Journal of the neurological sciences
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Antiplatelet therapy is an integral component of effective secondary prevention after non-cardioembolic ischemic stroke. Numerous clinical trials have tested the efficacy and safety of different antiplatelet regimens, including aspirin monotherapy, clopidogrel monotherapy, the combination of aspirin plus clopidogrel, and the combination of aspirin plus dipyridamole, in patients with a history of arterial ischemic stroke and transient ischemic attack (TIA). Although competing, head-to-head comparisons between aspirin plus dipyridamole and clopidogrel were not previously available, various professional societies have outlined evidence-based recommendations for antiplatelet therapy in patients with ischemic stroke or TIA. ⋯ The results of PRoFESS thus highlight the pitfalls of making conclusions of relative therapy efficacy in the absence of head-to-head comparisons. This article presents an overview of the factors that differ between clinical trials and "real-world" patient populations, as well as factors that differ among clinical trials themselves. The article also addresses the potential impact these differences may have on clinical trial results and subsequent clinical decision making.
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This article reviews the definition, epidemiology, and current evidence on pathophysiology, neuroanatomy, clinical features, and treatment of central post-stroke pain.
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Intracranial bleeding is an important and dangerous complication associated with thrombolytic therapy for acute ischemic stroke. Spinal hemorrhage has been reported after systemic thrombolysis for various conditions other than acute ischemic stroke. Our patient presented with an acute ischemic stroke and showed significant clinical recovery during intravenous thrombolysis. ⋯ She was treated conservatively and showed a satisfactory recovery. We report, probably the first case of spinal epidural hemorrhage after systemic thrombolysis for acute ischemic stroke. Spinal hemorrhage should be considered as a differential diagnosis for neurological worsening after intravenous thrombolysis for acute ischemic stroke, especially when the brain imaging studies do not reveal an appropriate intracranial pathology.
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To date, pre-treatment with anti-platelet agents does not constitute a contraindication for thrombolysis in acute ischemic stroke. We tested the hypothesis that combined pre-treatment with aspirin and clopidogrel is a risk factor for thrombolysis-related symptomatic intracerebral hemorrhage (sICH). ⋯ In our retrospective study, only pre-treatment with aspirin and clopidogrel was associated with thrombolysis-related intracerebral hemorrhage. This finding should be further validated in large prospective databases like the SITS-MOST registry.
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To identify the main determinants of health-related quality of life (HRQoL) in Brazilian stroke survivors. ⋯ Post-stroke depression and disability are consistent determinants of HRQoL in Brazilian stroke patients.