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Question What are the clinical features, triggers, and risk factors of poststroke recrudescence?
Findings This crossover cohort and case-control study of 153 patients admitted for poststroke recrudescence found that it occurs approximately 4 years after the index stroke and is characterized by mild worsening of poststroke deficits that usually resolve within 1 day. Infection, hypotension, hyponatremia, insomnia or stress, and benzodiazepine use are important precipitants; recrudescence is more common in women, African American individuals, and patients with vascular risk factors, severe deficits, or infarcts affecting deep white matter tracts within the middle cerebral artery territory.
Meaning Results from this study should enable prompt diagnosis and help distinguish poststroke recrudescence from mimics.
Importance Reemergence of previous stroke-related deficits (or poststroke recrudescence [PSR]) is an underrecognized and inadequately characterized phenomenon.
Objective To investigate the clinical features, triggers, and risk factors for PSR.
Design, Setting, and Participants This retrospective study incorporated a crossover cohort study to identify triggers and a case-control study to identify risk factors. The study used the Massachusetts General Hospital Research Patient Data Repository to identify patients for the period January 1, 2000, to November 30, 2015, who had a primary or secondary diagnosis of cerebrovascular disease, who underwent magnetic resonance imaging of the brain at least once, and whose inpatient or outpatient clinician note or discharge summary stated the term recrudescence. In all, 153 patients met the preliminary diagnostic criteria for PSR: transient worsening of residual poststroke focal neurologic deficits or transient recurrence of prior stroke-related focal deficits, admission magnetic resonance imaging showing a chronic stroke but no acute infarct or hemorrhage, no evidence of transient ischemic attack or seizure, no acute lesion on diffusion-weighted imaging, and no clinical or electroencephalographic evidence of seizure around the time of the event.
Main Outcomes and Measures Clinical and imaging features of PSR; triggers (identified by comparing PSR admissions with adjacent admissions without PSR); and risk factors (identified by comparing PSR cases with control cases from the Massachusetts General Hospital Stroke Registry).
Results Of the 153 patients, 145 had prior infarct, 8 had hypertensive brain hemorrhage, and 164 admissions for PSR were identified. The patients’ mean (SD) age was 67 (16) years, and 92 (60%) were women. Recrudescence occurred a mean (SD) of 3.9 (0.6) years after the stroke, lasted 18.4 (20.4) hours, and was resolved on day 1 for 91 of the 131 episodes with documented resolution time (69%). Deficits were typically abrupt and mild and affected motor-sensory or language function. No patient had isolated gaze paresis, hemianopia, or neglect. During PSR, the National Institutes of Health Stroke Scale (NIHSS) score worsened by a mean (SD) 2.5 (1.9) points, and deficits were limited to a single NIHSS item in 62 episodes (38%). The underlying chronic strokes were variably sized, predominantly affected white matter tracts, and involved the middle cerebral artery territory for 112 patients (73%). Infection, hypotension, hyponatremia, insomnia or stress, and benzodiazepine use were higher during PSR admissions. Compared with the control group (patients who did not experience recrudescence), the PSR group (patients who were hospitalized for recrudescence) had more women, African American individuals, and those who self-identified as being from “other” race. The PSR group also had more diabetes, dyslipidemia, smoking, infarcts from small-vessel disease, and “other definite” causes and worse onset NIHSS scores. Six patients (4%) received intravenous tissue plasminogen activator without complications.
Conclusions and Relevance The PSR features identified in the study should enable prompt diagnosis and distinguish recrudescence from mimics, such as transient ischemic attacks, migraine, Todd paralysis, and Uhthoff phenomenon. Prospective studies are required to validate the proposed diagnostic criteria and to decipher underlying mechanisms.
Get registered today! Click Here to view the detailed scientific program. Please view below featured AINA Members who are presenting at the Meeting! *These presenters are according to our current records. Please let us know if you are presenting and are an AINA member, and we will send an updated list.
Nominations are now being accepted for the awarding of the 2018 AINA Lifetime Achievement Award. Learn more and submit a nomination today! The deadline for nominations is October 27, 2017.
TO ALL RESIDENTS AND FELLOWS OF INDIAN ORIGIN:
The Association of Indian Neurologist in America (AINA) is establishing a Resident & Fellow (R&F) section. The R&F section has several goals, including to serve as a networking platform, explore opportunities for mentoring, and advance the potential of international exchange with colleagues from centers in India. Please review the AINA website at www.4aina.com
AINA invites all resident and fellows of Indian origin at neurology training programs in the US to join the R&F section.
AINA is also looking for four trainees to serve on the R&F executive committee. This is a good opportunity to interact with AINA leaders and show your leadership skills.
If you are interested in applying for the R&F executive committee, please send a 1-2 paragraph statement of interest along with your CV to Jamie Michael, AINA Association Director, at Jamie@badgerbay.co.
Applications for the R&F executive committee will be accepted until Aug 15, 2017.
Indian Academy of Neurology Turns "25" in 2017. On behalf of the Organizing Committee of IANCON2017, it gives us great pleasure to announce that the 25th Annual Conference of the Indian Academy of Neurology, will be held in Chennai, at ITC Grand Chola from the 7th to the 10th September 2017. We consider it a proud privilege that we have been given the opportunity to host this landmark event at the Medical Capital of India. Plans are Already underway to ensure that this conference will be a scientific feast and we welcome you to Chennai, the biggest cultural, economic and educational center in southern India. Vanakkam Dr. U Meenakshisundaram
Dr C U Velmurugendran
Dr U Meenakshisundaram
Dr. Deepak Arjundas
Dear AINA members and friends:
It is an honor to take on the leadership of this organization. I would like to thank the outgoing President, Dr. Ramesh Madhavan, for leading our organization over the past two years. I would also like to thank all the outgoing executive committee members.
Going forward, we need to find new avenues to engage our younger neurologists of Indian origin. There are many residents and fellows and young neurologists who can and should contribute to AINA. We also look forward to the first AINA-Indian Academy of Neurology joint meeting. Thanks to Dr. Sanjay Singh for taking the lead on this initiative. We also need to continue to build on previous successful subspecialty meetings, such as the AINA forums held at the American Epilepsy Society under the leadership of Dr. Singh and Prakash Kotagal.
Our professional community of Indian neurologists has great achievements to share with each other and we need to support each other. The Tarang newsletter, developed by Aarti Sarwal, is one area where we can highlight our community achievements. We also need to continue our strong partnership with the American Academy of Neurology and American Brain Foundation.
Finally, thanks to the staff of Badger Bay for providing AINA with professional association management for the past two years. We look forward to a continued, successful relationship.
Please reach out to me if you have any ideas to help AINA grow and prosper.
-Seemant Chaturvedi, MD, FAAN
Professor of Clinical Neurology
University of Miami Miller School of Medicine
The 34th Annual Dinner meeting was also the event host to the awarding of the 2017 Lifetime Achievement Award to Kapil D Sethi, MD, FRCP, FAAN. Dr. Sethi shared warm comments with the audience reflecting on his career and his hopes for the future growth and strengthening of AINA. He shared the proud history of bringing together Neurologists of Indian origin and encouraged residents and fellow to see the value in coming together to support each other through AINA and throughout their practice and careers.
Trainees were certainly in attendance at the Annual Dinner Meeting and AINA leadership were especially happy to honor and recognize those that were winners of the AINA Neurology Trainee Award. Trainees currently enrolled in a training program in North America were invited to submit their abstract submitted for presentation at the American Academy of Neurology annual meeting for consideration of this award. This year had a record number of submissions! The following were selected and recognized:
1st Place - Vamshi Krishna Sai Balasetti, Omaha, NE - Post hospitalization follow-up clinic visits in neurological diseases
2nd Place - Deepak Gupta, Jersey City, NJ - Glucose-regulated protein 78 (GRP78) in plasma and CSF is associated with Parkinson's disease
3rd Place (Tie) - Vasu Saini, Miami, FL - Safety Outcome of Carotid Artery Stenting in Long Carotid Lesion with Proximal versus Distal Embolic Protection Devices
3rd Place (Tie) - Apratim Chatterjee, Kolkata - Barriers to Thrombolysis in a tertiary care institute in Eastern India
While at the Annual Meeting, attendees also had the opportunity to learn more and hear directly from leaders of the Indian Academy of Neurology (IAN) regarding plans for the 25th Annual National Conference of IAN a join meeting of IAN and AINA. This event is scheduled for September 7-10, 2017 in Chennai, the Medical Capital of India. All are invited to learn more about this event by visiting www.iancon.net , www.ian.net.in , www.iancon2017.org.
The evening concluded with business of the organization presented by the AINA board. Through this presentation AINA leaders shared the current state of the organization finances, new officers and plans for some new work in 2018 and beyond. Thanks to all that were able to attend and please watch your email and the AINA website for details on the 2018 Annual Meeting that will take place in conjunction with the AAN Conference scheduled for April 21-27, 2018 in Los Angeles, CA. More details coming soon!
The AINA Board is proud to welcome the new AINA Board members in their respective roles.
Sanjay Singh, President Elect
Aarti Sarwal, Treasurer
Prakash Kotagal, Secretary
The four newly elected members are:
Vishal Jani, Nebraska Chirag Shukla, New JerseyPrachi Mehndiratta, Virginia Arun Anthony, Pennsylvania
Find out more about the AINA Board by clicking here.
The portal for abstract submission the 25th Annual Conference of Indian Academy of Neurology jointly with the Association of Indian Neurologists in America, to be held on September 07-10, 2017 at Chennai is live at www.iancon.net/abstract.
Those of you who are already registered at the Abstract Submission portal during IANCON 2016 or INTROPICON will have to use the same user name and password. If you do not remember the password, the same are retrievable via you e mail inbox. Those who are submitting an abstract for the first time on this portal will have to register afresh with a username and password.
Please read the instructions on the website before filling up the online abstract form. You will have to first select an abstract theme from the list provided.
The body of the abstract should be in English language with an upper limit of 300 words. It might be copied and pasted from a word file or typed in directly.
Please note that once the body of the abstract is finalized, there is no need to hit any submit button. You may simply log out after completing the abstract. The deadline for abstract submission is Monday, May 31st, 2017.
After logging out, you will receive an acknowledgement e mail from noreply044@eregnow.com In case you do not receive the acknowledgement, please first check your spam folder or else feel free to contact iansecretary@gmail.com
Best Wishes,
Dr. U. Meenakshisundaram, Organizing Secretary, IANCON 2017
Dr. A V Srinivasan, President, IAN
Dr. Gagandeep Singh, Secretary, IAN
The Tarang complements our website and monthly update emails in order to provide information about our organization, medical and professional topics, and upcoming professional meetings of interest to our readers.
The 2017 Tarang Newsletter is now available! Please click here to view. If you have any interesting events, awards, recognitions, activities to report about neurologist of Indian origin, please email a brief summary along with photographs to aina@badgerbay.co.
