TAG: "Stroke"

Colds may temporarily increase stroke risk in kids

Study shows colds, flu can create short-lived increased stroke risk in vulnerable children.

A new study suggests that colds and other minor infections may temporarily increase stroke risk in children. The study found that the risk of stroke was increased only within a three-day period between a child’s visit to the doctor for signs of infection and having the stroke.

The study was led by researchers at UCSF Benioff Children’s Hospital San Francisco in collaboration with the Kaiser Permanente Division of Research.

“These findings suggest that infection has a powerful but short-lived effect on stroke risk,” said senior author Heather Fullerton, M.D., a pediatric vascular neurologist and medical director of the Pediatric Brain Center at UCSF Benioff Children’s Hospital San Francisco.

“We’ve seen this increase in stroke risk from infection in adults, but until now, an association has not been studied in children.”

Strokes are extremely rare in children, affecting just 5 out of 100,000 kids per year. “The infections are acting as a trigger in children who are likely predisposed to stroke,” said Fullerton. “Infection prevention is key for kids who are at risk for stroke, and we should make sure those kids are getting vaccinated against whatever infections – such as flu – that they can.”

The study appears in today’s (Aug. 20) online issue of Neurology.

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Coalition teams to help reduce heart attacks, strokes in San Diego County

UC San Diego part of regional project awarded $5.8M Health Care Innovation grant.

Approximately 84 million people in the United States suffer from some form of cardiovascular disease, and about 720,000 Americans have a heart attack every year, which works out to one every 44 seconds. To address these alarming statistics, the Be There San Diego Initiative has been awarded a $5.8 million Health Care Innovation grant for a coalition project to help reduce heart attacks and strokes in San Diego County.

The initiative’s program, San Diego: A Heart Attack and Stroke Free Zone, is a regional collaboration of health care organizations and stakeholders to improve health care delivery and patient outcomes.

The goal during the three year project is to enroll 4,000 high-risk patients and lower their blood pressure and cholesterol levels through evidence-based practices and a better understanding of the importance of treatment adherence. The project will also promote heart attack and stroke prevention measures, test novel, cost-effective technology solutions and provide educational opportunities both for patients and within the physician community.

Partners in the Be There Initiative include UC San Diego Health System, Arch Health Partners, Scripps Health, Sharp HealthCare, Kaiser Permanente, Palomar Medical Center, Naval Medical Center, Veterans Administration, the San Diego County Medical Society Foundation, the County of San Diego Health and Human Services Agency, community clinics and others. UC San Diego Health System serves as the fiscal agent for the project.

“Health organizations that are competitive in the market will be working together for the benefit of San Diego patients,” said Anthony DeMaria, M.D., principal investigator of the Heart Attack and Stroke Free Zone program and cardiologist at UC San Diego Health System. “This approach will decrease our community’s risk for cardiovascular disease and could result in saving millions in the county by preventing half of the heart attacks and strokes that would have otherwise occurred in the participating patient population.”

Patients will be educated about the program, consented and enrolled through their physician’s office beginning later this year. Participants will also receive blood pressure cuffs to monitor levels at home and work closely with a health care coach.

“Because it’s a silent condition, we find that many patients are unaware of having hypertension, and only about 40 percent of patients diagnosed with high blood pressure take their medication, which can directly lead to cardiovascular disease. We hope through the Heart Attack and Stroke Free Zone program, we can increase this to 80 percent,” said Katherine Bailey, executive director of the Be There Initiative.

The Health Care Innovation grant supporting the project is made possible by the Centers for Medicare and Medicaid Services (CMS) through the Affordable Care Act and is part of an ongoing effort to advance innovative solutions in delivering and improving patient care across the nation.

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UC Davis honored with quality achievement for stroke care

Medical center earns Gold Plus award.

UC Davis Medical Center has received the Get With The Guidelines-Stroke Gold-Plus Quality Achievement Award for using measures developed by the American Heart Association/American Stroke Association to improve care and quality of life for stroke patients.

UC Davis earned the award for implementing diagnostic and treatment guidelines — including specific medications and risk-reduction therapies — that can reduce deaths and disabilities and speed recovery from stroke.

“This award demonstrates our commitment to using the latest evidence-based clinical approaches to improve outcomes for patients,” said Ann Madden Rice, chief executive officer of UC Davis Medical Center. “We owe this recognition to the multidisciplinary team of physicians, nurses, imaging specialists, educators and rehabilitation therapists in our stroke program and their determination to make sure our patients have access to the most current care and resources.”

The UC Davis Medical Center Stroke Program includes a designated team of stroke specialists who provide acute inpatient hospital care as well as outpatient management of cerebrovascular disease. Patients receive aggressive medical care and treatment, including thrombolytic therapy, interventional neuroradiologic techniques and new medications under clinical investigation.

“We are pleased to recognize the team at UC Davis Medical Center for their commitment and dedication to stroke care,” said Deepak L. Bhatt, national chairman of the Get With The Guidelines steering committee. “Studies show that hospitals that consistently follow Get With The Guidelines quality improvement measures can reduce patients’ length of stays and 30-day readmission rates and reduce disparity gaps in care.”

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Stroke treatment, outcomes improve at hospitals taking part in UCLA-led initiative

Study finds jump in patients receiving clot-busting drug within “golden hour.”

Gregg Fonarow, UCLA

Administering a clot-dissolving drug to stroke victims quickly — ideally within the first 60 minutes after they arrive at a hospital emergency room — is crucial to saving their lives, preserving their brain function and reducing disability.

Given intravenously, tPA (tissue plasminogen activator) is currently the only Food and Drug Administration–approved therapy shown to improve outcomes for patients suffering acute ischemic stroke, which affects some 800,000 Americans annually.

Now, a UCLA-led study demonstrates that hospitals participating in the “Target: Stroke” national quality-improvement program have markedly increased the speed with which they treat stroke patients with tPA. Researchers looked at more than 1,000 hospitals participating in the initiative, which was conceived by UCLA faculty and is conducted in collaboration with the American Heart Association/American Stroke Association.

The findings of the study are published in today’s (April 23) issue of JAMA, the Journal of the American Medical Association.

The researchers report that at participating hospitals, the average time it took to deliver tPA to patients fell from 74 minutes to 59 minutes. This speedier treatment, they said, was accompanied by improved outcomes, including reduced mortality, fewer treatment complications and a greater likelihood that patients would go home after leaving the hospital instead of being referred to a skilled nursing facility for advanced rehabilitation.

“These findings reinforce the importance and clinical benefits of faster administration of intravenous tPA. Through this national initiative, more patients were able to be treated with this beneficial therapy and in a safer, more effective fashion,” said first author Dr. Gregg C. Fonarow, UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

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Study IDs new cause of brain bleeding immediately after stroke

Research by UC Irvine, Salk Institute points to novel therapies for minimizing damage.

Dritan Agaliu, UC Irvine

By discovering a new mechanism that allows blood to enter the brain immediately after a stroke, researchers at UC Irvine and the Salk Institute have opened the door to new therapies that may limit or prevent stroke-induced brain damage.

 A complex and devastating neurological condition, stroke is the fourth-leading cause of death and primary reason for disability in the U.S. The blood-brain barrier is severely damaged in a stroke and lets blood-borne material into the brain, causing the permanent deficits in movement and cognition seen in stroke patients.

Dritan Agalliu, assistant professor of developmental & cell biology at UC Irvine, and Axel Nimmerjahn of the Salk Institute for Biological Studies developed a novel transgenic mouse strain in which they use a fluorescent tag to see the tight, barrier-forming junctions between the cells that make up blood vessels in the central nervous system. This allows them to perceive dynamic changes in the barrier during and after strokes in living animals.

While observing that barrier function is rapidly impaired after a stroke (within six hours), they unexpectedly found that this early barrier failure is not due to the breakdown of tight junctions between blood vessel cells, as had previously been suspected. In fact, junction deterioration did not occur until two days after the event.

Instead, the scientists reported dramatic increases in carrier proteins called serum albumin flowing directly into brain tissue. These proteins travel through the cells composing blood vessels – endothelial cells – via a specialized transport system that normally operates only in non-brain vessels or immature vessels within the central nervous system. The researchers’ work indicates that this transport system underlies the initial failure of the barrier, permitting entry of blood material into the brain immediately after a stroke (within six hours).

“These findings suggest new therapeutic directions aimed at regulating flow through endothelial cells in the barrier after a stroke occurs,” Agalliu said, “and any such therapies have the potential to reduce or prevent stroke-induced damage in the brain.”

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Bone marrow stem cells show promise in stroke treatment

UC Irvine analysis reveals that they trigger repair mechanisms, limit inflammation.

Steven Cramer, UC Irvine

Stem cells culled from bone marrow may prove beneficial in stroke recovery, scientists at UC Irvine’s Sue & Bill Gross Stem Cell Research Center have learned.

In an analysis of published research, neurologist Dr. Steven Cramer and biomedical engineer Weian Zhao identified 46 studies that examined the use of mesenchymal stromal cells – a type of multipotent adult stem cells mostly processed from bone marrow – in animal models of stroke. They found MSCs to be significantly better than control therapy in 44 of the studies.

Importantly, the effects of these cells on functional recovery were robust regardless of the dosage, the time the MSCs were administered relative to stroke onset or the method of administration. (The cells helped even if given a month after the event and whether introduced directly into the brain or injected via a blood vessel.)

“Stroke remains a major cause of disability, and we are encouraged that the preclinical evidence shows [MSCs’] efficacy with ischemic stroke,” said Cramer, a professor of neurology and leading stroke expert. “MSCs are of particular interest because they come from bone marrow, which is readily available, and are relatively easy to culture. In addition, they already have demonstrated value when used to treat other human diseases.”

He noted that MSCs do not differentiate into neural cells. Normally, they transform into a variety of cell types, such as bone, cartilage and fat cells. “But they do their magic as an inducible pharmacy on wheels and as good immune system modulators, not as cells that directly replace lost brain parts,” he said.

In an earlier report focused on MSC mechanisms of action, Cramer and Zhao reviewed the means by which MSCs promote brain repair after stroke. The cells are attracted to injury sites and, in response to signals released by these damaged areas, begin releasing a wide range of molecules. In this way, MSCs orchestrate numerous activities: blood vessel creation to enhance circulation, protection of cells starting to die, growth of brain cells, etc. At the same time, when MSCs are able to reach the bloodstream, they settle in parts of the body that control the immune system and foster an environment more conducive to brain repair.

“We conclude that MSCs have consistently improved multiple outcome measures, with very large effect sizes, in a high number of animal studies and, therefore, that these findings should be the foundation of further studies on the use of MSCs in the treatment of ischemic stroke in humans,” said Cramer, who is also clinical director of the Sue & Bill Gross Stem Cell Research Center.

The analysis appears in the April 8 issue of Neurology. Quynh Vu, Kate Xie and Mark Eckert of UC Irvine contributed to the project, which received support from UC Irvine’s Institute for Clinical & Translational Science through the National Center for Research Resources (grant 5M011 RR-00827-29) and the National Institutes of Health (grants K24HD074722 and R01 NS059909).

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Stroke study finding a ‘game-changer’

Quick magnesium treatment fails to improve stroke outcomes, but study has silver lining.

Jeffrey Saver, UCLA

In the first study of its kind, a consortium led by UCLA physicians found that giving stroke patients intravenous magnesium within an hour of the onset of symptoms does not improve stroke outcomes.

However, the 8-year trial did find that with the help of paramedics in the field, intravenous medications can frequently be administered to stroke victims within that so-called “golden hour,” during which they have the best chance to survive and avoid debilitating, long-term neurological damage.

The latter finding is a “game-changer,” said Dr. Jeffrey Saver, director of the UCLA Stroke Center and a professor of neurology at the David Geffen School of Medicine at UCLA. Saver served as co-principal investigator on the research, which was presented Feb. 13 at the American Stroke Association’s International Stroke Conference.

“Stroke is a true emergency condition. For every minute that goes by without restoration of blood flow, 2 million nerve cells are lost,” Saver said. “Since time lost is brain lost, we wanted to develop a method that let us get potentially brain-saving drugs to the patient in the earliest moments of onset of the stroke. If these patients don’t get protective drugs until two, three or four hours later, irreversible brain damage has already occurred.”

While the Phase 3 clinical trial found that magnesium does not improve stroke-related disability, the search is now on for new drugs and treatments that can be administered in the field to improve long-term outcomes. The infrastructure to treat patients quickly was created by this study is in place, and that is a major accomplishment, Saver said.

The trial, called Field Administration of Stroke Therapy–Magnesium, or FAST–MAG, involved collaboration among 315 ambulances, 40 emergency medical-service agencies, 60 receiving hospitals and 2,988 paramedics in Los Angeles and Orange counties. Conducted between 2005 and 2013, the study showed that 74 percent of the 1,700 study patients were treated in the first hour, with the magnesium administered within a median time of 45 minutes.

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New NIH network revolutionizes stroke clinical research

UCLA, UC San Diego, UCSF fight stroke as key centers for nationwide effort.

Brett Meyer, UC San Diego

Brett Meyer, UC San Diego

A network of 25 nationally recognized stroke centers has been created to rapidly address the three core features of stroke research and care: prevention, treatment and recovery. The regional coordinating centers (RCCs), working with nearby satellite facilities, will span the country and have teams of researchers representing every stroke-related medical specialty, with the primary goal of bringing new therapies and strategies to the stroke community more rapidly. The centers, which include UCLA, UC San Diego and UC San Francisco as grant recipients, were announced Dec. 12 by the National Institutes of Health.

“The new system is intended to streamline stroke research, by centralizing approval and review, lessening time and costs of clinical trials, and assembling a comprehensive data sharing system,” said Petra Kaufmann, M.D., associate director for clinical research at the National Institute of Neurological Disorders and Stroke (NINDS).

NINDS, which will fund and manage the NIH Stroke Trials Network, or NIH StrokeNet, has a strong history of successful stroke clinical trials over the past 40 years, leading to critical advances in treatment and prevention of the disease, including the first treatment for acute stroke in 1995, the rt-PA clot-buster.

UC San Diego Health System and its health partners were integral to the rt-PA approval and numerous other stroke developments such as using hypothermia for stroke, telemedicine for rt-PA decision-making, novel endovascular approaches for clot removal and new neuroprotective approaches. In 2012, UC San Diego Health System had one of the first five facilities in the country to be certified as a Comprehensive Stroke Center (CSC), the newest level of certification for advanced stroke care awarded by The Joint Commission.

The new StrokeNet program will enable novel and critical research to be performed at a more rapid and collaborative pace since it encourages other San Diego health care systems to collaborate as partners with UC San Diego Health System.

“NIH Stroke Net has enabled UC San Diego to partner with the ‘best of the best’ in our California clinical community to provide cutting-edge stroke clinical trial opportunities to as many community members as possible, irrespective of geographical location,” said Brett C. Meyer, M.D., vascular neurologist, co-director of the UCSD Stroke Center and medical director of UC San Diego Health System Enterprise Telemedicine.

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Rendered speechless

Aphasia/stroke victim, UC Irvine expert to launch lecture series.

AphasiaBefore it happened, Carl McIntyre was an actor – not exactly a Hollywood phenom but a successful actor nonetheless, with a couple of film roles and a steady stream of television, stage and commercial gigs to his credit. Communication was his commodity.

But on the evening of Sept. 15, 2005, while rocking his young son to sleep, McIntyre’s right arm and leg suddenly grew tingly and then went completely dead. A large blood clot had dislodged from his heart, traveled up to his brain and wedged itself inside a major artery, cutting off the blood supply and depriving most of his left cerebral hemisphere of oxygen.

Brain tissue starved of oxygen dies within minutes, and once dead, it doesn’t regenerate. This was a stroke, and it was massive.

McIntyre didn’t know it at the time, but the stroke had destroyed virtually all of his brain’s language control circuits. In his prime at age 44, with a wife and three small children, he acquired severe aphasia the loss of language ability due to brain injury.

Aphasia affects more Americans than spinal cord injury and cerebral palsy combined. It’s as prevalent as Parkinson’s disease or schizophrenia, yet relatively few people have heard of aphasia or realize its devastating impact.

The disorder is caused by brain lesions that interfere with the neurological process that translates thought into speech.

For the past 10 years, Gregory Hickok, professor of cognitive sciences at UC Irvine and director of the campus’s Center for Language Science, has been using fMRI to study the brain and the neural abnormalities that impair language ability in stroke victims.

He has received more than $6 million from the National Institutes of Health to fund his work, including a landmark aphasia study in which McIntyre is a participant.

Exhaustive therapy has helped McIntyre regain his faculty for speech, though he still has difficulty with sentences longer than a few words.

Hickok and McIntyre will kick off the School of Social Sciences’ 2013-14 Expert Speaker Series on Monday, Nov. 18, with a 6 p.m. program in Room 1517 of the Social & Behavioral Sciences Gateway building.

McIntyre will screen his award-winning short film “Aphasia,” a documentary about his experience. He and Hickok will then give a brief presentation and answer questions about aphasia research at UC Irvine. A reception will follow.

The event is sponsored by the Multisite Aphasia Research Consortium and the university’s Center for Language Science, Center for Hearing Research and School of Social Sciences.

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Microbleeds important to consider in brain-related treatments

Stroke prevention strategies should address both blood clotting, protection of vessels.

Mark Fisher, UC Irvine

Mark Fisher, UC Irvine

As growing numbers of America’s baby boomers reach retirement, neuroscientists are expanding their efforts to understand and treat one of the leading health issues affecting this population: age-related neurological deterioration, including stroke and dementia.

One factor coming under increased study is cerebral microbleeds, experienced by nearly 20 percent of people by age 60 and nearly 40 percent by age 80. Research into these small areas of brain bleeding, caused by a breakdown of miniscule blood vessels, is shedding light on how the condition may contribute to these neurological changes.

With microbleeds common in older individuals, physicians need to take it into consideration when treating other brain-related issues, said Dr. Mark Fisher, professor of neurology, anatomy & neurobiology, and pathology & laboratory medicine at UC Irvine. This is especially important with stroke prevention measures, which often involve medications that interfere with blood clotting and could exacerbate microbleeds. Stroke risk escalates with age, especially after 55, making stroke one of the leading causes of disability and death in the elderly.

In two current papers published online in Frontiers in Neurology and Stroke, Fisher writes about the brain’s intricate system to protect itself against hemorrhaging. This system seems to break down as we get older, resulting in microbleeds that develop spontaneously and become increasingly common with aging.

“The next step in stroke prevention will require that we address both blood clotting and protection of the blood vessels,” he said. “This seems to be the best way to reduce the risk of microbleeds when it’s necessary to limit blood clotting for stroke prevention.”

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UCLA, UC Irvine, USC get $2M to develop stroke center network

Center will marshal network of 49 acute stroke, rehabiliation medical centers in Southland.

Jeffrey Saver, UCLA

Jeffrey Saver, UCLA

Stroke is the second leading cause of death in Los Angeles County and the fourth in the U.S. In order to cut those numbers, it’s imperative that new treatments be developed and refined for stroke prevention, acute therapy and recovery after stroke.

Now, a three-way partnership between the UCLA Stroke Center at Ronald Reagan UCLA Medical Center, the USC Comprehensive Stroke and Cerebrovascular Center at Keck Medicine of USC, and UC Irvine has been awarded a $2 million grant from the National Institutes of Health to address these three stroke priorities.

Together, the three universities will form the Los Angeles–Southern California Regional Coordinating Center, which will marshal a network of 49 acute stroke and rehabilitation medical centers throughout Los Angeles and Orange counties. Combined, these centers will perform five to 10 stroke-related clinical trials that will examine ways to improve prevention and enhance therapies and recovery. Within this network, 12 working groups with expertise in specific neurovascular research will facilitate the implementation of these trials and serve as a resource to the Regional Coordinating Center’s leadership and the individual sites.

Ronald Reagan UCLA Medical Center and Keck Medicine of USC will jointly lead the center.

“This research network is built upon the robust foundation of two decades of cooperative clinical care and clinical trials in cerebrovascular disease in Southern California,” said Dr. Jeffrey Saver, director of the UCLA Stroke Center and a professor of neurology. “The close collaboration of all three academic medical centers in the region — UCLA, USC and UCI — represents a natural and important evolution of our extensive past collaborations.”

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Which hospitals provide the best stroke care?

Hospitals in GWTG-stroke program more likely to provide recommended treatment.

Gregg Fonarow, UCLA

Gregg Fonarow, UCLA

Timely stroke treatment is critical to ensuring good outcomes for patients. A new national study compared two programs designed to help hospitals adhere to nationally accepted standards and guideline recommendations for stroke treatment and found that hospitals participating in the Get With The Guidelines–Stroke program were more likely than Primary Stroke Center–certified hospitals to provide all the guideline-based measures of care for patients.

The study appears in the Oct. 14 issue of the Journal of the American Heart Association.

The American Heart Association/American Stroke Association’s Get With The Guidelines–Stroke (GWTG–Stroke) Performance Achievement Award (PAA) recognizes hospitals that meet specific criteria in following research-based guidelines for stroke care.

Primary Stroke Center (PSC) certification, given by the American Heart Association/American Stroke Association and the Joint Commission, the entity that accredits U.S. hospitals, provides a framework for consistent clinical processes and program structure to help hospitals meet established standards of care.

The study authors, led by UCLA’s Dr. Gregg Fonarow, compared quality stroke-care performance indicators for 400,707 acute ischemic patients at 1,356 hospitals between 2010 and 2012. These indicators included giving stroke patients the clot-busting drug tPA (tissue plasminogen activator) within three hours of stroke-symptom onset, blood thinners within 48 hours of admission, and prescriptions for high cholesterol and atrial fibrillation, if needed, at discharge.

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