel my left side. I couldn’t speak properly or swallow easily. I was terrified, I had no idea what was going on.”

Louise’s stroke had been caused by an aneurysm in the brain, which burst. It was found during a routine epilepsy scan, but doctors thought it was outside the brain rather than inside.

After an operation to drain the blood and fit a coil and stent, Louise was discharged from hospital – and it was then she realised the hardest part was yet to come.

Social care, such as help to wash and dress, and even getting a wheelchair, were only available privately.

“I didn’t fit the typical age bracket for a stroke, so I couldn’t tick this box and didn’t fit into that category.

“The first few months were tough. I felt anxious and isolated. There was no one to talk to who would understand what I was going through.”

With intense physio, Louise, from Renfrew, has made good progress but now walks with a stick, has no sensation down her left side and cannot see out of the corner of her left eye.

“More people need to know the devastating impact of stroke – the fact that it can change people’s lives in an instant like it did mine.

“Lives after stroke can be rebuilt again. But it takes specialist help and support and a ton of courage. I was lucky to have my friends and family, the NHS and the support of a charity behind me.

“We must continue to make stroke a priority in Scotland so that more lives can be saved and rebuilt again.”

 

Ideal CV health scores confer lower risk for most stroke subtypes

 As far as I can tell this is just distractions from the FACT there IS NOTHING TO GET YOU EVEN MINIMALLY CLOSE TO 100% RECOVERY.  Hey, look over here; a squirrel! Because this is just setting the stage for your doctor to blame you for having a stroke and if you don't recover, that's on you also.  Don't look to your doctor for recovery, they know absolutely nothing. Ask them, their answer will prove that. They'll mention useless guidelines but NO PROTOCOLS and besides they already let billions of neurons die during the first week in the neuronal cascade of death. Bet they didn't mention that. 

The American Heart Association’s Life’s Simple 7 (LS7) (now Essential 8)defines ideal cardiovascular health by 7 metrics: not smoking, regular physical activity, normal body mass index, blood pressure, plasma glucose, and total cholesterol levels, and a healthy diet. 

I was off the charts on my physical activity so I should have not had a stroke, but there are no hereditary metrics in here. My dad had 85% carotid blockage and his doctor did not inform him to have his children tested for blockage.  

Ideal CV health scores confer lower risk for most stroke subtypes

Ideal American Heart Association CV health scores were associated with substantially lower risks for stroke, ischemic stroke, intracerebral hemorrhage and unspecified stroke, but not subarachnoid hemorrhage, researchers reported.

“Previous studies ... showed that better CV health was associated with lower risks of stroke; however, there were also some studies that found no significant association between global CV health score and stroke,” Zhi Cao, MD, from the School of Public Health at Tianjin Medical University and the department of big data in health science at the School of Public Health and Zhejiang University School of Medicine in Hangzhou, China, and colleagues wrote in EClinicalMedicine, a clinical journal published by The Lancet. “Moreover, data are sparse regarding the influence of behavioral and biological CV health status on the risks of stroke subtypes, including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage.”

Ideal American Heart Association CV health scores were associated with substantially lower risks for stroke, ischemic stroke, intracerebral hemorrhage and unspecified stroke, but not subarachnoid hemorrhage. Data were derived from Cao Z, et al. EClinicalMedicine. 2021;doi:10.1016/j.eclinm.2021.100791.

The AHA Life’s Simple 7 measures of ideal CV health include smoking, diet, physical activity and BMI as behavioral metrics and blood glucose, blood cholesterol and BP as biological metrics.

The researchers analyzed 354,976 participants (55% women) aged 40 to 70 years without stroke and CHD from the UK Biobank from 2006 to 2010 who were followed up to 2020. Participants’ CV scores were categorized into poor, intermediate and ideal groups.

During a median follow-up period of 11 years, researchers observed 5,804 incident stroke cases that included 3,664 cases of ischemic stroke, 714 cases of intracerebral hemorrhage, 453 cases of subarachnoid hemorrhage and 426 cases of unspecified stroke. In the cohort, 21.2% of participants were categorized as having poor CV health scores, 64.3% were categorized as intermediate and 14.5% were categorized as ideal.

There was a significant reduction in risk for stroke with both increasing behavioral CV health scores (HR = 0.9; 95% CI, 0.88-0.91) and biological CV health scores (HR = 0.82; 95% CI, 0.8-0.84). Participants in the ideal behavioral CV health group demonstrated significantly lower risks for all stroke subtypes. Those in the ideal biological CV health group had reduced risk for all stroke events except subarachnoid hemorrhage (HR = 1.24; 95% CI, 0.88-1.76), according to the researchers.

Each 1-point increment in global CV health score was associated with 13% lower risk for ischemic stroke and unspecified stroke, 11% lower risk for stroke and 8% lower risk for intracerebral hemorrhage. Overall, participants with poor behavioral and biological CV health had a nearly threefold increased risk for stroke compared with participants with ideal behavioral and biological CV health scores (HR = 2.78; 95% CI, 2.36-3.28).

Researchers observed no significant dose-dependent association between global CV health and subarachnoid hemorrhage.

“Our study highlights the benefits of maintaining better CV health across the life course and call attention to the need for comprehensive strategies to preserve and restore high CV health score to prevent stroke events,” the researchers wrote.

 

Biomimetic Nanoparticles as a Theranostic Tool for Traumatic Brain Injury

This would seem to be much much better at identifying specific areas of the brain that are damaged. Much better than CT or MRI scans which indirectly identify brain damage. Now we just need our stroke leadership to improve this vastly so results can come back in minutes rather than 24 hours. BUT NOTHING WILL OCCUR, WE HAVE NO STROKE LEADERSHIP, we have no one with any brains at all in stroke. Your children and grandchildren will be screwed when they have strokes unless we get survivors in charge.

Biomimetic Nanoparticles as a Theranostic Tool for Traumatic Brain Injury

 Assaf Zinger,* Sirena Soriano, Gherardo Baudo, Enrica De Rosa, Francesca Taraballi,* and Sonia Villapol* 

Traumatic brain injury (TBI) triggers both central and peripheral inflammatory responses. Existing pharmacological drugs are unable to effectively and quickly target the brain inflamed regions, setting up a major roadblock towards effective brain trauma treatments. Nanoparticles (NPs) have been used in multiple diseases as drug delivery tools with remarkable success due to their rapid diffusion and specificity in the target organ. Here, leukocyte-based biomimetic NPs are fabricated as a theranostic tool to directly access inflamed regions in a TBI mouse model. This NP systemic delivery is visualized using advanced in vivo imaging techniques, including intravital microscopy and in vivo imaging system. The results demonstrate selective targeting of NPs to the injured brain and increased NPs accumulation among the peripheral organs 24 h after TBI. Interestingly, increased microglial proliferation, decreased macrophage infiltration, and reduced brain lesion following the NPs treatments compared to sham vehicle-treated mice are also found. In summary, the results suggest that NPs represent a promising future theranostic tool for TBI treatment.

Ice cube tray failures

 Our St. Patricks day dinner had  a Whiskey Cider Julep starter; Teeling whiskey.

a fake corned beef and cabbage dinner with Guinness blonde beer.

Apres dinner drink of Irish mead(White wine with honey), not true mead since it wasn't totally made with honey. Too sweet for me.

We finished the beer and the mead over the next two nights, whiskey was pretty much completely full.

So in order to consume some of it I need ice cubes. Since these are the plastic trays the standard way to pop the ice cubes out is to grab the ends with both hands and twist. That is impossible.

1. I can't open my left hand and get it around one end at the same time.

2. I don't have the gripping power to hold on, or the ability to twist my wrist at the same time.

 

 

 

 

 

 

 

 

 

So the hip check method as proposed in One-Handed in a Two-Handed World (Second Edition) (Spiral-bound) by Tommye-K. Mayer was the way to go.

Sneezing failure

The left arm has massive movements when sneezing. So far I haven't broken my laptop by flinging it across the room. Any time I feel a sneeze coming on I have to empty my right hand of what ever it is doing and immediately forcefully grab my left wrist.  I've already spilled coffee and water all over the place in my hurry to get the mug set down. I've seen nothing, no research, nada on stopping these involuntary muscle movements(Sneezes, coughs, yawns)

Novel Device OK'd to Treat MS Gait Deficits — Tongue stimulator generates pulses to combat ataxia

 In case you want your doctor to use this to treat your ataxic gait.

What is Ataxic Gait?

Ataxic gait is often characterized by difficulty walking in a straight line, lateral veering, poor balance, a widened base of support, inconsistent arm motion, and lack of repeatability. These symptoms often resemble gait seen under the influence of alcohol.

If you want to evaluate your ataxia yourself in violation of doctor's purview, here you go.

Scale for Assessment and Rating of Ataxia

The latest here:

Novel Device OK'd to Treat MS Gait Deficits - Tongue stimulator generates pulses to combat ataxia

by Judy George, Senior Staff Writer, MedPage Today March 26, 2021

A novel stimulator device to treat gait deficits in multiple sclerosis (MS) patients with mild to moderate symptoms earned a nod from the FDA Friday.

The device, known as the Portable Neuromodulation Stimulator (PoNS), generates electrical pulses on the tongue to stimulate trigeminal and facial nerves to treat motor deficits. To be available by prescription, it is to be used only as part of a supervised therapeutic exercise program in MS patients 22 and older, the agency said. The FDA authorized the device through its "de novo" premarket review pathway for new devices posing low to moderate risks for adverse effects.

"MS is one of the most common neurological diseases in young adults. Today's authorization offers a valuable new aid in physical therapy and increases the value of additional therapies for those who live with MS on a daily basis," Christopher Loftus, MD, acting director of the Office of Neurological and Physical Medicine Devices in the FDA's Center for Devices and Radiological Health, said in a statement.

Most people with MS experience their first symptoms between the ages of 20 and 40 and the disease occurs more frequently in women than in men. MS can cause a variety of symptoms, including problems with walking and balance.

The PoNS device delivers mild neuromuscular electrical stimulation to the dorsal surface of the patient's tongue. A control unit, worn around the neck, sends signals to a mouthpiece the patient holds lightly in place with their lips and teeth. A therapist can view usage data later to identify "potential areas of missed or shortened sessions," the FDA noted.

Two clinical studies underpinned the agency's favorable review. One involved 20 MS patients with gait deficits (10 who used PoNS; 10 who used a sham device), the PoNS group showed "statistically significant and clinically significant" improvement in Dynamic Gait Index (DGI) scores at 14 weeks not seen in controls, the FDA said.

The other study, in 14 patients, demonstrated improvements from baseline in sensory organization task scores (but not in DGI scores) at 14 weeks. No serious safety adverse events were reported in the clinical studies or retrospective analysis of real-world data.

The PoNS device should not be used by patients with penetrating brain injuries, neurodegenerative diseases, oral health problems, chronic infectious diseases, unmanaged hypertension or diabetes, pacemakers, or a history of seizures, the FDA cautioned. "Because the PoNS device delivers electrical stimulation directly to the surface of the tongue, precautions for use are similar to those for transcutaneous electrical nerve stimulation," the agency said. Electrical stimulation should not be used if there is an active or suspected malignant tumor, near recent bleeding or open wounds, or in areas that lack normal sensation. The PoNS device has not been tested on and should not be used by people under age 22, who are pregnant, or who are sensitive to nickel, gold, or copper.

This was device maker Helius Medical's second attempt to win FDA authorization; the agency rejected the PoNS device in 2019 when the company sought clearance through the less rigorous 510(k) pathway, though it had been approved in Canada. It had been featured extensively in the media after former television host Montel Williams promoted the device in 2016, which he used to treat his MS symptoms.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

 

If You Have This Blood Type, Your Stroke Risk May Be Higher, Study Says:(Women; non-O)

You'll have to ask your doctor EXACTLY  the protocols to follow to counteract this risk to nothing.

If You Have This Blood Type, Your Heart Attack Risk Is Higher, Study Says:(Women; non-O).

Some women with non-O blood types may be at an increased risk of early-onset stroke.

iStock

At the American Stroke Association's (ASA) 2021 International Stroke Conference, research funded by the National Institute of Neurological Disorders and Stroke looked at the association between blood type and stroke risk. According to the study, the researchers found that non-O blood types (A, B, or AB) may be at an increased risk of early-onset stroke for women who smoke and take oral contraceptives.

But you may be able to tell if you're more at risk of a stroke, whether silent or symptomatic, if you're aware of the factors that contribute to this dangerous health condition—and it turns out, your blood type is one of those factors. Read on to find out which blood type is associated with an increased stroke risk, based on a new study, and for more things your blood type can tell you, check out 

The researchers looked at nearly 350 women who had experienced a stroke before the age of 50 and compared their data to 383 women who had not had a stroke. They concluded that women with non-O blood types who smoked and took oral contraceptives were nearly twice as likely to have a stroke before turning 50.

 

EXPRESS: Physical Exercise in Patients with Subacute Stroke (PHYS-STROKE): safety analyses of a randomized clinical trial

 Well it better be safe, your doctor expects you do do physical exercise as much as possible. All because your doctor did nothing in the first week causing billions of neurons to die.

EXPRESS: Physical Exercise in Patients with Subacute Stroke (PHYS-STROKE): safety analyses of a randomized clinical trial

Show all authors

Torsten Rackoll, Alexander Heinrich Nave, Martin Ebinger, ...

First Published March 16, 2021 Research Article 

https://doi.org/10.1177/17474930211006286

Article information

  

Abstract

Background and aim: 

To report the six-month safety analyses among patients enrolled in the ‘Physical Fitness Training in Subacute Stroke – PHYS-STROKE’ trial and identify underlying risk factors associated with serious adverse events (SAE).

Methods: 

We performed a pre-specified safety analysis of a multicenter, randomized controlled, endpoint-blinded trial comprising 200 patients with moderate to severe subacute stroke (days 5-45 after stroke) that were randomly assigned (1:1) to receive either aerobic, bodyweight supported, treadmill-based training (n=105) or relaxation sessions (n=95, control group). Each intervention session lasted for 25 minutes, five times weekly for four weeks, in addition to standard rehabilitation therapy. SAE defined as cerebro- and cardiovascular events, readmission to hospital, and death were assessed during six months of follow-up. Incident rate ratios (IRR) were calculated and Poisson regression analyses were conducted to identify risk factors for SAE and to test the association with aerobic training.

Results: 

Six months after stroke, 50 SAE occurred in the trial with a higher incidence rate (per 100 patient-months) in the training group compared to the relaxation group (6.31 vs 3.22; IRR 1.70, 95% CI 0.96 to 3.12). The association of aerobic training with SAE incidence rates were modified by diabetes mellitus (IRR for interaction: 7.10, 95% CI 1.56 to 51.24) and by atrial fibrillation (IRR for interaction: 4.37, 95% CI 0.97 to 31.81).

Conclusions: 

Safety analysis of the PHYS-STROKE trial found a higher rate of SAE in patients randomized to aerobic training compared to control within six months after stroke. Exploratory analyses found an association between SAE occurrence in the aerobic training group with pre-existing diabetes mellitus and atrial fibrillation which should be further investigated in future trials.

Data access statement: 

The raw data and analyses scripts are provided by the authors on a secure online repository for reproduction of reported findings.

Keywords Aerobic treadmill training, Risk factors, safety, serious adverse events, stroke rehabilitation, subacute stroke

Access Options

 

Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

All you are measuring is intermediate steps, survivors don't give a damn about those, they want to know how you are getting them 100% recovered.

Dynamics of cerebral perfusion and oxygenation parameters following endovascular treatment of acute ischemic stroke

1. http://orcid.org/0000-0003-2461-1407Gianluca Brugnara1,
2. Christian Herweh1,
3. http://orcid.org/0000-0002-3085-3886Ulf Neuberger1,
4. Mikkel Bo Hansen2,
5. Christian Ulfert1,
6. Mustafa Ahmed Mahmutoglu1,
7. Martha Foltyn1,
8. Simon Nagel3,
9. Silvia Schönenberger3,
10. Sabine Heiland1,
11. Peter Arthur Ringleb3,
12. Martin Bendszus1,
13. Markus Möhlenbruch1,
14. http://orcid.org/0000-0003-0672-5718Johannes Alex Rolf Pfaff1,
15. http://orcid.org/0000-0002-6224-0064Philipp Vollmuth1

1. Correspondence to Dr Philipp Vollmuth, Department of Neuroradiology, University Hospital Heidelberg, Heidelberg 69120, Baden-Württemberg, Germany; philipp.vollmuth@med.uni-heidelberg.de

Abstract

Background We studied the effects of endovascular treatment (EVT) and the impact of the extent of recanalization on cerebral perfusion and oxygenation parameters in patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO).

Methods Forty-seven patients with anterior LVO underwent computed tomography perfusion (CTP) before and immediately after EVT. The entire ischemic region (T_max >6 s) was segmented before intervention, and tissue perfusion (time-to-maximum (T_max), time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF)) and oxygenation (coefficientof variation (COV), capillary transit time heterogeneity (CTH), metabolic rate of oxygen (CMRO₂), oxygen extraction fraction (OEF)) parameters were quantified from the segmented area at baseline and the corresponding area immediately after intervention, as well as within the ischemic core and penumbra. The impact of the extent of recanalization (modified Treatment in Cerebral Infarction (mTICI)) on CTP parameters was assessed with the Wilcoxon test and Pearson’s correlation coefficients.

Results The T_max, MTT, OEF and CTH values immediately after EVT were lower in patients with complete (as compared with incomplete) recanalization, whereas CBF and COV values were higher (P<0.05) and no differences were found in other parameters. The ischemic penumbra immediately after EVT was lower in patients with complete recanalization as compared with those with incomplete recanalization (P=0.002), whereas no difference was found for the ischemic core (P=0.12). Specifically, higher mTICI scores were associated with a greater reduction of ischemic penumbra volumes (R²=−0.48 (95% CI –0.67 to –0.22), P=0.001) but not of ischemic core volumes (P=0.098).

Conclusions Our study demonstrates that the ischemic penumbra is the key target of successful EVT in patients with AIS and largely determines its efficacy on a tissue level. Furthermore, we confirm the validity of the mTICI score as a surrogate parameter of interventional success (There is no success if not 100% recovered! You are assuming your intermediate step of recanalization can be called success. NO IT CAN'T) on a tissue perfusion level.

http://dx.doi.org/10.1136/neurintsurg-2020-017163

• Request Permissions

View Full Text

Footnotes

• Twitter @GianBrugna, @vollmuthp

• Contributors Research concept and design: PV, GB, MB. Data acquisition: all authors. Imaging data post-processing: GB, MAM, MF, UN. Data analysis and interpretation: GB, PV. Statistical analysis: GB, PV. Drafting the manuscript: PV, GB. Critical revision of the manuscript for important intellectual content: all authors. Responsibility for funding and supervision: PV.

• Funding PV was supported by the Else Kroner-Fresenius Foundation (Else-Kroner Memorial Scholarship).