stroke guidelines

stroke guidelines

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GUIDELINES for Stroke Management

The ESO Guidelines 2008 represent an update of the ESO 2008 and 2003 EUSI Guidelines. Again, they cover the whole spectrum of ischaemic stroke, from teaching and awareness, to stroke unit and stroke management strategies, primary and secondary prevention, acute treatment and rehabilitation.

The WordPress.com stats helper monkeys prepared a 2013 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 910 times in 2013. If it were a cable car, it would take about 15 trips to carry that many people.

Click here to see the complete report.

Background

The SOCRATES study compares ticagrelor versus aspirin for the prevention of major vascular events in patients with acute ischemic stroke or transient ischemic attack [1,2].

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SOCRATES (Acute Stroke Or Transient IsChaemic Attack TReated with Aspirin or Ticagrelor and Patient OutcomES) is a global clinical trial involving 9,600 patients who have experienced an acute ischemic stroke or transient ischemic attack (TIA). Annually, 15 million people worldwide suffer a stroke of this type. Ischemic strokes occur as a result of an obstruction of a vessel supplying blood to the brain. A TIA is secondary to a temporary insufficient blood supply to parts of the brain and is often considered a warning sign that a stroke may follow.

SOCRATES is a randomized, parallel group study evaluating the efficacy of ticagrelor compared to aspirin in reducing major vascular events (composite of all-cause mortality, myocardial infarction [MI], and stroke) in patients with acute ischemic stroke (NIHSS ≤ 5) and TIA.

Also announced today is the initiation of THEMIS (Effect of Ticagrelor on Health Outcomes in DiabEtes Mellitus Patients Intervention Study), a global clinical trial involving 17,000 patients with Type 2 diabetes at high risk of cardiovascular (CV) events. Of the 340 million people who suffer from the disease, 90 percent have type 2 diabetes and 50 percent of whom die from CV disease.

“A major goal of treating patients with diabetes is to reduce their cardiovascular risk,” said THEMIS study co-chair Deepak L. Bhatt, MD, MPH, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women’s Hospital.

“THEMIS will allow us to test a bold new strategy in the care of patients with diabetes who are at high risk of myocardial infarction, stroke, and cardiovascular death,” stated THEMIS study co-chair Ph. Gabriel Steg, MD, Professor of Medicine at Université Paris-Diderot and Director of the Coronary Care Unit at Hôpital Bichat.

THEMIS is an event-driven, randomized, parallel group study evaluating the efficacy of long-term treatment with ticagrelor versus placebo for the prevention of major CV events – the composite of CV death, MI or stroke – in patients with Type 2 diabetes without a history of previous MI or stroke but with documented coronary atherosclerosis.

SOCRATES and THEMIS will be monitored by Independent Data Monitoring Committees who will review the safety and efficacy of treatments in these trials. The trials will be conducted in accordance with Good Clinical Practice. Both studies will be posted on clinicaltrials.gov in the near future.

AstraZeneca is currently collaborating with over 4,000 clinical investigators in more than 30 countries as part of the PARTHENON program, and has established partnerships with a number of pre-eminent research institutions. Other studies in the PARTHENON program include PEGASUS, studying BRILINTA for secondary prevention in patients with previous myocardial infarction, and EUCLID studying patients with Peripheral Artery Disease.

PARTHENON will provide an unparalleled dataset to build scientific understanding of BRILINTA in a broad a range of atherothrombotic conditions. AstraZeneca has approved more than 100 investigator sponsored studies, which will be starting during the coming year.

BRILINTA is currently not approved for the treatment of patients with ischemic stroke, TIA, peripheral artery disease, or for secondary prevention in patients with a history of previous myocardial infarction.

BRILINTA Indications

BRILINTA is indicated to reduce the rate of thrombotic cardiovascular (CV) events in patients with ACS (unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). In PLATO, BRILINTA has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI), or stroke compared to clopidogrel. In PLATO, the difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis.

BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin above 100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin above 100 mg daily.

References

1.Giacalone G, Abbas MA, Corea F. Prevention strategies for cardioembolic stroke: present and future perspectives. Open Neurol J. 2010; 4:56-63. doi: 10.2174/1874205X01004020056.

2.Silvestrelli G, Corea F, Micheli S, Lanari A. Clinical pharmacology and vascular risk.Open Neurol J. 2010;4:64-72. doi: 10.2174/1874205X01004020064.

Neurology meeting in Perugia under the patronage of the Società Italiana di Neurologia. Hosted by the Neurolgy Department University of Perugia, Paolo Calabresi, Aroldo Rossi, Lucilla Parnetti, Nicola Tambasco.
First ever as far as i know. I can remember in 1996 a joint tosco-umbro meeting at palazzo Murena.

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After a decade of preparation….

At the EFNS/ENS Joint Congress of European Neurology in Istanbul, June 2014, one strong unified European neurological society, the

EUROPEAN ACADEMY OF NEUROLOGY

will be founded.

ean_logo_4c_final

THE ASSEMBLY OF DELEGATES will be the democratic heart of the EAN: 45 national delegates representing the 45 member nations of the EAN and an equal number of delegates representing the currently 900 individual members.

THE EAN BOARD – 7 elected and two appointed officers: President, Vice President, Secretary General, Treasurer, Chairpersons of the Scientific and Liaison Committees and one Member at Large; Congress Programme and Education Committees chairpersons.

THE EAN HEAD OFFICE will be in Vienna, Austria with two branch offices in Brussels, Belgium and Basel, Switzerland.

THE EUROPEAN JOURNAL OF NEUROLOGY will be the official publication of the EAN.

THE FIRST EAN CONGRESS will be held in Berlin, Germany in June 2015.

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Course Chairs and Programme Committee.

Valeria Caso, Maurizio Paciaroni, Giancarlo Agnelli,

 

 

Local Advisory Board.

Giancarlo Agnelli, Monica Acciarresi, Andrea Alberti, Valeria Caso, Cataldo D’Amore, Maurizio Paciaroni, Michele Venti

 

 

ESO Executive Committee

President: Michael Brainin, President Elect: Kennedy Lees

Past President: Didier Leys,

Vice Presidents: Angel Chamorro, Heinrich Mattle

Secretary General: Patrik Michel, Treasurer, Turgut Tatlisumak

Members at Large: Natan Bornstein, Valeria Caso

Delegate CVD: Michael  Hennerici, Delegate ESC: Bo Norrving

 

Members co-opted from ESC Programme Committee:

Martin Brown; José Ferro; Jean-Louis Mas

 

 

 

 

Locations

Sala della Vaccara di Palazzo dei Priori

Aule 5/6, Facoltà di Medicina e Chirurgia – Edificio B – Piano -2


 

Sunday, September 8th 2013

 

18:00

 

18:30

 

 

 

Welcome Reception

 

Key lecture

Sala della Vaccara

New Challenges in NeuroCritical Care

W. Hacke (Heidelberg, Germany) Founding ESO President

 


 

Monday, September 9th 2013

 

8:00

 

 

 

 

8:30

 

9:00

 

9:30

 

 

10:00

 

10:30

 

 

11.15

 

12:00

 

 

 

12:45

 

 

 

 

15:00

 

15:30

 

16:00

 

 

16:30

 

17:00

 

 

17:30

 

 

 

Transfer to the University of Perugia Medical School

 

Morning Session

 

Ischemic stroke syndromes

How to recognise stroke mimics and stroke chamaleons

M. Paciaroni (Perugia, Italy)

Anatomy and clinical features of posterior circulation strokes

T. Moulin (Besancon, France)

Anatomy and clinical features of anterior circulation strokes

A. Carolei (L’Aquila, Italy)

 

Break

 

Bedside differential diagnosis of disturbed consciouness: focus on stroke patients

L. Csiba (Debrecen, Hungary)

TIA: New definitions and treatment options

C. Weimar (Essen, Germany)

Causes and pathophysiology of haemorrhagic stroke

C. Cordonnier (Lille, France)

 

 

Working Lunch

 

Afternoon Session

 

Stroke etiologies

Cardioembolic stroke: not only secondary to atrial fibrillation

C. Becattini (Perugia, Italy)

Large artery stroke: the open questions

L.J. Kappelle (Utrecht, the Netherlands)

Small vessel stroke: a benign etiology?

L. Pantoni (Florence, Italy)

 

Break

 

Rare causes of stroke: focus on migraine e reversible cerebral vasoconstriction syndrome

V. Di Piero (Roma)

Cryptogenetic stroke: more frequent in younger stroke patients?

A. Pezzini (Brescia, Italy)

 

 


 

Tuesday, September 10th 2013

 

08:00

 

 

 

 

08:30

 

09:15

 

 

10:00

 

10:30

 

11:15

 

11:45

 

 

 

12:30

 

 

 

13:30

 

14:00

 

15:15

 

 

16:00

 

 

16:15

 

 

16:45

 

 

                                       

Transfer to the University of Perugia Medical School

 

Morning Session

 

Diagnosis of stroke

KEY LECTURE: PET imaging in aphasia

W.D. Heiss (Cologne, Germany)

Ultrasound in acute stroke and long-term follow-up

R.W. Baumgartner (Zurich, Switzerland) 

 

Break

 

Diagnosis and treatment of subarachnoid haemorrhage

M. Venti (Perugia, Italy)

Diagnosis and treatment of cerebral haemorrhage

 T. Steiner (Frankfurt, Germany)

KEY LECTURE: New oral anticoagulants in stroke prevention

G. Agnelli (Perugia, Italy)

 

 

Working Lunch

 

Afternoon Session

 

The impact of post-stroke dementia on recovery after stroke

D. Inzitari (Florence, Italy)

Intravenous thrombolysis: state of the art

D. Toni (Rome, Italy)

Emergency assessment of acute stroke

T. Tatlisumak, (Helsinki, Finland)

 

Break

 

Interventional Neuroradiology

Neuroradiological interventional therapy for intracranial aneurysms: insight into the European guidelines

G.J.E. Rinkel (Utrecht, the Netherlands)

Critical appraisal of interventional therapy in acute stroke

P. Schellinger (Minden, Germany)

 


 

Wednesday, September 11th 2013

 

08:00

 

 

 

 

08:30

 

 

09:00

 

09:30

 

 

10:00

 

 

10:30

 

11:00

 

11:30

 

 

12:00

 

 

 

 

12:30

 

 

Transfer to the University of Perugia Medical School

 

Morning Session

 

Critical care of stroke

Malignant MCA infarction: medical therapy or hemicraniectomy for all patients?

E. Juettler (Berlin, germany)

Basilar artery occlusion

H. Mattle (Bern, Switzerland)

Neuroprotection in acute stroke: is hypothermia the only way to protect the brain?

K. Lees (Glasgow, UK)

Haemorrhagic transformation in acute ischemic stroke

V. Caso (Perugia, Italy)

 

Break

 

Stroke and seizures

A. Alberti (Perugia, Italy)

The role of imaging in patient selection

P. Michel (Lausanne, Switzerland)

 

Special Lecture

Perspectives in stroke care: unused windows, unmet needs

M. Brainin (Krems, Austria) ESO-President

chaired by L. Provinciali (Ancona, Italy)

 

Working Lunch

 

 

 

 

 

14:00-17:00 ESO Executive Meeting

 

 



 

 

 

 

 

14:00

 

Afternoon Session

 

Workshops

Group A

Case reports

M. Acciarresi/C. D’Amore (Perugia, Italy)

My challenging case reports

Course participants

 

 

Group B

Principles of Neuroradiology

M. Paciaroni (Perugia, Italy)

 

Group C

Case simulation: management issues of acute stroke patients

P. Santalucia (Milan, Italy)/M. Del Pinto (Perugia, Italy)

 

 

 

 

Thursday, September 12th 2013

 

08:30

 

 

 

09:00

 

 

09:30

 

 

10:00

 

 

10:30

 

 

 

 

11:00

 

 

11:30

 

 

12:00

 

 

 

12:30

 

Afternoon

 

 

14:00

 

 

 

 

 

Transfer to the University of Perugia Medical School

 

Morning Session

 

Are ACAS and ACST still valid?

N. Bornstein (Tel Aviv, Israel)

 

Symptomatic carotid stenosis: State of the art

M. Brown (London, UK)

 

Other stroke etiologies: is PFO part of stroke prevention?

J. L. Mas (Paris, France)

 

New insights into cervical artery dissection

D. Leys (Lille, France)

 

 

Break

 

Stroke Prevention

Overview of stroke risk factors

G. Tsivgoulis (Alexandropolis, Greece)

 

Acute and long-term prevention of cardioembolic stroke

J. Ferro (Lisbon Portugal)

 

 

Working lunch

 

 

 

 

Workshops

Group A

Case simulation: management issues of acute stroke patients

P. Santalucia (Milan, Italy)/M. Del Pinto (Perugia, Italy)

 

Group B

Case reports

M. Acciarresi/C. D’Amore (Perugia, Italy)

My challenging case reports

Course participants

 

Group C

Principles of Neuroradiology

M. Paciaroni (Perugia, Italy)

 

 

 

 

 

 

 

 

 

Friday, September 13th 2013

 

08:00

 

 

 

 

08:30

 

09:00

 

 

 

09:45

 

 

11:00

 

 

11:30

 

12:00

 

 

12:30

 

 

13:00

 

 

 

14:00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transfer to the University of Perugia Medical School

 

Morning Session

 

Rare and “not well known” stroke syndromes

Stroke in women

V. Caso (Perugia, Italy)

Cerebral Venous thrombosis

J. Stam (Amsterdam, the Netherlands)

 

Special Lecture

Eye Movement Disorders in Stroke

D. Kömpf (Lübeck, Germany)

 

Coffee Break

 

Stroke rehabilitation and late complications

Post-stroke neuropsychiatric disorders

F.R. Pezzella (Rome, Italy)

Motor rehabilitation after acute stroke: Advantages and disadvantages  of rehabilitation techniques

K. Sunnerhagen (Stockholm, Sweden)

Neglect after stroke: new therapeutic approaches in neurorehabilitation

T. Brandt (Heidelberg, Germany)

 

Working Lunch

 

Afternoon Session

 

Workshops

Group A

Principles of Neuroradiology

M. Paciaroni (Perugia, Italy)

 

Group B

Case simulation: Management issues of acute stroke patients

P. Santalucia (Milan, Italy)/M. Del Pinto (Perugia, Italy)

 

Group C

Case reports

M. Acciarresi/C. D’Amore (Perugia, Italy)

My challenging case reports

Course participants

 

 

 

Saturday, September 14th 2013

 

8:30

 

 

 

 

9:00

 

9:45

 

10:30

 

 

10:45

 

11:30

 

 

12:15

 

 

12:45

 

 

 

Transfer to the University of Perugia Medical School

 

Morning Session

 

Basics of statistics and use of Stroke Scores

Proper Application of univariate and multivariate models

P. Reboldi (Perugia, Italy)

Optimal designs of RCTs and Meta-analyses

P. Sandercock (Edinburgh, UK)

KEY LECTURE: How to design a correct animal model

P. Calabresi / M. Di Filippo (Perugia, Italy)

 

Break

 

Stem cells in stroke treatment: the promise and the challenges

K. Muir (Glasgow, UK)

 

Quiz and Prices

 

 

Short introduction of 18th ESO Stroke Summer School

K. Muir (Glasgow, UK)

 

Lunch and farewell

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At the Congress of the European Neurological Society held in Barcelona, researchers are discussing the advantages and disadvantages of OPs or catheter interventions to eliminate thrombi and arteriosclerotic plaque in acute cases. New insights into molecular processes could be the key to medications for combatting dangerous oedemas following a stroke.

Starting on 29 May 2013 with many Oral Sessions fresh updates on Stroke Large clinical trials (RCTs)
at 11:25-12:30 Room: Auditorium INTERACT2, STICH II, CHIMES, IST-3, SPS3, next day PC-Trial, RESPECT, ALIAS, PHANTOM-S, ICSS, EVA-3S, STICH II.
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The annual national Italian stroke survey was published on a large diffusion journal (FOCUS) inclusion criteria >50 stroke patients admitted per year in 2011. Markers of performance mortality a 1-month, re-admission in the month following the discharge for a stroke. Data as usual available from the national  health care authorities.

Mortality rates in 2011 was 11.6 and re admission 10.62 (the best Italian centres had 2.73 and 7.31).

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Boehringer in end 2012 announced the approval in 15 European countries with the mutual recognition procedure, the extent of window treatment with alteplase, rt-PA in cases of acute ischemic stroke within 4 hours of symptom onset and after have ruled out the diagnosis of intracranial hemorrhage. The completion of the regulatory process has been reported by Germany, the Reference Member State, and will allow the implementation of this approval also to the European Union member states that adhere to the mutual recognition procedure. Alteplase is indicated for the fibrinolytic treatment of acute ischemic stroke, or for the dissolution of the clot that has blocked artery, helping to restore the normal blood flow, preventing or limiting damage to ischemic brain tissue. To achieve the greatest possible benefits, treatment should be initiated as early as possible after symptom onset. Alteplase was approved in 1987 for various indications in many countries, and since 1996 for the treatment of ischemic stroke with administration within three hours of the onset of symptoms. The combined analysis of the results of different studies, with placebo control group, showed that treatment with rt-PA within 180 minutes after the onset of ischemic symptoms allows more likely to residuare 30% in less than disability arising from ischemic damage compared to untreated patients or little or no disability after three months of the event compared to patients who did not receive thrombolytic therapy. An official statement by the Italian regulatory agency is likely to be soon released in early 2013. For many Italian hospitals until the official statement of the agency the use of alteplase will not be considered fully appropriate

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