Evidence-Based Neurology
CATEGORY: Stroke / Vascular
Early decompressive
craniectomy reduced mortality in patients with malignant middle
cerebral artery stroke
Date appraised: January
2008
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ASA
reduces the incidence of stroke in women with
no previous history of cardiovascular events
Date appraised: May 2007
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In antiphospholipid antibody
patients, moderate intensity warfarin was not superior to aspirin
for secondary stroke prevention
Date appraised: July 2006
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Current evidence does
not support aneurysm screening in first-degree
relatives of patients with subarachnoid hemorrhage
Date appraised: May 2005
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Large size,
posterior location, and prior history of SAH from another aneurysm was associated
with an increased five-year rupture rate of unruptured intracranial
aneurysms
Date appraised: January 2005
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The potential risk or
benefit of restarting warfarin in a patient with atrial
fibrillation following an intracranial hemorrhage
could not be determined given the current evidence
Date appraised: December 2004
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Hemorrhage as initial
AVM presentation, male gender and deep venous drainage were predictors of subsequent
hemmorhage in patients with intracranial AVMs
Date appraised: October 2004
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Induced
hypothermia reduced neurological disability and death when
initiated early after VF cardiac arrest.
Date appraised: July 2004
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There was no difference
in mortality when rate control versus rhythm
control was used in the management of atrial fibrillation
Date appraised: May 2004
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In patients with
atherothrombotic non-disabling stroke there
was no reduction in mortality, MI or stroke with the use of triple vitamin
therapy; high dose folic acid, pyridoxine (B6), and cobalamin (B12).
Date appraised: April 2004
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MR angiography
and Duplex ultrasonography were highly accurate in detecting
high-grade carotid stenosis.
Date appraised: February 2004
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Coiling
reduced the rate of death or dependency at one year in patients with ruptured
intracranial aneurysms considered suitable for either surgical
clipping or endovascular coiling
Date appraised: December 2003
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Oral contraceptives
increased the risk of stroke 2.75-fold (95% CI, 2.24, 3.38).
There was no significant increased risk among patients with migraine.
Date appraised: October 2003
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There was no direct
evidence to support the hypothesis that tight glycemic control improves
stroke outcomes
Date appraised: March 2003
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Poor quality evidence
suggested that surgical decompression for life-threatening cerebral
edema following acute ischemic hemispheric stroke, reduced the risk
of death or dependency compared to medical therapy.
Date appraised: November 2002
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In middle-aged patients
with vascular disease, diabetes or hypertensive males age > 65, simvastatin
reduced the 5-year risk of death (NNT 56) and major vascular events (NNT 19),
irrespective of initial cholesterol concentrations.
Date appraised: August 2002
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Age, neurological deficit,
and consciousness, predicted survival after a stroke. Urinary
continence predicted ability to return home.
Date appraised: May 2002
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Hormone replacement
therapy with estrogen alone or combination therapy did not prevent stroke
in moderate and high risk populations.
Date appraised: April 2002
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Clopidogrel plus aspirin
therapy for acute coronary syndromes without ST-elevation modestly reduced the
risk of myocardial infarction (NNT 40) and the composite outcome of cardiovascular
death, non-fatal MI, stroke OR refractory ischemia (NNT 43)
Date appraised: February 2002
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Diagnostic testing for coagulopathies
had a low yield in patients with ischemic stroke, except for Antiphospholipid
Antibodies.
Date appraised: November 2001
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Ambulatory
ECG detected paroxysmal atrial fibrillation in 2-5% of ischemic stroke
patients with normal baseline ECG.
Date appraised: August 2001
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In cerebral
sinus thrombosis, low molecular weight heparin (nadoparin) therapy for
3 weeks followed by 3 months of oral anticoagulation demonstrated a non-significant
trend towards benefit over placebo. No clinically significant hemorrhages occurred
among those with preexisting hemorrhage.
Date appraised: July 2001
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A negative DWI MRI
within 48 hours of stroke symptoms ruled out anterior circulation stroke
Date appraised: June 2001
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In patients with
vascular risk factors, ramipril reduced the risk of stroke by 1.5%, NNT
67 (CI 43-143) over a mean duration of four years.
Date appraised: March 2001
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The combination
of dipyridamole and aspirin was more efficacious than aspirin
alone in the secondary prevention of stroke.
Date appraised: November 2000
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In secondary stroke
prevention, HMG Co-A reductase inhibitors reduced the incidence of fatal
and nonfatal strokes and total mortality.
Date appraised: September 2000
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In highly selected patients,
thrombolysis reduced the overall death and dependency rate in acute ischemic
stroke.
Date appraised: September 2000
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Echocardiography in the
investigation of ischemic stroke is not indicated in all cases, but should
be limited to patients with cardiac disease by history, CXR or EKG.
Date appraised: June 2000
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For patients
with non-valvular atrial fibrillation, warfarin was indicated
to reduce stroke if they are over 65 years of age or have any of the
following risk factors: prior stroke, HTN, DM, CHF, heart disease or MI.
Date appraised: May 2000
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The overall risk of neurological
sequella following a coronary artery bypass graft surgery (CABG) in the
immediate post operative period was 6.1%. The risk increases with increased
associated risk factors.
Date appraised: April 2000
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In people with proven SAH
on CT or LP, MRA detected an aneurysm with a sensitivity of 92% and specificity
of 98%.
Date appraised: February 2000
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Stroke patients who receive
organized inpatient care in a stroke unit are more likely to be alive,
independent, and living at home one year after the stroke.
Date appraised: August 1999
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Ticlopidine
may be cost-effective in secondary stroke prevention in high-risk patients.
Date appraised: April 1999
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In cerebral
edema following stroke, both mannitol and hypertonic saline
may reduce raised intracranial pressure acutely.
Date appraised: November 1998
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The overall risk of developing
a post-stroke seizure is 5.7% (3.5-7.9) at 1 year, and 11.5% (4.8-18.2)
at 5 years.
Date appraised: October 1998
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In highly selected patients, intravenous
t-PA given within 3 hours of ischemic stroke onset improves outcome
and mortality.
Date appraised: August 1998
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