International Journal of Stroke: Podcast Series

Computed tomographic angiography in stroke and high-risk transient ischemic attack: Do not leave the emergency department without it!: Brett R Graham

Stroke is a major cause of morbidity and mortality worldwide, and effective treatment requires rapid diagnosis and recognition of relevant vascular lesions.

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Brett Graham from the Calgary Stroke Program in Saskatchewan lead author of the review Computed tomographic angiography in stroke and high risk TIA: Don’t leave the ED without it!  

In this review the authors discuss the usefulness and versatility of computed tomography angiography in the setting of stroke, highlighting the use of computed tomography angiography in decision making in transient ischemic attacks, acute disabling ischemic stroke, and hemorrhagic stroke.

http://journals.sagepub.com/doi/full/10.1177/1747493018764172

Music for this podcast: Kool Kats by Kevin Mcloud

Bruce Campbell EXTEND- IA TNK

Johanna Wardlaw

Carmen Lahiff-Jenkins, managing editor of the IJS chatted to Fienburg award recipient, Johanna Wardlaw

DEFUSE 3

Interview on the ground with Michael Mlynash

Cerebral amyloid angiopathy associated with inflammation - Hugh Markus

This podcast interview is based on the article Cerebral amyloid angiopathy associated with inflammation (CAA-I): a systematic review of clinical and imaging features and outcome, by Andrej Corovic, Siobhan Kelly and Hugh Markus.

Cerebral amyloid angiopathy associated with inflammation (CAA-I) is an increasingly recognised condition, characterised by an inflammatory response to the vascular deposits of β-amyloid within the brain that are the hallmark of cerebral amyloid angiopathy (CAA). 

I’m Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to Dr Hugh Markus who along with authors Siobhan Kelly and first author Andrej Corovic sought to summarise the clinical features, imaging appearances and available data on outcome and treatment responses, using information derived from a systematic review of pathologically-proven cases of CAA-I. 

You’ve been listening to a podcast interview with Dr. Hugh S Markus from the University of Cambridge and Carmen Lahiif-Jenkins Managing Editor of the International Journal of Stroke. The international Journal of Stroke is the flagship publication of the World Stroke Organization, please consider becoming a member. Did you know that many stroke societies around the world have an opt-in option for the World Stroke Organization membership, find out if your society has this option. 

 http://journals.sagepub.com/doi/full/10.1177/1747493017741569

Guidelines for Treatment of Susac Syndrome (SuS)

Susac syndrome (SuS) affects the brain, retina, and inner ear. And whose treatment is particularly challenging. Adding to the challenge is the absence of objective biomarkers of disease activity and the great variability in presentation, timing and extent of peak severity, duration of peak severity, and natural disease course. 

I’m Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to Dr Robert Rennebohm from The Susac Syndrome Consultation Service at the Cleveland Clinic, based in Cleveland, Ohio in the USA; and he gave us an expert insight into this little-known syndrome.

http://journals.sagepub.com/doi/full/10.1177/1747493017751737

The music is ‘Black and Blue’ from the album ‘Breath before the plunge’

Shared decision making after severe stroke- how can we improve patient and family involvement in treatment decisions?

Shared decision making after severe stroke- how can we improve patient and family involvement in treatment decisions?

Akila Visvanathan from The University of Edinburgh, Centre for Clinical Brain Sciences

You have probably heard someone say, at least once in your lifetime that they would rather die than attempt to live after a severe stroke, which could leave them permanently disabled. But when survivors of severe stroke and serious disability are asked that question after the event they inevitably say they are happy to have survived! Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. So we know that clinicians need to support patients and families in making informed decisions about the use of these treatments, and this is a process termed ‘shared decision-making.

I’m Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke, and I spoke to first author Akila Visvanathan, of the paper ‘Shared decision making after severe stroke- how can we improve patient and family involvement in treatment decisions’ published in the International Journal of Stroke. 

 

The PRE-hospital Stroke Treatment Organization (PRESTO)

The PRE-hospital Stroke Treatment Organization (PRESTO) was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. PRESTO’s mission is to improve stroke outcomes by supporting research and advocacy for pre- hospital stroke treatment in Mobile Stroke Units. The plan is that PRESTO will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRESTO will also facilitate the appropriate proliferation and distribution of MSUs by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support.  PRESTO is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRESTO has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a MSU in operation. PRESTO convenes satellite meetings for membership at the ISC and ESOC each year to address the PRESTO mission. 

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and the World Stroke Academy spoke to Prof. James Grotta.

The International Journal of Stroke and the World Stroke Academy are the flagship publication, and the education platform of the World Stroke Organization - please consider becoming a member. 

Refining the Ischaemic Penumbra with Topography

Thanh Phan; Monash University, Department of Medicine 

It has been forty years since the ischaemic penumbra was first conceptualised through work on animal models. The topography of penumbra has been portrayed as an infarcted core surrounded by penumbral tissue and an extreme rim of oligaemic tissue. In the paper‘Refining the Ischaemic Penumbra with Topography’ first Author Thanh Phan et al reviewed the understanding of the topography of the ischaemic penumbra from the initial experimental animal models to current developments with neuroimaging which have helped to further define the temporal and spatial evolution of the penumbra and refine our knowledge. 

I’m Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to Dr Phan.

The International Journal of Stroke is the flagship publication of the World Stroke Organization 

Llink to article

Tobacco control with Lubna Bhatti for the World Health Organisation

Carmen Lahiff-Jenkins, Managing Editor for the Internaitonal Journal of Stroke spoke to Lubna Bhatti, Technical officer and Epidemiologist for the the World Health Organization on the latest Tabacco report from the WHO and it's impact and reach for stroke management globally! 

October 28th is #WorldStrokeDay and we are spreading the word on prevention. Join us and sign up to the thunder clap here http://thndr.me/5we9TL”

Show the world we are fighting!

 

Viral and parasitic pathogen burden and the association with stroke in a population-based cohort, Brad Pearce

Higher cumulative burden of viral and bacterial pathogens may increase the risk of stroke, but the contribution of parasitic infections in relation to cumulative pathogen burden and risk of stroke has rarely been examined. 

Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke  spoke to Dr Brad Pearce, Emory University, author of the article 'Viral and parasitic pathogen burden and the association with stroke in a population-based cohort'. Their group aimed to estimate the association of multiple persistent viral and parasitic infections with stroke in a representative sample of adults in the United States. 

Kool Kats by Kevin MacLeod 

The incidence of pregnancy-related stroke: A systematic review and meta-analysis

Richard H. Swartz 

Department of Medicine (Neurology) and the Hurvitz Brain Sciences Research Program, Sunnybrook HSC, and the University of Toronto

Stroke affects 30/100,000 pregnancies, with ischemia, CVST and hemorrhage causing roughly equal numbers and with highest risk peripartum and postpartum. Organized approaches to the management of this high-risk population, informed by existing evidence from stroke and obstetrical care are needed, given the profound impact of stroke on women of childbearing age, their families, and health systems. And given the increasing organization of both stroke and obstetrical care internationally, it is vital to have accurate estimates of stroke incidence in and around pregnancy to facilitate both clinical decision-making and health system planning.

I’m Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke and I spoke to Richard H. Swartz lead author of the article The incidence of pregnancy-related stroke: A systematic review and meta-analysis published in the International Journal of Stroke.

The International Journal of Stroke is the Flagship publication of the World Stroke Organisation; please consider becoming a member. 

This podcast uses Kool Kats by Kevin MacLeod 

 

 

Fibrinolytic for Treatment of Intraventricular Haemorrhage

Fibrinolytic for Treatment of Intraventricular Hemorrhage: A Meta-Analysis and Systematic Review

Alexandra Baker and Krissia Rivera Perla 

Johns Hopkins Hospital, Baltimore, Maryland

Intraventricular haemorrhage is a significant cause of mortality and morbidity worldwide. Treating it with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention. But what is the role of this treatment in hypertensive intraventricular haemorrhage patients and what are the effect sizes for survival as well as level of function at differing time points?

I’m Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to Alexandra Baker and Krissia Rivera Perla from John Hopkins Hospital, Baltimore, Maryland, they are the joint first editors for the article Fibrinolytic for Treatment of Intraventricular Haemorrhage: A Meta-Analysis and Systematic Review.

 

Long-term Predictors of Stroke in Healthy Middle-aged Men - Erik Prestgaard

As you can imagine a longitudinal study of 2014 Norwegian men who were recruited from 1972-1975, and then followed up until 1997, is an amazing source of data. Researchers from the Institute of Clinical Medicine, and the Department of Informatics at the University of Oslo, and from the Department of Cardiology, Oslo University Hospital, Ullevål, Norway investigated the long term predictive impact on stroke risk of baseline variables including haemodynamic variables measured at rest and during exercise in these same middle-aged, healthy men. 

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke and I spoke to Dr Erik Prestgaard, lead author of the paper‘Long-term Predictors of Stroke in Healthy Middle-aged Men, recently published in the International Journal of Stroke.

Where to now? AVERT answered an important question, but raised many more

The AVERT trial was a Phase 3 randomised trial with over 2100 subjects designed to end the controversy about the early mobilisation of stroke patients. It sounds intuitive doesn’t it, if a patient has a stroke get them up and moving as soon as possible get the blood flowing and consequently the patient healing faster.

But this wasn’t the case, and the stroke community, especially the rehab and recovery arm were collectively shocked by the results which indicated that early mobilization may actually cause harm.  

Undoubtedly this ultimately successful trial answered an important clinical question, opening the door for more large scale rehab and recovery trials.

Now the priority questions are: (1) What is the optimal dose in minutes of VEM in duration and frequency? (2) How intense should the exertion be? (3) How should we design trials that compare different specified doses for different subgroups? 

I’m Carmen Lahiff-Jenkins Managing Editor of the International Journal of Stroke and I spoke to Mark Bayley author of Where to now? AVERT answered an important question, but raised many more recently published in the International Journal of Stroke.

Stroke while driving: frequency and association with automobile accidents

Driving while having a stroke is potentially life threatening, imagine driving down a dark road at night, or a busy peak hour city street and suffering a stroke? A group of researchers in Japan, have looked at stroke while driving and they may be on the way to pinpointing the risk factors, that may potentially be modified to make driving safer to those at risk of stroke. 

Carmen Lahiff-Jenkins, Managing Editor of the International Journal of Stroke spoke to Dr Joji Inamasu from Saiseikai Utsunomiya Byoin, Department of Neurosurgery in Tochigi, Japan. This article is published online, via the International Journal of Stroke. Please follow this link to read this article

In this study a majority of patients with stroke while driving were women, with a medium age of 63, age however, did not differ from gender, and the most common co-morbidity was hypertension across both stroke types.

The international Journal of Stroke is the flagship publication of the World Stroke Organisation, please consider becoming a member. Click here to open our webpage

 

The music used in this podcast ‘Kool Kats’ composed by Kevin MacLeod is licence free. 

Stroke Recovery and Rehabilitation Roundtable - development, monitoring and reporting - Marion Walker

Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable (SRRR) 

An international partnership of stroke rehabilitation experts committed to developing consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016 15    recommendations were made under the auspice of the Stroke Recovery and Rehabilitation Roundtable taskforce! 

Recent reviews demonstrate that the quality of stroke rehabilitation research has continued to improve over the last four decades, however, despite this progress there are still so many barriers to moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. 

To validate the need for the 15 recommendations the #SRRR group reviewed all stroke rehabilitation trials published in 2015 (n=182 papers) and found that highlighted was that the majority of publications didn’t clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention calls into question many interventions that have been evaluated for efficacy. 

More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless the majority of reporting recommendations were still not adequately described. 

To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence based clinical care we urge the research community to endorse and adopt our recommendations. 

I’m Carmen Lahiff-Jenkins and I spoke to Professor Marion Walker who took me through the recommendations and the thinking behind their development.  

Please clink this link to go to the landing page for the series

 

Stroke Recovery and Rehabilitation Roundtable - definitions - Karen Borschmann and Kate Hayward

Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. 

Common language and definitions were required to develop an agreed framework spanning the four working groups for the The Stroke Recovery and Rehabilitation Roundtable taskforce: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. 

The Stroke Recovery and Rehabilitation Roundtable (SRRR) was convened with the aim to move rehabilitation research forward. Working collectively across four initial priority areas the #SRRR team reviewed, discussed, and attempted to achieve consensus on key recommendations in each of the areas of translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. 

I’m Carmen Lahiff-Jenkins, Managing Editor of the International journal of Stroke and I spoke to Karen Borschmann and Kate Hayward researchers involved in the SRRR project. 

Click or tap here to go straight into the series free online

The music for this podcast was 'Kool Kats' by Kevin MacLeod 

 

 

Stroke Recovery and Rehabilitation Roundtable - Translational/Preclinical with Dr Dale Corbett

Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. We know that moving preclinical treatments into the clinical realm has been fraught with notorious difficulties, one very well known area has been, of course the incredible disappointments with neuroprotection. In comparison stroke recovery involves distinct biological principles and a very different time window, it is in fact unlike acute stroke at all!

 

We spoke to Dr Dale Corbett Proferssor in Cellular and mollecular medicine in the faculty of Medicine at the Univeristy of Ottawa, who was the lead author on the Stroke Rrecovery and Rehabilitation Roundtable paper on Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline.

 

The music used in this podcast is 'Kool Kats' by Kevin MacLeod

Stroke Recovery and Rehabilitation Roundtable - Biomarkers with Dr Lara Boyd

A biological marker or biomarker is a naturally occurring molecule, gene, or characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention

Dr Lara Boyd, Physical therapist from the University of British Columbia, Canada. 

@laboyd47; @UBC_BrainLab

The music for this podcast was 'Kool Kats' by Kevin MacLeod