A5010343477- Acute Ischemic Stroke Management
- Hemoglobinopathies and Related Disorders
- Cerebrovascular and Carotid Artery Diseases
- Bone and Joint Diseases
- MRI in cancer diagnosis
- Advanced MRI Techniques and Applications
- Stroke Rehabilitation and Recovery
- Traumatic Brain Injury and Neurovascular Disturbances
- Iron Metabolism and Disorders
- Advanced Neuroimaging Techniques and Applications
- Fetal and Pediatric Neurological Disorders
- Neurological Complications and Syndromes
- Intracerebral and Subarachnoid Hemorrhage Research
- Neurological Disease Mechanisms and Treatments
- Blood groups and transfusion
- Folate and B Vitamins Research
- Neurological and metabolic disorders
- Venous Thromboembolism Diagnosis and Management
- Clinical practice guidelines implementation
- Ocular Diseases and Behçet’s Syndrome
- Pharmacological Effects and Toxicity Studies
- Brain Tumor Detection and Classification
- Intracranial Aneurysms: Treatment and Complications
- S100 Proteins and Annexins
- Peripheral Artery Disease Management
Washington University in St. Louis
2016-2025
Mallinckrodt (United States)
2015-2025
University of Missouri–St. Louis
2025
Vanderbilt University Medical Center
2024
Arcadia
2024
Hope Center for Neurological Disorders
2008-2022
Johns Hopkins University
2010-2020
Johns Hopkins Medicine
2010-2020
Icahn School of Medicine at Mount Sinai
2020
American Heart Association
2020
Importance Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It unknown whether anticoagulation, which has proven benefit fibrillation, prevents patients and no Objective To compare anticoagulation vs antiplatelet therapy for secondary prevention cryptogenic evidence cardiopathy. Design, Setting, Participants Multicenter, double-blind, phase 3 randomized clinical trial 1015 participants cardiopathy, defined as P-wave terminal force...
Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology develop a streamlined intravenous tPA protocol.In early 2011, multidisciplinary team analyzed the steps required treat patients with using value stream analysis (VSA). directly compared tPA-treated in "pre-VSA" epoch "post-VSA" regard baseline characteristics, protocol metrics, and...
Objective Most acute ischemic stroke (AIS) patients with unwitnessed symptom onset are ineligible for intravenous thrombolysis due to timing alone. Lesion evolution on fluid‐attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) correlates duration, and quantitative mismatch of diffusion‐weighted MRI FLAIR (qDFM) might indicate duration within guideline‐recommended thrombolysis. We tested whether ≤4.5 hours from the time discovery is safe in qDFM an open‐label, phase 2a,...
<h3>Objective</h3> To determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of utilization (CMRO<sub>2</sub>) children with SCD. <h3>Methods</h3> Participants underwent brain MRIs measure voxel-based CBF, OEF, CMRO<sub>2</sub>. An infarct heat map was created from an independent pediatric SCD cohort silent infarcts compared prospectively obtained...
Previously we demonstrated that 90% of infarcts in children with sickle cell anemia occur the border zone regions cerebral blood flow (CBF). We tested hypothesis adults disease (SCD) have silent (SCIs) regions, a secondary older age and traditional stroke risk factors would be associated infarct occurrence outside zones.
<b><i>Background and Purpose:</i></b> Previous studies have found mortality among ischemic stroke patients to be higher on weekends. We sought evaluate whether weekend admission was associated with worse outcomes in a large comprehensive center (CSC) cohort. <b><i>Methods:</i></b> Consecutive presenting within 6 h of symptom onset were identified using the 8 CSC SPOTRIAS (Specialized Programs Translational Research Acute Stroke) database....
Penumbral biomarkers promise to individualize treatment windows in acute ischemic stroke. We used a novel magnetic resonance imaging approach that measures oxygen metabolic index (OMI), parameter closely related positron emission tomography-derived cerebral rate of utilization (CMRO2), derive pair thresholds: (1) an irreversible-injury threshold differentiates core from penumbra and (2) reversible-injury tissue not-at-risk for infarction.Forty patients with stroke underwent at 3 time points...
Abstract Central poststroke pain (CPSP) is a neuropathic disorder, the underlying mechanisms of which are not well understood. It has been suggested that stroke-associated loss inhibitory neurons in spinothalamic tract causes disinhibition thalamic neurons, autonomously generate ectopic nociceptive action potentials responsible for experience. We hypothesized CPSP result misinterpretation afferent sensory input by sensitized within brain, rather than generated spontaneously damaged central...
Although cerebral edema is a major cause of death and deterioration following hemispheric stroke, there remains no validated biomarker that captures the full spectrum this critical complication. We recently demonstrated reduction in intracranial cerebrospinal fluid (CSF) volume (∆ CSF) on serial computed tomography (CT) scans provides an accurate measure severity, which may aid early triaging stroke patients for craniectomy. However, application such volumetric approach would be too...
Background and Purpose— Atherosclerotic vertebrobasilar disease is an important cause of posterior circulation stroke. To examine the role hemodynamic compromise, a prospective multicenter study, Vertebrobasilar Flow Evaluation Risk Transient Ischemic Attack Stroke (VERiTAS), was conducted. Here, we report clinical features vessel flow measurements from study cohort. Methods— Patients with recent transient ischemic attack or stroke ≥50% atherosclerotic stenosis occlusion in vertebral basilar...
Individuals with sickle cell disease (SCD) experience cognitive deficits; however, it remains unclear whether medical treatments for SCD improve cognition. Given that executive abilities are typically impaired in individuals SCD, they were the focus of current study. Our primary hypothesis was would be higher acutely soon after a blood transfusion children and young adults SCD. We used tests from NIH Toolbox to assess 27 participants receiving chronic comparison 34 hydroxyurea (HU) 41...
Background and Purpose: Large-scale observational studies of acute ischemic stroke (AIS) promise to reveal mechanisms underlying cerebral ischemia. However, meaningful quantitative phenotypes attainable in large patient populations are needed. We characterize a dynamic metric AIS instability, defined by change National Institutes Health Stroke Scale score (NIHSS) from baseline 24 hours (NIHSS – NIHSS 24hours = ΔNIHSS 6-24h ), examine its relevance long-term outcomes. Methods: Patients with...
Chronic hypoxia-ischemia is a putative mechanism underlying the development of white matter hyperintensities (WMH) and microstructural disruption in cerebral small vessel disease. WMH fall primarily within deep (WM) watershed regions. We hypothesized that elevated oxygen extraction fraction (OEF), signature hypoxia-ischemia, would be detected where density highest. further OEF regions immediately surrounding WMH, at leading edge growth.In this cross-sectional study conducted from 2016 to...
During the first hours after stroke onset, neurological deficits can be highly unstable: some patients rapidly improve, while others deteriorate. This early instability has a major impact on long-term outcome. Here, we aimed to determine genetic architecture of measured by difference between National Institutes Health Stroke Scale (NIHSS) within 6 h onset and NIHSS at 24 h. A total 5876 individuals from seven countries (Spain, Finland, Poland, USA, Costa Rica, Mexico Korea) were studied...
Abnormal oxygen extraction fraction (OEF), a putative biomarker of cerebral metabolic stress, may indicate compromised delivery and ischemic vulnerability in patients with sickle cell disease (SCD). Elevated OEF was observed at the tissue level across brain using an asymmetric spin echo (ASE) MR method, while variable global OEFs were found from superior sagittal sinus (SSS) T2-relaxation-under-spin-tagging (TRUST) MRI method different calibration models. In this study, we aimed to compare...
Cellular elements of the neurovascular unit are essential for physiological functioning brain vessels. If any these vascular disturbed consequences can be dire. Cerebral amyloid angiopathy (CAA), a disorder caused by accumulation in cerebral vessels, provides case study progressive dysfunction leading to failure reactivity, smooth muscle cell loss, and eventual frank breakdown vessel integrity resulting recurrent sometimes fatal intracerebral hemorrhage.
Abstract Patients with sickle cell anemia (SCA) experience cerebral metabolic stress an increase in oxygen extraction fraction (OEF) to compensate for reduced carrying capacity due anemia. It remains unclear if alone drives this stress. Using MRI, we collected voxel‐wise OEF measurements test our hypothesis that would be elevated anemic controls without SCA (AC) compared healthy (HC), but even higher AC. Brain MRIs ( N = 159) were obtained 120 participants (34 HC, 27 AC, 59 SCA). While...