A5067201014- Acute Ischemic Stroke Management
- Cerebrovascular and Carotid Artery Diseases
- Stroke Rehabilitation and Recovery
- Venous Thromboembolism Diagnosis and Management
- Traumatic Brain Injury and Neurovascular Disturbances
- Atrial Fibrillation Management and Outcomes
- Cardiovascular and Diving-Related Complications
- Neurological Disorders and Treatments
- Peripheral Artery Disease Management
- Intracerebral and Subarachnoid Hemorrhage Research
- Healthcare Systems and Public Health
- Protease and Inhibitor Mechanisms
- Neurosurgical Procedures and Complications
- Cardiovascular Health and Disease Prevention
- Antiplatelet Therapy and Cardiovascular Diseases
- Intracranial Aneurysms: Treatment and Complications
- Alcohol Consumption and Health Effects
- Transcranial Magnetic Stimulation Studies
- Cardiac Arrest and Resuscitation
- Botulinum Toxin and Related Neurological Disorders
- Cardiac Arrhythmias and Treatments
- Cerebral Venous Sinus Thrombosis
- Neurological Disease Mechanisms and Treatments
- Traumatic Brain Injury Research
- Optical Imaging and Spectroscopy Techniques
University of South Florida
2015-2025
Arcadia
2024
Tampa General Hospital
2019-2023
Florida College
2016-2023
Neurology, Inc
2023
University of Puerto Rico System
2016-2018
University of Miami
2016-2018
Florida International University
2018
University at Buffalo, State University of New York
2017
National Institute of Neurological Disorders and Stroke
2016
TIMI angiographic classification measures coronary residual flow and recanalization. We developed a Thrombolysis in Brain Ischemia (TIBI) by using transcranial Doppler (TCD) to noninvasively monitor intracranial vessel signals. examined whether the emergent TCD TIBI correlated with stroke severity outcome patients treated intravenously administered tPA (IV-tPA).TCD examination occurred acutely on day 2. flows were determined at distal MCA basilar artery depths, depending occlusion site....
Background and Purpose —Clot dissolution with tissue plasminogen activator (tPA) can lead to early clinical recovery after stroke. Transcranial Doppler (TCD) low MHz frequency determine arterial occlusion monitor recanalization may potentiate thrombolysis. Methods —Stroke patients receiving intravenous tPA were monitored during infusion portable TCD (Multigon 500M; DWL MultiDop-T) headframe (Marc series; Spencer Technologies). Residual flow signals obtained from the clot location identified...
Background —Arterial recanalization precedes clinical improvement or may lead to hemorrhage reperfusion injury. Speed of clot lysis was not previously measured in human stroke. Methods and Results —Transcranial Doppler (TCD) the National Institutes Health Stroke Scale (NIHSS) were used monitor consecutive patients receiving intravenous tissue plasminogen activator (tPA), before tPA bolus at 24 hours. Patients with complete partial middle cerebral basilar artery on TCD studied. Recanalization...
Background and Purpose — Only a small minority of acute stroke patients receive approved therapy. We performed community professional behavioral intervention project to increase the proportion treated with Methods This study used quasi-experimental design. Intervention comparison communities were compared at baseline during educational intervention. The based in 5 nonurban East Texas counties. multilevel worked hospitals physicians while changing identification skills, outcome expectations,...
Background —The duration of cerebral blood flow impairment correlates with irreversibility brain damage in animal models ischemia. Our aim was to correlate clinical recovery from stroke the timing arterial recanalization after therapy intravenous tissue plasminogen activator (tPA). Methods —Patients symptoms ischemia were treated 0.9 mg/kg tPA IV within 3 hours onset (standard protocol) or 0.6 at 6 (an experimental institutional review board–approved protocol). National Institutes Health...
Intravenous tissue-type plasminogen activator (tPA) therapy using the National Institute of Neurological Disorders and Stroke criteria has been given with variable safety to less than 5% patients who have ischemic strokes nationwide. Our center is experienced in treating large numbers stroke intravenous tPA.To report our total 4-year experience treatment consecutive had an stroke.Prospective inception cohort registry all seen by team additional retrospective medical record review treated...
Background and Purpose —Transcranial Doppler (TCD) can demonstrate arterial occlusion subsequent recanalization in acute ischemic stroke patients treated with intravenous tissue plasminogen activator (tPA). Limited data exist to assess the accuracy of by TCD criteria. Methods —In middle cerebral artery (MCA) tPA, we compared posttreatment angiography (digital subtraction or magnetic resonance). On TCD, complete was defined absent minimal signals, partial blunted dampened normal stenotic...
Cryptogenic stroke is associated with an increased prevalence of patent foramen ovale. The Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) study hypothesized that patients cryptogenic have pelvic deep venous thrombosis (DVT).At 5 sites, 18 to 60 years age received MRI venogram (MRV) the pelvis within 72 hours new symptom onset. Clinical data were then determined. Radiologists blinded clinical later read scans.The 95 who met entry criteria scanned. Their mean+/-SD was 46+/-10...
Damage to the adult, primary visual cortex (V1) causes severe impairment that was previously thought be permanent, yet several pathways survive V1 damage, mediating residual, often unconscious functions known as "blindsight." Because some of these normally mediate complex motion perception, we asked whether specific training in blind field could improve not just simple but also discriminations humans with long-standing damage. Global direction discrimination administered five adults...
<h3>Objectives:</h3> To report and associate acute cerebral infarctions in 2 young, previously healthy siblings with use of the street drug known as “spice” (a synthetic marijuana product, also “K2”), which they independently smoked before experiencing embolic-appearing ischemic strokes. <h3>Methods:</h3> We present history, physical examination, laboratory data, cerebrovascular imaging, echocardiogram, ECG, hospital course these patients. <h3>Results:</h3> found that both spice was obtained...
Background and Purpose: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice developing countries like China needs to be confirmed. aim the study was determine whether EVT acute ischemic stroke randomized trials could generalized Chinese population. Methods: We conducted a prospective registry at 111 centers China. Patients with caused by imaging-confirmed intracranial receiving were included. primary outcome functional independence 90 days defined as...
ABSTRACT Background and Purpose . It has been suggested that intravenous tissue plasminogen activator (TPA) would not lyse the large thrombus associated with internal carotid artery (ICA) occlusion and, therefore, be ineffective in this setting. Vascular imaging, safety, outcome of TPA therapy for ICA is well described. Our goal was to determine site occlusion, early recanalization after infusion, its relationship outcome. Methods We reviewed our database all stroke patients treated IV...
Background No proven neuroprotective treatment exists for ischemic brain injury after cardiac arrest. Mild-to-moderate induced hypothermia (MIH) is effective in animal models. Methods and Results A safety feasibility trial was designed to evaluate mild-to-moderate by use of external cooling blankets Inclusion criteria were return spontaneous circulation within 60 minutes advanced life support, initiated 90 minutes, persistent coma, lack acute myocardial infarction or unstable dysrhythmia....
ABSTRACT Background. Tissue plasminogen activator (TPA) activity may be enhanced with ultrasound, potentially 2 MHz transcranial Doppler (TCD). The authors present Phase I data of the CLOTBUST (Combined Lysis Thrombus in Brain ischemia using Ultrasound and Systemic TPA). Subjects Methods. Nonrandomized stroke patients proximal arterial occlusion on a prebolus TCD receiving intravenous 0.9 mg/kg TPA within 3 hours after onset were monitored portable diagnostic equipment standard headframe....
Background and Purpose — Acute-stroke patients receiving standard intravenous tissue plasminogen activator (tPA) have been noted to experience early dramatic recoveries. The prevalence, clinical characteristics, outcome of experiencing recovery is not well described. Methods We prospectively studied all presenting with acute middle cerebral artery (MCA) stroke syndromes transcranial Doppler (TCD) evidence an MCA obstruction. All received tPA per the National Institute Neurological...
Background and Purpose— Sex-specific disparities in stroke care including thrombolytic therapy early hospital admission are reported. In a large registry of Florida Puerto Rico hospitals participating the Get With The Guidelines—Stroke program, we sought to determine sex-specific differences ischemic performance metrics overall treatment. Methods— Around 51 317 (49% women) patients were included from 73 sites 2010 2014. Multivariable logistic regression with generalized estimating equations...
Background and Purpose —Some stroke patients will deteriorate following improvement (DFI), but the cause of such fluctuation is often unclear. While resolution neurological deficits usually related to spontaneous recanalization or restoration collateral flow, vascular imaging in with DFI has not been well characterized. Methods —We prospectively studied who presented a focal deficit that resolved spontaneously within 6 hours symptom onset. Patients were evaluated bedside transcranial Doppler...
Favorable imaging profile according to the Alberta Stroke Program Early CT Score (ASPECTS) on non-contrast head is a key criterion for selection of patients with ischemic stroke from large vessel occlusion (LVO) IA revascularization therapies.To analyze factors associated changes in ASPECTS during inter-hospital transfer and determine how deterioration affects eligibility endovascular procedures.We analyzed their potential impact therapies anterior circulation strokes. Clinical demographic...
The association between the street drug spice (K-2 or herbal incense), a synthetic marijuana, and intracranial hemorrhage (ICH) has not yet been described, but it with acute ischemic stroke (AIS),1 seizure, myocardial infarction.2 Two young patients (31 25 years old) independently presented to our hospital subarachnoid (SAH) after inhalation. first also had 2 large intraparenchymal hemorrhages (IPH); other AIS. Both were previously healthy without hypertension, coagulopathy, bleeding...
Racial-ethnic disparities in acute stroke care can contribute to inequality outcomes. We examined race-ethnic performance metrics a voluntary registry among Florida and Puerto Rico Get With the Guidelines-Stroke hospitals.Seventy-five sites Stroke Registry (66 9 Rico) recorded 58 864 ischemic cases (2010-2014). Logistic regression models racial-ethnic differences measures defect-free (intravenous tissue plasminogen activator treatment, in-hospital antithrombotic therapy, deep vein thrombosis...
Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought identify race-ethnicity sex disparities direct oral anticoagulants (DOACs), aspirin, warfarin in IS patients AF temporal trends utilization these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 cases enrolled Florida-Puerto Collaboration Reduce Registry from 2010 2016. Multivariable...
Preliminary assessments of the feasibility, safety, and effects on neuronal reorganization measured with transcranial magnetic stimulation (TMS) from Constraint-Induced Movement Therapy (CIMT) upper extremity were made in eight cases subacute stroke. Within fourteen days their stroke, patients randomly assigned to two weeks CIMT or traditional therapy. Baseline motor performance cortical/subcortical representation for movement TMS assessed before treatment. Post-treatment at end treatment...
In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose to a higher intracranial hemorrhage risk. This study evaluated safety efficacy combined MT plus eptifibatide for acute ischemic stroke. was propensity-matched analysis data from 2 prospective trials in Chinese populations: ANGEL-ACT trial (Endovascular Treatment Key Technique Emergency Workflow Improvement...
Post-Traumatic Stress Disorder (PTSD) is associated with exposure to traumatic events, especially in the military setting. However, patients who experience stroke may develop anxiety about their event and re-experience transient neurological symptoms as a result. A significant portion persistent disabling of PTSD. At University South Florida, we conducted single-center, IRB-approved, observational pilot study 20 adult were diagnosed or ischemic attack (TIA) previous 31 days 1 year. Patients...