Podcasts about vascular neurology

It's time to rewire for wellness—your brain holds the blueprint for healing, and Dr. Steven Resnick is here to show you how! In this powerful episode of The Manifested Podcast, Kathleen Cameron sits down with neurologist Dr. Steven Resnick to explore how subconscious beliefs and identity shape our physical health. Discover how neurology and manifestation intersect—and how rewiring your mind could be the key to lasting wellness. Don't miss Dr. Resnick's holistic take on healing that goes far beyond traditional medicine.   In this episode: Your brain loves habits — even the unhealthy ones. Change takes awareness. Shifting your mindset can lead to real health breakthroughs. Positive self-talk and mindfulness help rewire old patterns. Beliefs and words can impact healing — even in medicine. Dr. Resnick shares how being present boosts well-being.   About The Guest: Dr. Steven Resnick is the Medical Director of the Mount Sinai Comprehensive Stroke Center. Board-certified in Neurology and Vascular Neurology, Dr. Resnick is an attending Neurologist with direct supervision of internal medicine and medical students at Mount Sinai Hospital. Dr. Resnick has co-authored a textbook entitled Practical Neuroimaging in Stroke and has published articles in the Journal of the Peripheral Nervous System, the Journal of Neurology, and the Journal of Neurology, Neurosurgery, and Psychiatry. He has lectured extensively on stroke prevention, acute ischemic stroke, practical Neuroimaging in cerebrovascular disease, and other related topics. Clinical research includes studies of drug therapies to treat Neuromuscular diseases.   Connect with Dr. Resnick Website: https://drstevenresnick.com/ Instagram: https://www.instagram.com/dr.stevenresnick Facebook: https://www.facebook.com/DrStevenResnick/ Podcast: https://drstevenresnick.com/the-healthy-mind-podcast/   Shop Iylia Premium Non-Alcoholics: https://iylia.com/   Subscribe To The Manifested Podcast With Kathleen Cameron: Apple Podcast | YouTube | Spotify Connect With The Kathleen Cameron: Facebook | Instagram | LinkedIn | Youtube | TikTok | Kathleencameronofficial.com   Unlock Your Dreams with House of ManifestationA community where you take control of your destiny, manifest your desires, and create a life filled with abundance and purpose? Look no further than the House of Manifestation, where your transformation begins: https://houseofmanifestation.com/ About Kathleen Cameron: Kathleen Cameron, Chief Wealth Creator, 8-figure entrepreneur, and record-breaking author. In just 2 years, she built a 10 Million dollar business and continues to share her knowledge and expertise with all of whom she connects with.  With her determination, unwavering faith, and powers of manifestation, she has helped over 100,000 people attract more love, money, and success into their lives. Her innovative approaches to Manifestation and utilizing the Laws of Attraction have led to the creation of one of the top global success networks, Diamond Academy Coaching, thousands of students have been able to experience quantum growth. The force behind her magnetic field has catapulted many students into a life beyond their wildest dreams and she is just getting started. Kathleen helps others step into their true potential and become the best version of themselves with their goals met. Kathleen graduated with two undergraduate degrees from the University of Windsor and the University of Toronto with a master's degree in nursing leadership. Her book, “Becoming The One", published by Hasmark Publishing, launched in August 2021 became an International Best Seller in five countries on the first day.    This Podcast Is Produced, Engineered & Edited By: Simplified Impact

Chime In, Send Us a Text Message!Episode 81: Managing PFO after Stroke: A discussion on diagnosis, treatment options including the patient perspectives and quality of life decisions with David Thaler,MD of Tufts Medical Center.This conversation in collaboration with the SAYA Consortium explores the relationship between patent foramen ovale (PFO) and stroke, particularly in young adults. Our expert guest, Dr. David Thaler, a vascular neurologist with Tufts Medical Center, discusses the definition of PFO, its diagnosis, and its implications for stroke risk. The discussion highlights the importance of understanding cryptogenic strokes, which often have no identifiable cause, the PFO paradox and how a PFO is often discovered with cryptogenic strokes, the diagnostic tests and the management options available for patients with PFO. The conversation emphasizes the need for patient education and awareness regarding stroke risks and prevention strategies. In this conversation, Dr. Thaler discusses the implications of PFO closure in recurrent stroke prevention, medical management and the importance of patient choice and quality of life, plus the outcomes of the RESPECT Trial. Co-host David Dansereau shares his patient experience as a stroke survivor with PFO who elected for device closure.  The dialogue highlights the evolving landscape of PFO research and the significance of understanding individual patient risks and lifestyle choices.More About Our Guest: David Thaler,MD-Tufts Medical CenterShow mentions:  Lester Leung,MD,  Katelyn Skeels, SAYA Consortium, RESPECT Trial , Co-Host David's Book ClosureThanks to: Rory Polera (guest on Ep.69), stroke survivor and interview outline reviewer with SAYA ConsortiumAdditional Education: Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack

In this episode, Jonathan Sackier welcomes Andrew Southerland, a distinguished neurologist and academic leader in the field of vascular neurology. They explore how machine learning is revolutionising prehospital stroke diagnosis, and how innovative strategies like telemedicine can reduce disparities in stroke care.   Timestamps: (00:00) – Introduction (03:00) – Neurologic lessons from the wild turkey (05:10) – Linking COVID-19 and stroke (10:28) – How can AI revolutionise prehospital stroke diagnosis? (18:39) – Stroke management in underserved populations (23:38) – Google Glass in medical education (29:06) – What is the i-corps programme? (33:24) – Wearable devices as diagnostic tools (37:08) – Andrew's three wishes for healthcare

José M. Morales, MD, MSc, is a vascular neurologist and neurointerventional surgeon, who specializes in minimally invasive endovascular procedures to treat conditions and diseases of the brain and spine.Dr. Morales completed his Master's degree in Integrative Neuroscience at Imperial College London. He graduated from the University of Chicago Pritzker School of Medicine, where he served as the President of the American Academy of Neurology (AAN) Student Interest Group in Neurology and participated in an extended curriculum program under the Scholarship and Discovery track to conduct research in Computational Neuroscience, which was funded by the AAN Medical Student Research Scholarship.Dr. Morales completed his Neurology Residency at Northwestern University, and Vascular Neurology and Interventional Neuroradiology Fellowships at the University of California Los Angeles.As a clinician-scientist and innovator, Dr. Morales has several medical device patents and has been awarded multiple grants for his innovative concepts, and is co-founder of the medical device company, Vonova, Inc.. He has published in prestigious journals, such as Neuron, Nature, and Stroke. Dr. Morales is dedicated to serving patients afflicted by neurologic disease and conditions with skill, expertise, and compassion.

Welcome back to the Neurophilia Podcast! In today's episode, we are joined by the podcast legend himself, Dr. Jim Siegler to discuss vascular neurology.  The field of vascular neurology has had incredible advancements within the past few decades through thrombolytics/mechanical thrombectomy and has seen increased public awareness and accessibility to stroke care. As a result of this, vascular neurology training is consistently among the top fellowships pursued by graduating residents.  Listen to this episode to hear more about the subspecialty of vascular neurology!Dr. Jim Siegler: After obtaining his bachelor's degrees in Neuroscience and History of Science, Medicine, and Technology at Johns Hopkins University, Dr. Jim Siegler completed his medical education at Tulane University School of Medicine in New Orleans. He then completed his adult neurology residency and vascular neurology fellowship at UPenn. He currently serves as the Inpatient Medical Director and Director of the Comprehensive Stroke Center at the University of Chicago. Dr. Siegler's research interests include atherosclerotic disease, perfusion imaging, and eligibility of neurointervention for acute intracranial occlusion for which he has published more than 200 peer-reviewed publications. Dr. Siegler is also a passionate medical educator; he is well-known for previously producing an independent podcast titled BrainWaves  a well as the official podcasts for the Neurocritical Care Society, American Academy of Neurology, American Neurological Association podcast ANA Investigates, but more recently he serves on the e-learning subcommittee of the AAN and helps produce their NeuroBytes, and he serves on the digital strategy team for journal Stroke: Vascular and Interventional Neurology where you might have heard his voice on their podcast, ACCESS. Follow Dr.  Jim Siegler on Twitter @JimSieglerFollow Dr.  Nupur Goel on Twitter @mdgoelsFollow Dr.  Blake Buletko on Twitter @blakebuletkoFollow the Neurophilia Podcast on Twitter and Instagram @NeurophiliaPodSupport the show

Links: Go to episode page (with episode resources) Subscribe to PREMIUM Get the Sigma email newsletter See Sigma's recommended resources About This Episode: Alzheimer's disease has a profound impact on individuals, families, and societies worldwide. As a progressive neurodegenerative disease, it not only robs individuals of their cognitive abilities but also places an immense emotional and economic burden on caregivers. Mechanistically, the causes of Alzheimer's are incredibly complex and not fully understood. And in terms of treatment, the landscape appears challenging. Drug discovery efforts for dementias, including Alzheimer's, have faced setbacks, leaving a void in effective treatments. Consequently, attention has shifted toward preventive strategies, including dietary patterns. From a prevention standpoint, both genetics and lifestyle should be considered. Which throws up many interesting questions… To what extent do genetic factors contribute to Alzheimer's risk compared to lifestyle choices, and how does this interaction influence disease development? What role does lifestyle play in Alzheimer's risk, and is there evidence supporting the influence of specific nutrients on cognitive health? How do diet patterns impact Alzheimer's risk? Are there discernible risk differences associated with specific dietary choices, and how do these interact with genetic factors, such as the ApoE genotype? In this episode, Drs. Ayesha Sherzai and Dean Sherzai are on the podcast to answer these questions and discuss this topic in more depth. About The Guests: Dr. Ayesha Sherzai is a neurologist and co-director of the Alzheimer's Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist. Dr. Dean Sherzai is co-director of the Alzheimer's Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine, and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University.

A new study found a daily multivitamin could help protect older people from memory loss. Newsline with Brigitte Quinn spoke with Dr. Rohan Arora, Director of Neurology and Vascular Neurology at Northwell Health.

How can we minimize the invasiveness of implantable brain-computer interfaces? What are the secrets behind using interventional neuroradiology approaches to create technology for brain interfacing? And what does it truly mean to innovate in the realm of healthcare? Welcome, dear listeners, to another exciting episode of the "Neurocareers: Doing the Impossible!" entrepreneurial podcast series! Today, we embark on a journey into the cutting-edge world of neurotechnology and innovation. Our focus? The incredible advancements in minimally invasive brain interfaces led by a pioneer in the field, Dr. Jose Morales. Dr. Morales, a co-founder of Vonova and an accomplished Neurointerventional Surgeon, combines his deep passion for neuroscience with a remarkable flair for innovation. With a background steeped in translational neuroscience and experience in molecular-scale research, Dr. Morales is pushing the boundaries of neurointervention. His mission? To revolutionize diagnostic and therapeutic approaches for various neurological conditions while minimizing the invasiveness of traditional neurosurgery. But Dr. Morales isn't just a visionary; he's a recognized leader in his field. His accolades include winning the UCLA Health Innovation Challenge and Radiological Sciences Exploratory Research seed grants, as well as being selected as a finalist for the inaugural MedTech Color competition and CLS FAST program in 2021. A co-founder of the neurotechnology company, Vonova, Inc., he and his team have been selected as an NIH Blueprint MedTach Seedling and EvoNexus Incubator portfolio company, as well as a UCLA Anderson Venture Accelerator company in 2023. At the forefront of Vonova lies the development of minimally invasive brain interfaces. The goal? To transform the treatment of drug-resistant epilepsy and other neurological disorders. Through the ingenious use of catheter-based technology, Vonova aims to provide solutions that are both less invasive and more effective for patients. In this episode, we'll delve into Dr. Morales's extraordinary journey, exploring his career as a Neurointerventional Surgeon, his deep-rooted passion for neuroscience, and the groundbreaking work unfolding at Vonova. Together, we'll uncover the challenges and opportunities in this dynamic field, shining a spotlight on the thrilling intersection of medicine and technology. Prepare to be inspired and enlightened as we engage in this captivating conversation with Dr. Jose Morales, a visionary shaping the future of neuroendovascular theranostics. Tune in to 'Neurocareers' and join us for this enlightening exploration of the boundless potential within the world of neuroscience and innovation. About the Podcast Guest: José Morales is an entrepreneur and a neurointerventional surgeon at Pacific Neuroscience Institute (Santa Monica, CA). He completed his Neurology Residency at the Ken and Ruth Davee Department of Neurology at Northwestern University and Vascular Neurology and Interventional Neuroradiology Fellowships at the University of California Los Angeles. He is a medical school graduate from the University of Chicago Pritzker School of Medicine, where he served as the President of the American Academy of Neurology (AAN) Student Interest Group in Neurology and participated in an extended curriculum program under the Scholarship and Discovery track to conduct research in Computational Neuroscience and Brain Machine Interface, which was funded by the AAN Medical Student Research Scholarship. Prior to enrolling in medical school, Dr. Morales investigated the neuroanatomical correlates of critical period plasticity in the dorsal lateral geniculate nucleus at Harvard Medical School. He is also a graduate of Imperial College London, where he completed a Master of Science in Integrative Neuroscience and investigated the functional connectivity of memory and language networks associated with normative and pathological aging in humans for his graduate thesis in the Computational, Cognitive, and Clinical Neuroimaging Laboratory. Dr. Morales is a clinician-scientist, who has published in journals, such as Neuron, Nature, and Stroke, and a medical device innovator with several issued medical device patents. For his innovative concepts, Dr. Morales was selected as a fellow for the 2021-2022 UCLA Biodesign Accelerator program. Learn about Vonova here: https://www.vonova.io/  Get in touch with Jose Morales, MD, via LinkedIn: http://linkedin.com/in/jose-m-9672344b About the Podcast Host: The Neurocareers podcast is brought to you by The Institute of Neuroapproaches (https://www.neuroapproaches.org/) and its founder, Milena Korostenskaja, Ph.D. (Dr. K), a neuroscience educator, research consultant, and career coach for people in neuroscience and neurotechnologies. As a professional coach with a background in the field, Dr. K understands the unique challenges and opportunities job applicants face in this field and can provide personalized coaching and support to help you succeed. Here's what you'll get with one-on-one coaching sessions from Dr. K: Identification and pursuit of career goals Guidance on job search strategies, resume and cover letter development, and interview preparation Access to a network of professionals in the field of neuroscience and neurotechnologies Ongoing support and guidance to help you stay on track and achieve your goals You can always schedule a free neurocareer consultation/coaching session with Dr. K at https://neuroapproaches.as.me/free-neurocareer-consultation Subscribe to our Nerocareers Newsletter to stay on top of all our cool neurocareers news at updates https://www.neuroapproaches.org/neurocareers-news

上集討論過急性眩暈的鑑別診斷 這集要進入如何使用比MRI還準的HINTS測試 幫助你區分出病人是因為中樞神經或周邊神經引起的眩暈！ Timecode: 00:00 Frank 近況與截肢個案們 08:40 Elain近況&婦產科醫師的合作模式 17:50 Roger & Stanley 如何進入Specialist呢? 23:44 前庭眩暈相關的診斷有哪些 25:55 HINTS: 比MRI還準的測試 (Head Impulse (Test), Nystagmus, Test of Skew) 27:48 Head Impulse Test 32:13 Spontaneous Nystagmus和Gazed Nystagmus要注意甚麼 36:50 Test of Skew 38:50 HINTS “Plus”：急性聽力受損可能是中風? 39:35: 買不起Frenzel Goggles怎麼辦，用Penlight Cover Test 40:52 Head Shaking Nystagmus和Bow and Lean Test 歡迎到Facebook, Instagram追蹤或來信來訊跟我們提出疑問～ Email: 2propt@gmail.com 也可以在此收聽： Apple podcast: https://tinyurl.com/y97q7tms Spotify: https://tinyurl.com/ydavzqxu Google podcast: https://tinyurl.com/yd86pbcl YouTube channel: https://tinyurl.com/y82ewo5b Music by Elizabeth's Groove by Amarià @amariamusique Creative Commons — Attribution 3.0 Unported — CC BY 3.0 Free Download / Stream: bit.ly/elizabeths-groove Music promoted by Audio Library youtu.be/-MO-mrBlo5s Reference: Kattah JCUse of HINTS in the acute vestibular syndrome. An OverviewStroke and Vascular Neurology 2018;3:doi: 10.1136/svn-2018-000160 Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-3510.

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with Brandon Giglio, MD, a vascular neurologist and clinical assistant professor of neurology at NYU Grossman School of Medicine, as well as the director of Vascular Neurology at NYU Langone Hospital in Brooklyn, New York. As May is annually designated as Stroke Awareness Month in the United States, Giglio sat down with us to extend that time of awareness and share his insight into the current public understanding of stroke, how effective the care paradigm is at prevention and poststroke care, and much more. Looking for more Stroke discussion? Check out the NeurologyLive® stroke clinical focus page. Episode Breakdown: 1:15 – Breaking down the signs and symptoms of stroke with B.E. F.A.S.T 2:45 – The importance of stroke awareness 3:55 – Treating patients with poststroke symptoms 5:45 – Neurology News Minute 10:40 – Notable risk factors for stroke 13:15 – The critical need for novel education tools in stroke This episode is brought to you by Medical World News, a streaming channel from MJH Life Sciences®. Check out new content and shows every day, only at medicalworldnews.com. The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: Potential Path for Phase 3 Study of AOC 1001 in Myotonic Dystrophy Becomes Clear After FDA Ease's Clinical Hold FDA Grants Fast Track Designation for Atrial Fibrillation Therapy Asundexian FDA Pushes Back Decision Date for Duchenne Gene Therapy SRP-9001 FDA Accepts NDA for DHE Nasal Powder Product STS101 for Acute Migraine CMS Announces Plan to Provide Coverage of Antiamyloid Therapies for Alzheimer Disease Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

A review of commonly tested topics and other high yield areas in vascular neurology, with Drs. Kevin Yan and Adam Jasne.Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.

Stroke survivors with physical deficits have to fight to get the muscles moving again. They also have to fight to stop some muscles from moving. Tone and spasticity are why our elbows curl, our fists squeeze tight, and our toes can curl under our feet so we crush our own toes as we walk. Dr. Wayne Feng is an expert in tone and spasticity after stroke and he joins us this week to explain how we can address these challenges If you don't see the audio player below, visit Strokecast.com/MSN/ToneBasics to listen to the conversation. Click here for a machine-generated transcript Who is Dr. Wayne Feng? From Dr. Feng's Duke Profile: I am the division chief for Stroke and Vascular Neurology in the Department of Neurology at Duke Health. I see stroke patient in the emergency department, inpatient service as well as in the outpatient clinic. I also treated post-stroke limb spasticity, a disabling complication after stroke. In addition to the patient care, I also run a brain modulation and stroke recovery lab at the Duke University campus to study stroke patients in my lab to develop new stroke recovery therapy. On my days off, my boys and I are big on fishing. I enjoy drinking and collecting tea. As a stroke doctor, I do not drink coffee at all (there is a reason for it). If you come to see, I will tell you. Current Appointments and Affiliations: Professor of Neurology, Neurology, Stroke and Vascular Neurology 2019 Chief of Stroke & Vascular Neurology in the Department of Neurology, Neurology, Stroke and Vascular Neurology 2019 Professor of Biomedical Engineering, Biomedical Engineering 2022 [youtube https://www.youtube.com/watch?v=SGeOGI2bry4&w=560&h=315] Tone and Spasticity Overview Mos of our limbs move because of the interaction between two types of muscles -- extensors and flexors. The flexors contract to bend a limb. The extensors contract to extend the limb. For example, the biceps are flexors. They pull our forearm up or into an angle. When people want to show off their arm muscle, the flex their arm -- they activate their flexors. The triceps on the back of the upper arm are extensors. When they activate, they extend the arm -- they pull the arm straight.  When flexors contract extensors relax. When extensors contract, flexors relax. That's how we control our limbs. After stroke, the flexors can activate on their own. And they can be, well, overenthusiastic, in those actions. That happens because the default behavior of the flexors is to be active and curl up. When we talk about curling up into the fetal position, that's most of our flexors activating. The reason we can go through life upright and with our limbs straight is that the cortex of the waking brain is constantly suppressing the normal contracting of the flexors. After stroke impacting the motor cortex of the brain, the corticospinal tract is disconnected. With that disconnect, the brain can no longer suppress the flexors so they do what they do -- they contract and curl and cause all sorts of problems. Peripheral vs Cortical Problems Categorizing issues as cortical or peripheral is a fancy way of saying brain or limb. A stroke is a cortical issue. The problem exists in the brain. That's where the disconnect happens. A peripheral issue is when something goes wrong in the limb. Shoulder subluxation, for example, is peripheral issue. Most PT and OT works with the limbs to treat the cortical issues. Tone and spasticity are caused by cortical issues. The long-term problems caused by tone and spasticity are peripheral issues. One of those peripheral issues is contracture. When tone and spasticity is severe and long term, the muscles, tendons, ligaments, and other soft tissue can actually shrink in the contracted position. When that happens, getting the extensors back online and suppressing the flexors no longer  helps. The limb can become almost permanently bent. Repairing peripheral issues, like contracture, may require surgery to sever and extend tendons and other tissue. Preventing and Treating Tone and Spasticity The first line of defense is in the immediate short-term after stroke. Getting the limbs moving and keeping them moving to drive the neuroplastic change of recovery helps. Beyond that, and once tone and spasticity set in, regular stretching is critical. A survivor needs to keep stretching those limbs to prevent contracture. That's why in conference calls and interviews, I'm often stretching my fingers back and my wrist back to counteract the tone and spasticity in my left arm and hand. Medication can help, too. Baclofen is a popular choice. It's basically a muscle relaxer that helps counteract the excessive action in my flexors. Some people find it can cause drowsiness so it's not the best choice for everyone. I tend to take my Baclofen before going to bed. If it makes me drowsy then that's great. It also helps reduce the tone I might experience overnight. For folks with severe tone and spasticity, a surgically implanted Baclofen pump can help. The medicine directly target the key muscles which means the patient needs much less medicine for a much greater impact. Since it is a low dose, it is less likely to induce the fatigue, too. Other medications to treat tone and spasticity include: Tizanidine Flexeril Gabapentin Botox, Dysport, and Xeomin are also treatments that can help. These are neurotoxins that a doctor can inject every three to four months. By delivering the toxins to the flexors, it reduces their ability to flex. That gives the extensors a chance to recover and rebuild a normal relationship. Of course, this is a short-term solution. Combined with exercise, it can definitely help. I'm probably overdue for my next Dysport treatment. Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery A promising area for relieving tone and spasticity is C7 nerve transfer. Recent studies are showing promising results. Neurosurgeons split the a nerve from the unaffected side of the brain that runs through the spine and reconnect half of it to the equivalent nerve on the affected side. The do this in the neck. Results show a quick reduction in tone and spasticity even in patients 15+ years after stroke. After a year, patients are experiencing improved use of the limb, too. The number of people in the studies so far is pretty small (36) and more research is needed. It is a promising result, though, and builds on techniques that have been used to treat non-stroke injuries. It also highlights the tremendous ability of the brain to adapt since now the unaffected side starts to control the affected side of the body. You can read a review of the technique and studies at the Journal of Clinical Medicine. Vagus Nerve Stimulation In 2021, I spoke with Dr. Jesse Dawson, a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital in Scotland about his research in Vagus Nerve Stimulation. This research is now being commercialized and used to treat patients in the US. The therapy involves surgically implanting a stimulator in a patient's chest that connects to the Vagus nerve. During PT or other exercises, the device sends an electric signal to the Vagus nerve. Stimulating the nerve while doing therapy has shown positive results in terms of limb use. It's interesting because it's not treating the Vagus nerve itself, but stimulating this nerve appears to make the other nerves in the brain more receptive to the therapeutic exercises. You can learn more about this research here: http://Strokecast.com/VNS. Survey What do you think of the Strokecast? Let me know what you like and what you would like to be different by completing the survey at http://Strokecast.com/Survey. I would really appreciate it. If you complete the survey by March 31, 2023, you could win a $25 Amazon gift card, too. Hack of the Week Hand grip exercisers are nice tools to encourage stretching and exercise throughout the day. These things are like a pair of pliers without the tool end. They are spring loaded. You squeeze them to exercise and they try to force your hand open. You can get them in a variety of strength levels. Start with light weight ones and move on to tougher ones as your strength improves. What I like about them is that closing a fist comes back before opening one. Closing your fist takes work. Opening your fist is often harder, but these gadgets force the hand open. So you get to practice the squeeze and you get a stretch into fingers, too, to address tone and spasticity. It's also one more way to reduce the odds of developing a contracture. Here are a couple options: https://strokecast.com/Hack/HandExerciserTraditional (Traditional design)* https://strokecast.com/Hack/HandExerciserAdjustable (Adjustable resistance)* Links Where do we go from here? Check out Dr. Feng's work at Duke University Share this episode with someone you know by giving them the link http://Strokecast.com/ToneBasics Complete the Strokecast survey at http://Strokecast.com/Survey Don't get best…get better More thoughts on Tone and Spasticity

On Episode 21 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the October 2022 issue of Stroke: “Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk” and “Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage.” She also interviews Dr. Shadi Yaghi about his article “Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Do hormone replacement therapies or oral contraceptives increase the risk of stroke? And if yes, does the age of the individual or the duration of therapy modify this risk? 2) Should survivors of intracranial hemorrhage who have atrial fibrillation be treated with antithrombotic therapies for secondary prevention of stroke? 3) And finally, what is the anticoagulant of choice for treatment of cerebral venous sinus thrombosis? We have the answers and much more in today's podcast as we continue to bring you the latest in cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another amazing issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine, and your host for the monthly Stroke Alert Podcast. The October issue of Stroke covers a number of timely topics. As part of our October Literature Synopsis, we have a nice paper by Dr. Farida Sohrabji and colleague, which summarizes three recently published animal studies to evaluate the association between small vessel ischemic injury and either development of Parkinsonism or the future risk of Parkinson's disease. These studies looked at how ischemia, specifically involving the lenticulostriate arteries, can modulate the nigrostriatal dopaminergic pathway and ultimately lead to Parkinsonism. As part of our Original Contributions, we have the results of a small randomized trial out of Korea, which was led by Dr. Yun-Hee Kim from Sungkyunkwan University School of Medicine in Seoul, where we learned that doing 20 sessions of transcranial direct current stimulation for about 30 minutes for each session at home can improve post-stroke cognition. This was found to be specifically effective in patients with post-stroke moderate cognitive decline. Now, transcranial current stimulation can be given using a handheld device at home, and if truly proven safe and efficacious in larger studies, can dramatically change the landscape of stroke recovery in cognitive rehabilitation. I encourage you to review these articles in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Shadi Yaghi from Brown University. Shadi will walk us through a systematic review and meta-analysis of published studies to compare the safety and efficacy of direct oral anticoagulants to that of vitamin K antagonists in patients with cerebral venous sinus thrombosis. Our devoted Stroke Alert Podcast listeners recall that we did cover this topic in our March podcast when we reviewed the results of ACTION-CVT, a multicenter international study that was led by none other than Shadi himself. I'm delighted to have him as a guest on my podcast today to talk more about the seminal study and all things cerebral venous sinus thrombosis. But first, with these two articles. Millions of women worldwide use exogenous hormones, most commonly in the form of oral contraceptives and hormone replacement therapies. Despite the many different formulations of these drugs that are now available on the market, the two therapies are similar in that both combined oral contraceptives and hormone replacement therapies, or HRTs, contain various dosage of estrogen and progestin. Now, the principal difference between them being that the hormone contents of oral contraceptives are at high enough dosage to prevent ovulation, whereas hormone replacement therapies are considered more physiological as their aim is to return post-menopausal hormone levels to what they were before menopause. Well, by now, you must wonder how is any of this even relevant to vascular neurology? Well, the answer lies in the close relationship between hormonal therapies and stroke. But before we get to that, we have to review a few things. First of all, it's long been known that the endogenous estrogen has strong and protective effects on the arteries. It promotes vasodilation and cell survival of the endothelial layer. It increases the endothelial mitochondrial efficiency and stimulates angiogenesis. In other words, endogenous estrogen is good for vascular health. And in fact, that's why we think that premenopausal women, in general, are at a lower risk of stroke as compared to their age and vascular risk factors–matched male counterparts. And to make things even better for estrogen, there's enough evidence to suggest that exogenous estrogen also does all of these good things for the endothelium. So, why are we even talking about an increased risk of stroke associated with use of hormonal therapies? The problem is, we have to remember that exogenous estrogen also does other things. It can increase the blood concentration of procoagulants, which, in turn, can increase the risk of thromboembolism, especially venous thrombosis. But there's still a lot of unknown on this topic. For instance, the majority of the prior research on the topic involves postmenopausal women using hormonal therapies. Some of that research has actually suggested that HRTs may be protective against vascular events, while others showed the opposite. Well, we know that a majority of oral contraceptive users are actually much younger and use these medications premenopausal. So, there seems to be a lot of gaps in our current knowledge on the simple question of whether or not oral contraceptives and hormonal replacement therapies do, in fact, increase the risk of stroke or not. In the current issue of the journal, a group of researchers led by Drs. Therese Johansson, Torgny Karlsson, and Åsa Johansson from the Department of Immunology, Genetics and Pathology at Uppsala University in Sweden set out to fill some of these gaps with their study titled, "Oral Contraceptives, Hormone Replacement Therapy, and Risk of Stroke," as part of a large UK Biobank population-based cohort. Just a bit about the UK Biobank. This was a large population-based cohort from 2006 to 2010 that included over 500,000 residents of the United Kingdom between the ages of 37 and 73. Participants at the time of enrollment would have extensive information collected from them through questionnaires, interviews, health records, physical measures, as well as some imaging and biological samples. Data on each participant was collected from the time of their birth all the way to the day of assessment, which is interesting, because the day of assessment would then count as the end of the follow-up for each participant. Now, for the current study, they included over 250,000 women of White race in whom information required for the study on whether or not they use hormonal therapies, duration of treatment, age at the time of exposure was available. And just a quick comment about their methodology. They analyzed their cohort once for oral contraceptive use and once for HRT use and compared each group to a reference group of either women who never used their set therapy or the number of years they contributed to the study prior to initiating that set treatment. So, for instance, if a person started using oral contraceptives at the age of 21, all of the years that she contributed to the study before that age would count as non-exposed user years and were included in the control cohort. So now, on to their findings. A total of 3007 stroke diagnosis of any type were identified prior to the initial visit to the assessment center, which, as we mentioned, was the end of the follow-up in the study. Of these, 578 were ischemic strokes, 177 intracerebral hemorrhage, and 478 were subarachnoid hemorrhages. But as expected for any large cohort, over half of total strokes were self-reported as stroke of any type and could not be classified into any of the above subtypes. Now, let's look at the effects of oral contraceptives on the outcome of stroke. Overall of the women included in the study, 81% were classified as oral contraceptive users, while 19% reported never having used oral contraceptives at any point during the study. On the association between oral contraceptive use and the risk of stroke, at first glance, things looked OK. The hazard rates of any stroke for any stroke subtypes were not different between women who had used oral contraceptives as compared to those in the reference group. That's great news. But when they looked deeper, they realized that the odds of development of any stroke was actually quite high during the first year after the initiation of oral contraceptives with hazard rate of 2.49 for any stroke, while there was no difference in hazard rates found during the remaining years of use and after discontinuation of oral contraceptive use. So, meaning that there was no lingering effects of oral contraceptives on increased risk of stroke after the first year or after discontinuing the medication. Now, on to HRTs. In total, 37% of women in the study had initiated HRTs at some point during the study, while 63% had never used this therapy. Here's the bad news. Overall, HRTs did increase the risk of stroke. An approximately 20% increase event rate of any stroke was noted among women who had initiated HRTs as compared to those who had not. When analyzing stroke subtypes, the use of HRTs was associated with increased risk of only the subarachnoid hemorrhage subtypes. We don't know why. Diving deeper, in considering timing of HRT initiation, very similar to what was observed for the oral contraceptives, during the first year after starting the HRTs, the treatment group was twice more likely to suffer from any type of stroke, and the hazard rate was also increased for all three stroke subtypes that were available in the study. But, unlike oral contraceptives, the hazard rate of any stroke remains significantly high even after the first year of use, not just for those who continued HRTs, but sadly, even for those who discontinued the therapy. Though the risk remained high, the hazard ratio declined over time as we went further away from the first year when treatment was initiated. So, bottom line, if women had initiated HRTs at some point in their life, the hazard risk of any stroke increased significantly in the first year. That hazard risk did decline over time, but it always remained significantly higher than non–HRT users. Now, what about timing of treatment in relation to the onset of menopause? Is the risk of stroke any different if women start on HRTs prior to or after their menopause? The answer is no. Initiation of HRTs was associated with an increased hazard rate of any stroke if it was started pre- or postmenopausal, but the risks were higher if the treatment was started prior to menopause. So, in summary, this large population-based cohort has truly given us some very important practical findings. We learned that both oral contraceptives and hormone replacement therapies do, in fact, increase the risk of stroke, an effect that was most notable in this study in the first year after initiation of both of these therapies, and in the case of oral contraceptives, was just actually limited to that one year alone. Why does this happen? I guess the easy answer is that these drugs, as we noted earlier, have an immediate prothrombotic effect, which gradually weakens over time. That's one plausible explanation, but for instance, why HRTs increase the risk of subarachnoid hemorrhage is something we can't explain based on the prothrombotic effects of HRTs. So, we have to come back to the vessels, the impact of hormone therapies and estrogen specifically on the blood vessels, on the endothelial cells, the potential increase in blood pressure, especially early on in the course of treatment with these medications. And also, we have to think about the role these drugs may play in increasing inflammatory markers, providing a more suitable milieu for accelerated atherosclerosis, as to why these associations were noted in this study. And it's fair to say that we need more research on this topic in the future. One challenging scenario that we commonly face in our daily practice is deciding whether or not we should resume antithrombotics in patients with atrial fibrillation who have survived an intracranial hemorrhage. The majority of intracranial hemorrhage survivors with atrial fibrillation actually have a very high CHA2DS2-VASc score, which means that they are actually at a very high risk of future ischemic stroke and systemic embolic events unless they're treated with anticoagulants. On the other hand, the risk of spontaneous intracranial bleeding is substantially higher in a person who has previously suffered from one, let alone if we treat them with anticoagulants. And to make matters worse, we have little evidence from the literature to guide us. So, in the current issue of the journal, in the study titled "Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage," a group of researchers from the UK led by Dr. Deirdre Lane, Professor of Medicine at the University of Liverpool, performed a much needed systematic review and meta-analysis of the available evidence on this subject. I have to say that lately, it seems that we've been covering a few of these reviews in our podcasts, and we are just getting started. In fact, my next paper in today's episode is also a systematic review and meta-analysis. These papers are packed with details, a testament to the work needed to complete them, but I have to say that even summarizing these papers for a podcast has been a bit challenging. So, feel free to put me on pause, go get some coffee, and let's power through this one together. For their methods, they used the usual search engines looking for papers that included adults over the age of 18 with atrial fibrillation who had survived a non-traumatic spontaneous intracranial hemorrhage of any size, any type, and any location, be it lobar, brain stem, deep, cerebellar, subdural, epidural, or subarachnoid hemorrhage. And very importantly, they included even those with evidence of microbleeds on neuroimaging. The intervention of interest was either long-term oral anticoagulation or antiplatelet therapy versus no antithrombotic use for the following three outcomes of interest: number one, recurrent thromboembolic events; number two, recurrent intracranial hemorrhage; and number three, all-cause mortality. Just a quick note that for this analysis, they excluded studies that looked at either short-term anticoagulation or non-oral anticoagulation use for any reason that was given to the patient other than for secondary prevention of stroke. For example, if a patient suffered from a pulmonary embolism and was treated with IV heparin or, for a short period of time after that, with oral anticoagulation, those patients or those studies were excluded from this meta-analysis. So, with this criteria, they pulled over 4,000 citations and abstracts, and finally included 20 papers that were published between 2015 and 2021 for a total of over 50,000 participants for this meta-analysis, very nice sample size. Most of the papers included were observational cohorts, but in addition, we had two small randomized trials, and I want to take a moment and review these trials for our listeners. The first one was a small noninferiority pilot trial out of the UK, the SoSTART trial, that looked at any anticoagulant versus either antiplatelet therapy or no antithrombotics in this population, and the other trial was the Phase 2 trial, the APACHE-AF, that studied apixaban versus no anticoagulation after anticoagulant-associated intracerebral hemorrhage. A reminder that both of these trials were published in Lancet Neurology in 2021. And before we move on to the findings of the meta-analysis, it's worth noting that they had included a mix of patients, some were oral anticoagulant–naive, and some had developed their index intracranial hemorrhage while already on treatment with anticoagulants or antiplatelet therapies. OK, now on to their findings, as mentioned, we're going to review three outcomes of recurrent thromboembolism, recurrent intracranial hemorrhage, and all-cause death for the following three groups: group one, oral anticoagulant therapy versus no therapy; group two, oral anticoagulation therapy versus either antiplatelet treatment or no therapy; group three, comparing new oral anticoagulants versus warfarin. So, for the first outcome of recurrent thromboembolic events in group one, when comparing oral anticoagulant therapy to no therapy, the study showed a significant reduction in thromboembolic events in favor of oral anticoagulation compared to no therapy. That's great news. Next, analysis of the studies that compared oral anticoagulation versus either antiplatelets or no therapy didn't show the same difference in prevention of embolic events in favor of either groups. Actually, no difference was noted between the two groups. Number three, now, in terms of comparing NOACs to warfarin, three studies had the information on this comparison, and they reported a significant reduction in the risk of thromboembolic events with NOAC as compared to warfarin. So, great news for oral anticoagulation overall, and especially for NOACs. Now, on the next outcome. Our second outcome was a recurrent intracranial hemorrhage. Keeping in mind that they included some studies where the outcome was defined as any form of intracranial hemorrhage, meaning they included subdurals, epidurals, etc., and some studies only included the outcome of intracerebral hemorrhage. So, on to the first group, comparing oral anticoagulants to no therapy, the pooled estimate revealed no statistically significant difference between oral anticoagulant–treated patients to those who were not treated with any antithrombotics on the risk of recurrent intracranial hemorrhage. That's great news. Next, on our second group, for the same outcome of recurrent intracranial hemorrhage, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found that oral anticoagulation was associated with a higher risk of recurrent intracranial hemorrhage as compared to antiplatelets or no therapy. And finally, third group comparing new oral anticoagulants to warfarin for the same outcome, the risk of recurrent intracranial hemorrhage was significantly reduced in patients treated with NOACs as compared to warfarin. And now, we're finally on to our last outcome of the study, which is the outcome of all-cause mortality. So, again back to group one, comparing oral anticoagulants to no therapy, this meta-analysis showed a significant reduction in all-cause mortality rate associated with oral anticoagulation. That's, again, great news. Next group, for the same outcome of mortality, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found no significant difference in the mortality rates between the two groups. And finally, comparing NOACs to warfarin, the pooled estimate showed that NOACs were associated with a significantly reduced risk of all-cause mortality. Amazing news for NOACs. So, in summary, here's what we learned from this big study. Oral anticoagulation use after intracranial hemorrhage in patients with atrial fibrillation did significantly reduce the risk of thromboembolic events and all-cause mortality without significantly increasing the risk of recurrent intracranial hemorrhage. In general, new oral anticoagulants, or NOACs, are preferred to warfarin as they do prevent embolic events with a lower risk of recurrent intracranial hemorrhage. But, of course, we still have a lot more questions. For instance, would any of the outcomes mentioned above be different in patients with lobar intracerebral hemorrhage, a condition typically associated with amyloid angiopathy, which carries a high risk of development of intracerebral hemorrhage? Also, we have to keep in mind that the majority of the studies included in the meta-analysis were observational. So, there remains an urgent need for a larger randomized trial on this subject, and we have to stay tuned for more research. Cerebral venous sinus thrombosis, or CVST, is an uncommon form of stroke resulting in headaches, seizure, or focal neurological symptoms due to either intracranial hemorrhage or venous ischemic infarcts. The rarity of the disease has made it difficult to study as part of randomized trials, so current treatment guidelines for CVST are consensus-based with much of the recommendations extrapolated from data on treatment of patients with systemic deep vein thrombosis. In general, based on the current evidence, the field agrees that a patient with CVST should be anticoagulated. The decision that is difficult and sometimes inappropriately delayed in the setting of acute hemorrhage in the brain. And not surprisingly, there's significant equipoise around the choice of anticoagulant, duration of therapy, and the role of heroic therapies, especially in the acute setting. Currently, there are a number of ongoing trials to address some of these issues. The direct oral anticoagulants present an attractive alternative to vitamin K antagonists for treatment of patients with CVST. This is partly because of their convenience of use. But how do direct anticoagulants compare in safety and efficacy to the vitamin K antagonists in the setting of CVST is less known. In our March podcast, we reviewed the results of ACTION-CVT, which was a multicenter international study that compared the safety and efficacy profile of the direct oral anticoagulants to that of warfarin in routine practice. The study included over a thousand imaging-confirmed CVST patients from multiple centers in the US, Italy, Switzerland, and New Zealand. And if you missed it, no worries at all. We're here to review some of the results again, as in this issue of the journal, many of the ACTION-CVT investigators, led by Dr. Shadi Yaghi, present the results of a systematic review and meta-analysis comparing the safety and efficacy of DOACs, or direct oral anticoagulants, to that of vitamin K antagonists. I'm joined today by Dr. Yaghi himself to discuss ACTION-CVT and the current meta-analysis. Dr. Yaghi is a Director of Vascular Neurology at Lifespan and Co-Director of Comprehensive Stroke Center and a Director of Research at the Neurovascular Center at Rhode Island Hospital. Good afternoon, Shadi, and welcome to our podcast. Dr. Shadi Yaghi:               Good afternoon, Dr. Asdaghi. Thank you so much for having me. Dr. Negar Asdaghi:         Thank you. And please call me Negar. Congrats on the paper. Before we talk about the meta-analysis, can you please remind us of the results of ACTION-CVT and why the systematic review, in your opinion, was an important next step to that effort? Dr. Shadi Yaghi:               Thank you so much for having me and for bringing up ACTION-CVT. So ACTION-CVT is a real-world multicenter international study that used real-world observational data to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The reason why we did ACTION-CVT was, as you know, cerebral venous thrombosis is a rare disease, and it's hard to have large studies that would be powered enough to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists. So, most of the studies that were done are small, retrospective. There's one randomized controlled trial, but most of them are underpowered to detect the difference between the two groups. So, we decided to do a large-scale international multicenter study using real-world data to compare the safety and efficacy of both. Dr. Negar Asdaghi:         OK, so we're glad you did. Let's start with the methodology of the current meta-analysis. Can you please give us an overview of the inclusion criteria for selection of the papers and the intervention and outcomes that you were interested in? Dr. Shadi Yaghi:               Of course. So, this is a systematic review and meta-analysis that included studies comparing direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The studies needed to have the two groups included, the direct oral anticoagulants and vitamin K antagonists, and they need to include at least one of the outcomes in our study to compare this outcome between the two groups. In addition, we included articles published in English, and we also included papers that had five patients or more in each group. Dr. Negar Asdaghi:         Perfect. So just recap for our listeners, in order to have been included in the meta-analysis, the paper had to have a reasonable number of patients, and you put that reasonable at the number five, and also they had to have at least one of the outcomes of interest reported in their papers. And those outcomes were either recurrent venous thromboembolism or recanalization rates. Right? Dr. Shadi Yaghi:               Correct. Yes. Dr. Negar Asdaghi:         Perfect. So with that, how many papers did you have to go through to come up with the current number of papers included? Dr. Shadi Yaghi:               That's a great question. We had a little over 10,000 papers, and then we went through a screening process. We used this tool that was developed by Brown University. It's called Abstrackr, and what you do is, we did the search and using several databases like PubMed, Cochrane, and then we included all these studies. We uploaded them in Abstrackr, and Abstrackr was utilized to be able to review all these abstracts and select studies that may or will probably qualify and then go through the studies and details that would qualify. So, we had about 10,000 studies with the initial search, and we had two reviewers go through each abstract, and from these 10,665, we excluded 10,411, and that left us with 254 studies. And then we went through these 254 studies in details. And then finally, we had 19 studies included that met our inclusion/exclusion criteria. And these 19 studies included three randomized control trials and 16 observational studies. Dr. Negar Asdaghi:         Incredible effort. So, three randomized trials in this meta-analysis and 16 observational studies. I think we're very ready to hear the primary outcomes. Dr. Shadi Yaghi:               Yeah, so, the primary outcomes were recurrent venous thrombosis, and that included recurrent venous thromboembolism like peripheral DVTs or PEs, for example, and including recurrent cerebral venous thrombosis. And we know that most of the events are recurrent VTEs, not CVTs, like probably about two-thirds to three-quarters were VTEs, and a third to a quarter were CVT. And then the other efficacy outcome is venous recanalization on follow-up imaging. And we found that direct oral anticoagulants and warfarin were not significantly different in the primary efficacy outcomes. Dr. Negar Asdaghi:         Thank you. I just want to repeat this for our listeners. So, you mentioned some important information here. First one was the fact that about three-quarters of recurrent events were actually systemic thromboembolic events rather than cerebral thromboembolism. So, an important outcome to keep in mind for our practicing physicians. And the fact that DOACs did the same as compared to vitamin K antagonist. So, I think you can already guess my next question, and that is, was there any compromise on the safety profile when using DOACs as compared to vitamin K antagonists in this meta-analysis? Dr. Shadi Yaghi:               Thank you. That's a great question. In ACTION-CVT, we found that there was a lower risk of major hemorrhage with direct oral anticoagulants compared to vitamin K antagonists. In this systematic review and meta-analysis, we didn't find a significant difference, but there were fewer events in patients treated with direct oral anticoagulants versus vitamin K antagonists. This did not reach statistical significance, but if you look at the raw data, it's kind of along the same lines as ACTION-CVT, so the risk of major hemorrhage was about 3.5% with warfarin, and that was about 2% with direct oral anticoagulants. Dr. Negar Asdaghi:         So, again, very important finding, and I want to repeat this for our listeners. So, important finding number one was that there was a superiority in favor of DOACs that you found in terms of a reduced risk of intracerebral hemorrhage in ACTION-CVT. You didn't find this superiority in the meta-analysis, but there was sort of a hint to perhaps lower risk of intracerebral hemorrhage in patients that were treated with DOACs. Did I get that right? Dr. Shadi Yaghi:               Yes, that is correct, and in addition, also major hemorrhage in general, and that included also ICH. Dr. Negar Asdaghi:         Oh, OK, so not just intracranial, but systemic hemorrhages as well. All right. Very good. So, I think my next question would be, why do you think that DOACs have a lower chance of causing hemorrhage? Dr. Shadi Yaghi:               Yeah, that's a really good question. This is not unexpected with DOACs as opposed to vitamin K antagonists. We saw these same trends in patients with atrial fibrillation. We saw improved bleeding profiles with direct oral anticoagulants as compared to vitamin K antagonists. And the risks were along the same lines that we found in patients with cerebral venous thrombosis in ACTION-CVT. Also in the VTE trials as well, there was also reduced bleeding complications with direct oral anticoagulants as compared to vitamin K antagonists. So, it was kind of reassuring to see the same results in patients with cerebral venous thrombosis. Dr. Negar Asdaghi:         Perfect, so kind of expected based on what we know from treatment of systemic conditions with DOACs. The next question I have for you is that in routine practice, treatment of cerebral venous sinus thrombosis almost always starts parenterally with either unfractionated heparin or low molecular weight heparin and then we switch to an oral agent. In the observational studies, did you find any differences in terms of timing of this switch or characteristics of the patients in whom vitamin K antagonists were chosen over direct oral anticoagulants? Dr. Shadi Yaghi:               Thank you very much. Most of the studies did not report these details. I think the one study, off the top of my head, that does report the differences in characteristics between the two groups is RESPECT-CVT. That's the randomized controlled trial comparing dabigatran to vitamin K antagonists. In this study, there was a treatment with parenteral anticoagulation for several days, I think seven to 14 days, prior to transitioning to oral anticoagulation. And this is generally my practice. I typically would treat patients with at least seven days or so parenteral anticoagulation, and once they're clinically stable, then I would transition them to oral anticoagulation, either vitamin K antagonists or direct oral anticoagulant. Dr. Negar Asdaghi:         And I think my next question is along the lines of this question as well. We have several direct oral anticoagulants now available on the market. What was the most common DOACs used for treatment of CVST in these studies, and did you note a preference for the use of any particular agent over others? Dr. Shadi Yaghi:               Thank you so much for the question. Anti-Xa inhibitors were much more common than dabigatran, and the anti-Xa inhibitors most commonly used were apixaban and rivaroxaban. It's in line with what we saw in ACTION-CVT as well, although most of the randomized controlled trials or the largest randomized controlled trial, RESPECT-CVT, used dabigatran, but overall people have been using anti-Xa inhibitors, more particularly apixaban, which was also in line with what we saw in ACTION-CVT. Dr. Negar Asdaghi:         But I think it's fair to say that we don't really have data on superiority of one over others. Is that fair? Dr. Shadi Yaghi:               Yes, that is correct. Dr. Negar Asdaghi:         OK, and so now, where are we at in terms of the future of studies on this topic? We have one ongoing randomized trial now? Dr. Shadi Yaghi:               Yes, we have one randomized controlled trial ongoing, and this is the SECRET trial, and it's looking at rivaroxaban versus vitamin K antagonists in patients with cerebral venous thrombosis. There's another study, it's a prospective observational study that's called the DOAC-CVT study. It's an international study also looking at real-world data prospectively to see if there's a difference in outcomes between the two groups. Dr. Negar Asdaghi:         So, we look forward to the results of those studies. Shadi, a follow-up question I have on this topic is, how long should a duration of therapy be in idiopathic cases of cerebral venous sinus thrombosis? Dr. Shadi Yaghi:               Thank you so much for this question. So, it's unknown at this point for how long should we treat. The key things from the treatment are first achieving venous recanalization, and second is preventing another venous thromboembolic event from happening. So, regarding the venous recanalization, studies have shown that there's not a lot of recanalization beyond four months of treatment. So, a lot of the recanalization really happens early, and continuing anticoagulation beyond the six-months interval, for example, in order to achieve further venous recanalization probably has limited utility. And the second important reason why we treat patients with anticoagulation is also to reduce the risk of a recurrent venous thromboembolic event or cerebral venous thrombosis. And for that, if it's a provoked CVT, then I think usually it's three to six months. If it's unprovoked, up to maybe six to 12 months or even longer, depending on the profile. And if there's a persistent provoking factor, such as cancer, antiphospholipid antibody syndrome, then the treatment is lifelong or until this condition subsides. There's a lot of controversy about the duration of treatment. The European guidelines were very helpful in identifying the duration of treatment. Hopefully, also, we have some guidelines or at least a scientific statement by the AHA that also doles details out and provides some guidance to practitioners. Dr. Negar Asdaghi:         Shadi, what should be our top two takeaways from the current meta-analysis and also ACTION-CVT? Dr. Shadi Yaghi:               So, really, the top two from ACTION-CVT and the meta-analysis are, first is direct oral anticoagulants have a comparable efficacy to vitamin K antagonists in terms of recurrent venous thrombosis and achieving venous recanalization on follow-up imaging. And then the second point is direct oral anticoagulants are probably safer than vitamin K antagonists. We have to keep in mind that this data is based mostly on observational studies. And, as we mentioned earlier, we need more randomized controlled trials to support these findings. Dr. Negar Asdaghi:         Dr. Shadi Yaghi, it was a pleasure interviewing you on the podcast. Thank you very much for joining us, and we look forward to having you back on the podcast and reviewing this topic again in the future. Dr. Shadi Yaghi:               Thank you so much. I appreciate you having me. Dr. Negar Asdaghi:         Thank you. And this concludes our podcast for the October 2022 issue of Stroke Please be sure to check out this month's table of contents for the full list of publications, including an important update from the European Stroke Organisation by Prof. Martin Dichgans. I also want to draw your attention to this month's InterSECT paper, which is our International Stroke Early Career and Training section, to discuss the key topic of burnout and mental health amongst physicians, especially amongst neurologists and stroke neurologists. It's alarming to read in this article that neurology is one of the specialties with the highest reported rates of burnout syndrome, and stroke neurologists are at particularly higher risk than other neurological subspecialties. The article tackles some tough subjects, such as the barriers for physicians to seek help and important strategies to mitigate burnout and how to improve mental health in general. I think it's also timely to know that October is the Mental Health Awareness Month, and the theme for October 2022 is "Back to Basics." The basics of recognizing the burden of stress, anxiety, the burden of isolation and depression, not only on those who we take care of, but also on those who give care to us. So, whether you're a stroke physician, a stroke caregiver, or whether you've been touched by this disease in some way or shape, please know that you are part of the stroke community and a part of our Stroke podcast family. Thank you for listening to us, and, as always, stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.  

This week, Rusty Keys talks with Dr. Jennifer Majersik, Chief of Vascular Neurology & Stroke Center with the University of Utah Health shares valuable information regarding strokes, symptoms to look for and ways to minimize your risk. See omnystudio.com/listener for privacy information.

To effectively treat stroke and prevent stroke, you need to know just what is literally happening in a patient's head. CT Scans and MRI scans are tools most of us are familiar with. Generally if you suspect a stroke is possible, you need these two scans done. There's another tool out there, too, that's cheaper, more portable, and involves no radiation. It's called Transcranial Doppler Ultrasound. It's a great complement to the other scans, and it can provide impressive insight to supplement the information from the radiologists. A skilled practitioner is a great complement to the care team. I first talked about this technology in my conversation with Dr. Aaron Stayman a few years back (Is my Brain Pregnant? Ultrasound and Stroke: Transcranial Doppler Ultrasound). It's fascinating stuff. The problem is that it does require a skilled technician or someone specifically trained in the technique. Despite the work of advocates like Dr. Stayman and Dr. Mar Rubin, there just aren't enough of those techs. Dr. Mark Hamilton of Nova Signal has a solution. His robotic machine automates the whole process, makes it faster, more reliable, and cheaper while giving more accurate results in a lot of scenarios. The Nova Signal solution has the potential to make this technology available to patients and medical practitioners around the world. Drs. Rubin and Hamilton join me in this episode to discuss the technology, the research, and the device itself. If you don't see the audio player below, visit http://Strokecast.com/TCD to listen to the conversation.   Click here for a machine-generated transcript Who are Drs. Rubin and Hamilton? Dr. Mark N. Rubin is a vascular neurologist and associate professor of neurology with the University of Tennessee Health Science Center Department of Neurology. He specializes in vascular neurology and is experienced in stroke and cerebrovascular disease, and an experienced sonographer and expert interpreter of carotid duplex ultrasound and transcranial Doppler ultrasonography. He received his medical degree from University of Illinois College of Medicine and completed his Adult Neurology residency and fellowships (Neurohospitalist and Vascular Neurology) at the Mayo Clinic. Robert Hamilton, Ph.D. is the Chief Scientific Officer and Co-Founder of NovaSignal. He is an accomplished entrepreneur, engineer, and clinical researcher with a passion for innovative technologies that allow for increased access to care. Robert, a biomedical engineer by training, is an expert in image/signal processing and machine learning, with extensive experience in cerebral blood flow, traumatic brain injury, stroke, and other neurological disorders. Robert co-founded NovaSignal based on technology he developed during his Ph.D. During his tenure at the company, Robert has supported the entire lifecycle of the NovaSignal autonomous ultrasound platform from idea to commercialization with regulatory clearances in the US, Europe, and Canada. Additionally, Robert has designed and completed several clinical trials supporting the use of the technology in different neurological conditions and has acted as principal investigator on federal grants and contracts totaling more than $25M from the Department of Defense, National Institutes of Health, and the National Science Foundation.  Finally, Robert has achieved greater than 100 citations of his work in peer-reviewed publications and conferences and holds over 50 patent assets related to the core technology developed during his PhD studies. TCD vs Traditional Ultrasound When most of us think of ultrasound in medicine, we think of the sonograms of developing children, where parents and doctors swear they can see a human being in those black and white lines. Personally, they seem more like those Magic Eye pictures from the 90s. Traditional ultrasound can also capture pictures of the heart, the blood vessels in the neck, and the condition of other organs in the body. It can be another way of getting a picture of the structures at play. And then you can frame those pictures or make them your Facebook profile picture. TCD is different. The goal is not to capture a picture of the structures of the brain. The goal instead is to understand blood flow through the brain. The technology helps practitioners understand the rate of flow, where there may be leaks or disruptions, if stuff is flowing with the blood that shouldn't, the direction of flow, and whether things are shunting (or crossing) between the veins and arteries that shouldn't. That shunting is at the core of the recent study Nova Signal was part of and that we talk about in this conversation. There are several reasons shunting can occur, but one of the most common is a PFO, or a hole in the heart. I talked in more detail about just what a PFO is in the last episode here: http://Strokecast.com/Anna TCD is a great technology for helping doctors understand the dynamic flow of blood in each individual patient. And it doesn't involve the dedicated rooms or radiation that might come with CT  or MRI Scans. NovaGuide™ 2 Intelligent Ultrasound The Nova Guide 2 Intelligent Ultrasound is the device we talked about in this conversation. While TCD is a great tool, it does take a while to get the scan just right, and we face a dearth of practitioners who are able to do it. The Nova Signal solution is simpler. It's small and automated. The device can orient itself and complete a scan much quicker than a human can. The research shows it's more accurate, too. It doesn't take up much space in a medical facility and can easily be brought from one patient to another. Plus, an operator can perform a lot more scans per hour or get back to other tasks more quickly. With hospitals perpetually understaffed these days, that speed makes a lot of financial sense. And since, in stroke, time is brain, it can make a lot of medical sense, too. Nova Signal vs Transthoracic Echocardiography The information about the presentation at the International Stroke conference is here: https://eventpilotadmin.com/web/page.php?page=IntHtml&project=ISC22&id=1176 This is the data we talked about a lot in the conversation. The Nova Signal device was significantly better at detecting the vein-artery shunts indicative of PFO and other conditions than the gold-standard  evaluation technique using Transthoracic Echocardiogram. This matters in stroke because when we talk about shunting in tests we're usually talking about very small bubbles. Outside of the test context we're usually talking about clots and other stuff sneaking across from veins to arteries, bypassing the body's filters. When they do that they can go to the brain and cause a stroke. Accurate detection of shunting allows physicians to make more appropriate treatment recommendations and decisions. Hack of the Week Cultivating a sense of gratitude, as unlikely as it may seem, is something that helps a lot of folks deal with the challenges pf post stroke life. Simply being alive means thing can get better. And being alive in the 21 century with the medical resources available is a huge asset to the community. Of course those medical resources are not evenly distributed within the US and around the world, but they exist, and that's a start. Develop a sense of purpose. After stroke, it can be hard to see a way forward, especially if you have severe disabilities. People who succeed in their recovery, or in their goals in general, typically have a pretty strong "Why?" driving them. Achieving their goals gets them closer to something important to them. In the dark times, when you find yourself feeling it's just not worth it, your why -- your sense of purpose can give you a reason to push through. We sometimes ask, "Why should I go on?" almost rhetorically to express or pain. For some folks, though, it can be an exercise to identify the things that matter to you. So ask yourself that question, but assume there is an answer. And write down everything that could be an answer. Cultivate the sense of purpose to get through the darkness. Links Where do we go from here? To learn more about Nova Signal and the research around TCD, visit http://NovaSignal.com Share this link with someone you know by giving them the link http://Strokecast.com/TCD Share a recent win (we all have them) at 321-5Stroke or by email Don't get best…get better.

Equitable tele-neurologic care starts with first identifying disparities, then identifying how to overcome them – learn about both with Dr. Lee Schwamm on the latest ANA Investigates. Series 3, Episode 11. Featuring: Guest: Dr. Lee Schwamm, C Miller Fisher Endowed Chair in Vascular Neurology and the Director of the Center for TeleHealth at Massachusetts General Hospital, Professor of Neurology at Harvard Medical School and Vice President for Digital Patient Experience at the Mass General Brigham Health System. Interviewer/Producer: Amanda Jagolino-Cole, Director of the UT Teleneurology Division at McGovern Medical School at the University of Texas Health Science Center in Houston. Disclosures: None

We have an amazing Grand Rounds follow up interview for you today! Dr. Andrew Barreto is an Associate Professor at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). He is board certified in both Neurology and Vascular Neurology, and sees patients of all ages. His clinical interests involve a combination of treatments for thrombolysis in ischemic strokes, ultrasound-enhanced treatments for ischemic strokes, advanced CT and MRI vascular neuroimaging and endovascular treatment for strokes. His Grand Rounds presentation with medical students and faculty at McGovern Medical School was on Ultrasound Imaging in Cerebrovascular Disease. One of our new fellows this year, Mahan Shahrivari, interviewed Dr. Barreto following his presentation to ask some more in depth questions. As with our previous Grand Rounds episode, we added the Q&A from the live Grand Rounds because it added so much value to this episode. Dr. Andrew Barreto. MD MS, is a vascular neurologist, neurosonologist, clinical trialist and associate professor at the McGovern Medical School at the University of Texas Health Science Center at Houston, Texas. He is currently the director of the UT Neurosonology laboratory. He is the Clinical Stroke Director at MHH-Texas Medical Center, co-PI for several practice changing NIH-funded MOST trial: Multi-Arm Optimization of Stroke Thrombolysis. Dr. Barreto's area of expertise are neurosonology and acute ischemic stroke clinical trials. Combination treatments for thrombolysis in ischemic stroke and Ultrasound-enhanced treatments for ischemic stroke. For more information on Dr. Barreto visit https://med.uth.edu/neurology/faculty/andrew-d-barreto-md-ms/ ------- The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Hosts: Mahan Shahrivari Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice.

For this week's chai time, we are proud to present Stony Brook Medicine's own Dr. Jason Mathew! Dr. Mathew started his journey at Rutgers as a premed with a passion for neuroscience. After leaning into his interests through neurotoxicity research, he enrolled as a medical student at NYIT, after which he completed his training in Vascular Neurology at the Cleveland Clinic. If you've been looking to get to know more about Neurology, look no further. Join us for not just a glimpse, but an entire inside look at everything Neurology- patient populations, day to day life, thrilling innovations in stroke medicine, and larger obstacles faced by physicians in medicine. We also go over some of the points Dr. Mathew looks out for when interviewing Residency applicants! Have any feedback or episode requests? Reach out to us through Instagram or directly (Wali Pirzada & Sayeed Khan)

If you have a hole in the middle of your heart and it's not supposed to be there, is that a problem? Should it be fixed? The answer is a resounding, "Maybe." Dr. David Thaler and his colleagues looked at the impact of PFO closure on stroke patients and found that often, the best solution is to leave it alone. They developed a scoring system to help neurologists and cardiologist make the best decision on a patient-by-patient basis. Dr. Thaler joins me in this conversation to talk about the research and recommendations. (If you don't see the audio player below, visit http://Strokecast.com/PFO) Click here for a machine generated transcript. About Dr. Thaler Dr. David Thaler, MD, PhD, FAHA, is the Neurologist in Chief at Tufts University Medical school. He is the Chairman and an active professor in the Department of Neurology. Additionally, he continues to treat patients and is a clinician focused on stroke care. He  continues to work to advance the field with a research focus on acute management of cerebrovascular disease, secondary stroke prevention, cryptogenic stroke and patent foramen ovale (PFO). Dr. Thaler's training involves work at: Oxford University John Radcliffe Hospital, UK Brigham and Women's Hospital St. Elizabeth's Medical Center He is a Board Certified specialist in Neurology and Vascular Neurology. Stroke Basics with Dr. David Thaler Dr. Thaler works on projects ranging from advance neurological  research to the fundamentals of stroke education. This video is an excellent, short introduction to stroke  that is also sharable: https://youtu.be/i_gtxYQlECc One of the things that is especially interesting about this video is that in describing the symptoms of stroke the first one he mentions is tingling on one side of the body. This usually isn't mentioned as a stroke symptom by most warnings. In episode 156, coming up in a few weeks, I talk with a survivor who had this exact symptom and was told by first responders that she definitely wasn't having a stroke and by emergency room personnel that she probably wasn't having a stroke. It turns out she was having a stroke. BEFAST and AHORA are excellent starting points for recognizing the signs of a stroke, but they are not comprehensive. They do not cover every sign of stroke. They are just a useful short hand. What is a PFO? A PFO is a hole in the heart. Roughly 25% of the population has one. I have one. Guests Misha Montana and Christine Lee both had PFOs that led to their strokes. After we are born, our blood follows a path through the heart. It comes in the right side. When the heart beats, the blood on the right side heads out of the heart to the lungs. There, it drops of CO2, picks up oxygen, filters out clots, and heads to the left side of the heart. It will pour into the left side and when the heart beats, it sends that oxygen-rich blood on to the brain and other parts of the body. Then that blood drops off its oxygen, picks up CO2, and heads back to the right side of the heart to start the whole cycle over. Before we are born, though, the process is different. While we are developing in our mothers' uteruses, we don't breath air. All the oxygen and nutrients we need to build fingers and toes and kidneys and hearts and brains comes from the umbilical cord. Since we're not breathing air, there's no point in sending blood to the lungs. Instead, in utero it goes straight from the right side of the heart to the left side of the heart through a hole in the middle. That hole is called a Patent Foramen Ovale, or a PFO. It normally closes on its own shortly after we are born. A quarter of the time it doesn't close after birth, and that allows unoxygenated, unfiltered blood to sneak across the heart, skip the lungs and drag a blood clot to the brain. So, if you've had a stroke, and you have a PFO, should you have surgery to close that hole? Maybe. Christine and Misha had their PFOs closed. I did not Dr. Thaler's research helps doctors make the best recommendation for the patient: to close or not? Neurology, Illustrated When you visit the doctor's office, what do you see on the walls? Probably posters showing the warning signs of stroke or heart attack. Maybe information about COVID-19 protection and policies. Probably lots of important, useful, stressful, and boring text. If you visit the Neurology department at Tufts Medical Center, you'll have a different experience. There you'll see art all about neurology -- from centuries old brain drawings to photos reflecting the impact of stroke on world events to modern pieces exploring the diversity of the brain and nervous system we live with today. You can also see these images and read more about them at  Neurology, Illustrated on the Tufts website. Here's a video of Dr. Thaler explaining the program. https://youtu.be/hNodeeqhK8c International Stroke Conference Panel I will be moderating a panel for the Stroke Connection program from the American Heart Association's International Stroke Conference called "Post-Acute Rehabilitation After Stroke: Getting It Right." I'm pretty excited about it. The Stroke Connection program is in its second year. It's goal is to connect researchers and academics with the general stroke community. The idea is that we can all benefit when scholarly scientific research is shared with the broader community. Tickets to the webinar are available from the American Heart Association for $10 each. You can learn more, see the list of all the available webinars, and register to attend here: https://www.stroke.org/es/stroke-connection/iscstrokeconnection/stroke-connection-at-isc-registration Hack of the Week Slow down. Kawan Glover explained that doing tasks after stroke often means stopping and pausing for a few seconds to think about what you want to do. How can you break your task down into smaller tasks and movements. In the pre-stroke days, we could more easily do tasks that involve all sides of our body without even thinking about it. A subtle shift of weight or minuscule flex of a finger could be all it takes to complete a particular movement. We built this symphony of movement gradually over the years from the time we are a new born exploring our limbs to the time of our stroke. After stroke, we may be tempted to do physical things the same way we did before, but we might not be able to yet. The symphony is broken. The automated process is broken. And the consequences could be anything from failing a task to spilling a beverage to falling and picking up another head injury. To reduce the chances of that happening, pause. Take a breath. Break down a task into multiple little steps and figure out how to accomplish them. Then do it. As the carpenters say, "Measure twice. Cut once," Links (If you don't see the list of links below, visit http://Strokecast.com/PFO) [wptb id=2697] Where do we go from here? Check out the links above to review Dr. Thaler's research and learn more. Share this episode with someone you know by giving them the link http://Strokecast.com/PFO. Subscribe to the Strokecast newsletter by going to http://Strokecast.com/news. Don't get best…get better.

Dr. Katherine Fu gives insight to the interesting field of pediatric vascular neurology.

  Click here for a macine generated transcript   Surviving a stroke is not the end of a medical issue. It's the start of a new journey, with new challenges. Major depression is often one of those challenges. It interferes with recovery, rehab, adjusting to a new life, and maintaining relationships. In short, it's big problem. And it's pretty common. According to new research by Dr. Laura Stein from the Icahn School of medicine, depression after stroke is twice as likely to occur as depression after heart attack. There's something unique about stroke that leads to depression. On top of that, if a person lived with Generalized Anxiety Disorder before stroke, they are 1.7 x as likely to experience Major Depression after stroke. In this conversation, Dr. Laura Stein talk about her research and what survivors, caregivers, and medical practitioners need to know. Bio Laura K. Stein, MD, MPH is an Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers. She is board certified in Neurology and Vascular Neurology by the American Board of Psychiatry and Neurology. Dr. Stein received a BA from Amherst College and her MD and MPH from the Icahn School of Medicine at Mount Sinai. She completed her internship, neurology residency, and vascular neurology fellowship at Mount Sinai.  Dr. Stein's interests are in stroke clinical care, stroke outcomes research, and medical education. She is the Neurology Residency Associate Program Director and precepts first year medical students in the Art and Science of Medicine preclinical skills course. Dr. Stein received the Department of Neurology Resident Class of 2020 Award of Appreciation for Dedication & Commitment Towards Excellence in Mentorship and 2020 Institute for Medical Education Excellence in Teaching Award.  The Research Dr. Stein's research was part of the American Stroke Association's virtual International Stroke Conference. You can read the paper here. You can read the article where I first encountered her work here. The approach of looking at depression after heart attack vs looking at depression after stroke is an interesting one. It's a nice way of controlling for other potential causes. The research looked at Medicare recipients, Medicare is a US government health insurance program, generally for folks 65 and older. It lets researchers draw from a rich collection of data. There are two significant tradeoffs, of course. First, it's restricted to the US so there's no international representation in the study. Obviously, depending on the research question in particular, that may or may not be an issue. Second, it's restricted to folks 65 and older. Can we say that the results of this study apply to younger stroke survivors? Maybe? Probably? We don't know. And this study was not designed to answer that question. I'd say it does get us closer, though, and it opens up an opportunity to do further research that asks different but related questions. That's what good studies do. The answer specific question with solid evidence and clear analysis. And the result can introduce new questions for researchers to explore in different studies. In the meantime, it's likely safe to say, that regardless of age, stroke survivors are probably more likely to experience depression, and the community needs to be vigilant for the signs of depression and seek treatment accordingly. Symptoms of Major Depression Diagnosing depression involves identifying symptoms from a couple lists. To "earn" a depression diagnosis, a patient needs 5 symptoms from list 1 and all 4 from list 2. They are: List 1 (Pick 5 or more) Depressed Mood (most days) Loss of Interest or pleasure Weight loss or gain Insomnia or hypersomnia (nearly every day) Psychomotor agitation or limitation Fatigue (nearly every day) Feelings worthless or experiencing inappropriate guilt Decreased concentration (nearly everyday) Thoughts of death or suicide List 2 (All 4) Symptoms cause significant distress or social/professional impairment Symptoms not attributable to a substance or medical condition Symptoms not explained by another disorder No history of manic episodes You can read more details about the symptoms here. You can probably see one of the issues. Many of those symptoms may be directly attributed to the disabilities and brain damage of the stroke without it being Major Depression. That's why it's important to work with a medical professional to tease them apart. Symptoms of Generalized Anxiety Disorder Generalized Anxiety Disorder is about more than feeling nervous. It's more complicated and severe. The National Institute of Mental Health describes it this way: People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. Generalized anxiety disorder symptoms include: Feeling restless, wound-up, or on-edge Being easily fatigued Having difficulty concentrating; mind going blank Being irritable Having muscle tension Difficulty controlling feelings of worry Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep You can read more about the condition here. Neuropsychology While most psychologists and psychiatrists can help stroke survivors and others with depression and other conditions, there is a specialty that may be even more helpful -- neuropsychology. A while back, I talked with Dr. Karen Sullivan from I Care For Your Brain. She wrote the "Interactive Stroke Recovery Guide."*  You can listen to that conversation or learn more at http://Strokecast.com/Karen A neuropsychologist has additional, specialized training to work specifically with folks who have brain injuries. They dive deep into the details of the injury to provide the best customized treatment plan, leveraging expertise that generalists don't have. They work with folks with a wide array of functionality and challenges. FLAME vs FOCUS As long as we are talking about depression, we should also talk about antidepressants a little -- specifically SSRIs and how the relate to stroke. In 2011, the FLAME study was published in the Lancet. In short, it demonstrated that stroke survivors who took Prozac (Fluoxetine) experienced stronger motor recovery. Many hospitals saw those results and began putting more stroke survivors on Prozac because, well, why not? If the patient tolerates it well, and it can help folks work better, it's probably a good idea. And if it reduces or prevent post stroke depression (or other depression) that's a solid win. I talked with Dr. Nirav Shah about this back in November of 2018. You can listen to that episode here. That's how I started on an SSRI in my stay. They originally tried Prozac with me, but I had a not great reaction to it. It apparently gave me an anxiety attack. So we quickly stopped that (thank you, Xanax, I think). We talked about it some more and tried again with a different SSRI -- Lexapro (Escitalopram) because I had tolerated it well during a tough time some years earlier. Cheap, no negative side effects, and potentially helpful is win. A month after my interview with Nirav, and a year and a half after my stroke, the FOCUS study came out, attempting to duplicate the results of the FLAME study on a bigger scale. It failed. The scientific consensus now is that SSRIs do not help with motor recovery. They do still help with depression. The hospital no longer recommends SSRIs as part of the motor recovery protocol. So what does that mean for folks like me? I asked my doctor last year if that meant I should stop taking them. We talked about it and she explained I could certainly stop if I wanted to. "But, dude -- it's 2020." And she had a valid point. (Okay, maybe I paraphrased that) And that's why Escitalopram still has a place in my pill organizer. As always, everyone's stroke and circumstances will vary, so talk to your doctor before making any changes to your medication. Hack of the Week Get a dog. A dog can be helpful after stroke, whether it's a service dog or simply a companion animal. When you have a dog, you have a responsibility to take care of it. You have to feed it, walk it, groom it, and give it cuddles. Sometimes that may be reason enough to get out of bed and get moving for the day. Links Where do we go from here? If you think there's a chance you might be experiencing depression, talk to your medical team Share this episode with someone you know with the link http://Strokecast.com/depression Subscribe to the free, monthly Strokecast email newsletter at http://Strokecast.com/news Don't get best…get better.

A National survey says only 40% of U.S. adults who have witnessed a stroke called 911 as their first reaction.  In fact, stroke symptoms come on suddenly and require immediate emergency care, but only 1 in 5 respondents could recognize 10 signs and symptoms of a stroke. Dr. Sheryl Martin-Schild:Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience.  Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas.Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana.  Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild's research focuses on access to stroke care, racial disparities in the outcome, and augmentation of rehab potential with neurostimulators. She has more than 100 manuscripts published in peer-reviewed journals.   For more information about the signs, symptoms, and risk factors for stroke, visit www.strokeawareness.com 

A National survey says only 40% of U.S. adults who have witnessed a stroke called 911 as their first reaction.  In fact, stroke symptoms come on suddenly and require immediate emergency care, but only 1 in 5 respondents could recognize 10 signs and symptoms of a stroke. Dr. Sheryl Martin-Schild:Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience.  Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas.Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana.  Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild's research focuses on access to stroke care, racial disparities in the outcome, and augmentation of rehab potential with neurostimulators. She has more than 100 manuscripts published in peer-reviewed journals.   For more information about the signs, symptoms, and risk factors for stroke, visit www.strokeawareness.com 

In this episode, I interviewed husband and wife neurologists Dr. Dean Sherzai and Dr. Ayesha Sherzai. We discuss how they utilize a plant-based lifestyle to help prevent many diseases in their patients, different ways for you to be able to stick with healthy habits, and much more! Dr. Dean Sherzai is co-director of the Alzheimer’s Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine, and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University. Dr. Ayesha Sherzai is a neurologist and co-director of the Alzheimer’s Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist. They have also just released their new book “The 30 Day Alzheimer’s Solution” you can check it out at teamsherzai.com To be apart of the healthy minds initiative visit https://www.healthymindsinitiative.org/ To connect with Dr. Dean & Dr. Ayesha: Instagram @sherzaimd Facebook @sherzaimd Twitter @sherzaimd

Dr. Thalia Field is a Stroke Neurologist at Vancouver Coastal Health and Associate Professor at the University of British Columbia. She completed medical school at Dalhousie University followed by residency training in adult neurology at the University of British Columbia; fellowships in Stroke, Vascular Neurology, and Clinical trials at UBC and the University of Calgary; and a Master's of Health Science in Clinical Epidemiology from UBC. As a clinician-researcher, she is the principal investigator on several clinical trials including the Study of Rivaroxaban for CeREbral venous Thrombosis (SECRET). She is also a leader in education—developing the postgraduate stroke fellowship at the Vancouver Stroke Program and currently serving as its program director. Show notes available at northernexposurepodcast.ca

Our guest for this two-part series is Dr. Stephanie Lyden. Dr. Lyden is a stroke neurologist, telemedicine expert, and an assistant professor in the Department of Neurology and the Division of Vascular Neurology. She did her undergrad at the University of Wyoming and medical school training at the University of Washington followed by a residency in neurology at Rush University and a fellowship in vascular neurology here at the University of Utah. In today's podcast, Dr. Lyden is going to help us figure out the best way to set up a telemedicine visit as a provider, how telemedicine has changed rapidly as a result of the Covid-19 pandemic, ways to succeed and overcome the challenges of telemedicine, as well as how to continue to teach while in a telemedicine or virtual environment. Enjoy! You can find additional Telemedicine resources and AMA Credit Information at: https://medicine.utah.edu/students/programs/md/curriculum/ruute/preceptor/cme-podcast.php

: Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience. Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas. Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana. Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild’s research focuses on access to stroke care, racial disparities in outcome, and augmentation of rehab potential with neurostimulants. She has more than 100 manuscripts published in peer-reviewed journals. On behalf of Genentech, a nationwide Stroke Awareness Survey was conducted on March 25 – April 10, 2020 among 2,009 adults ages 35+ in the U.S. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. © 2011 Intermountain Healthcare. All rights reserved. Support for this campaign is provided by Genentech Inc., a member of the Roche Group. © 2020 Genentech USA, Inc. All rights reserved

Welcome to the NeurologyLive Mind Moments podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we're joined by Dr. Shadi Yaghi, an associate professor in the Department of Neurology at NYU Grossman School of Medicine and the Director of Clinical Vascular Neurology Research at NYU Langone Health and of Vascular Neurology at NYU Langone Hospital-Brooklyn. Dr. Yaghi offers his perspective on a recent study he and colleagues conducted of patients with stroke and COVID-19 and the difficulties in understanding their relationship.  For more neurology news and expert-driven content, visit neurologylive.com (https://www.neurologylive.com/) . REFERENCE Yaghi, S, Koto I, Torres J, et al. SARS2-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020;51:00–00. doi: 10.1161/STROKEAHA.120.030335

NATIONAL STROKE AWARENESS MONTH   Special guest: DR. CAROLYN BROCKINGTON Carolyn D. Brockington, MD is the Director of the Stroke Center at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York City. She is board certified by the American Board of Psychiatry and Neurology and has a subspecialty board certification in Vascular Neurology.  In addition, she works with the American Stroke Association (ASA), as a volunteer medical spokesperson, regarding a campaign to increase stroke awareness and highlight prevention strategies, particularly in young adults. She was named one of “New York’s Best Doctors” by New York magazine in 2003 and has written several articles about stroke related issues. 

In Episode 78 I sit down with Neurologists, Drs Dean & Ayesha Sherzai for a second episode on brain health (previously guests for Episode 64). I cannot even begin to describe how brilliant these guys are. In this information packed 2 hour episode we talk about: Creating an environment to help kids flourish The importance of sleep for brain health Tips for optimising sleep Why it's important to be able to hyper focus How to improve focus Removing inhibitions and the practice of 'fearless' living What we should be eating and much more. What makes these two qualified to speak about brain health? Dean Sherzai, MD, PhD, is co-director of the Alzheimer's Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine, and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University. Ayesha Sherzai, MD is a neurologist and co-director of the Alzheimer's Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist. Hope you enjoy the episode friends. If you have any comments or questions, the Sherzais (@teamsherzai) and myself (@plant_proof) would love to hear from you. Please tag us on social media or leave a quick review on iTunes. To learn more about the Sherzai's visit their website. And be sure to keep an eye out for their own Podcast launching soon - I personally cannot wait for it. Want to support the show? If you are enjoying the Plant Proof podcast a great way to support the show is by leaving a review on the Apple podcast app. It only takes a few minutes and helps more people find the episodes. Simon Hill, Nutritionist, Sports Physiotherapist Creator of Plantproof.com and host of the Plant Proof Podcast Author of The Proof is in the Plants Connect with me on Instagram and Twitter Download my two week meal plan

In Episode 78 I sit down with Neurologists, Drs Dean & Ayesha Sherzai for a second episode on brain health (previously guests for Episode 64). I cannot even begin to describe how brilliant these guys are. In this information packed 2 hour episode we talk about:Creating an environment to help kids flourishThe importance of sleep for brain healthTips for optimising sleepWhy it's important to be able to hyper focusHow to improve focusRemoving inhibitions and the practice of 'fearless' livingWhat we should be eating and much more. What makes these two qualified to speak about brain health? Dean Sherzai, MD, PhD, is co-director of the Alzheimer’s Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine, and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University.Ayesha Sherzai, MD is a neurologist and co-director of the Alzheimer’s Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist.Hope you enjoy the episode friends. If you have any comments or questions, the Sherzais (@teamsherzai) and myself (@plant_proof) would love to hear from you. Please tag us on social media or leave a quick review on iTunes. To learn more about the Sherzai's visit their website. And be sure to keep an eye out for their own Podcast launching soon - I personally cannot wait for it.Bali October Retreat:In case you are looking for a week away - I have decided to host a second plant based retreat this year with Journey Retreats October 4-10 in Bali. For now if you are interested in receiving more information about the retreat please email me (simon@plantproof.com) or send me a DM on Instagram with your email and I will have the right people get in touch. The retreats are an incredible week - a mix of exercise, connecting with like minded people, guest speakers, cooking demonstrations, delicious plant based meals and snacks, massages and plenty of down time to relax by the pool or explore the local area.Simon HillCreator of Plantproof.com - your FREE resource for plant based nutrition informationIf you want to receive FREE nutritional information to your inbox subscribe to the Plant Proof NewsletterBook coming out 2020 with Penguin (all proceeds being donated to charity)

Today’s episode of Nutrition Rounds is all about how nutrition effects your brain! We discuss with Dr. Ayesha Sherzai and Dr. Dean Sherzai, how you can PREVENT almost all dementia with whole food plant based nutrition. Yes, a significant amount of Alzheimer’s is preventable with lifestyle modification.  We discuss how plant based nutrition and lifestyle modification lowers your risk of other neurological disease ranging from stroke to multiple sclerosis. This episode is NOT TO BE MISSED!    About Team Sherzai A unique husband and wife team on the cutting edge of brain science, Dr. Dean and Dr. Ayesha Sherzai are dedicated to educating people on the simple steps to long-term health and wellness through their work as Directors of the Alzheimer’s Prevention Program at Loma Linda University Medical Center, with patients, as well as through online writing, videos, and books. There is a tsunami of diseases of the brain such as Alzheimer’s, stroke and Parkinson’s disease permeating our culture. In our own communities and families, we all have known at least one person suffering from these illnesses and in many cases seen the fallout first-hand. There is no treatment for these diseases, and the emotional, financial and social burden is immense. These diseases are thieves, stealing time, money and ravaging the minds of our loved ones. The Sherzais see scientists and physicians working furiously to find a cure or these diseases, and in this frantic race against time somehow, the big picture is usually lost among the molecules and chemicals related to the diseases. As Co-Directors of the Alzheimer’s Prevention Program at Loma Linda University Medical Center, the Sherzais, through research and their extensive collective medical backgrounds, work to demystify the steps to achieving long-term brain health and the prevention of devastating diseases such as Alzheimer’s and dementia. Dean Sherzai, MD, PhD, is co-director of the Alzheimer’s Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine, and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University. Ayesha Sherzai, MD is a neurologist and co-director of the Alzheimer’s Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist.   Remember - this is not individualized medical advice. This is a generalized discussion on health and nutrition. Discuss potential changes in your lifestyle and nutrition with your healthcare provider.   Hosted by: Dr. Danielle Belardo Instagram: @theveggiemd Twitter: @theveggiemd Facebook: The Veggie MD Today’s guest: Team Sherzai Instagram: @teamsherzai Produced by: Dr Kasey Johnson Instagram: @drkaseyjohnson

Dean Sherzai, MD, PhD is co-director of the Alzheimer’s Prevention Program at Loma Linda University. Dean trained in Neurology at Georgetown University School of Medicine and completed fellowships in neurodegenerative diseases and dementia at the National Institutes of Health and UC San Diego. He also holds a PhD in Healthcare Leadership with a focus on community health from Andrews University.   Ayesha Sherzai, MD is a neurologist and co-director of the Alzheimer’s Prevention Program at Loma Linda University, where she leads the Lifestyle Program for the Prevention of Neurological Diseases. She completed a dual training in Preventative Medicine and Neurology at Loma Linda University, and a fellowship in Vascular Neurology and Epidemiology at Columbia University. She is also a trained plant-based culinary artist.   As Co-Directors of the Alzheimer’s Prevention Program at Loma Linda University Medical Center, the Sherzais, through research and their extensive collective medical backgrounds, work to demystify the steps to achieving long-term brain health and the prevention of devastating diseases such as Alzheimer’s and dementia. They are also the authors of the much acclaimed book, The Alzheimer's Solution: A Breakthrough Program to Prevent and Reverse the Symptoms of Cognitive Decline at Every Age (October 2017). For more information, visit TeamSherzai.com     MORE LISTENING OPTIONS Apple Podcasts: http://bit.ly/vdritunes Spotify: http://bit.ly/vdrspotify   TEAM SHERZAI http://TeamSherzai.com https://twitter.com/TeamSherzai https://www.facebook.com/TeamSherzai https://www.instagram.com/teamsherzai/   * * * * MORE FROM ME Read - http://veggiefitkids.com/blog Listen: http://bit.ly/vdrpodcast Watch - http://bit.ly/vfkvideos TEDx Talk - http://bit.ly/DOCTORYAMITEDX   * * * * Exclusive offers, news, and education: SIGN UP - http://bit.ly/veggiefitfamily   SHARE THE EPISODE http://bit.ly/VDRepisode44   Please check out Rocket Surgeons at: Facebook.com/RocketSurgeonsMusic RocketSurgeonsBand.com FIND ME AT Facebook.com/VeggieFitKids Veggiefitkids.com Email me: VeggieDoctor@veggiefitkids.com Remember to share this podcast, rate and review! Have a plantastic day!  

Dr. Clay Johnston, MD, PhD and Dean of the Dell Medical School at The University of Texas at Austin, comes on the show to talk about how Dell Medical School started and how he got involved, an overview of the curriculum and structure of medical education in the U.S, what makes Dell Medical School unique to other medical programs, what changes Dell is looking to make to improve better education to students and community care, how Dell helps with preparing for the STEP exam, what needs to change in medical school education to best prepare students for being physicians in today's day and age and how students/clinicians/educators can contribute to these issues, and more. Biography: Dr. Clay Johnston has served as the inaugural Dean of the Dell Medical School at The University of Texas at Austin since March 2014. His ambitious vision includes building a world-class medical school by creating a vital, inclusive health ecosystem that supports new and innovative models of education and healthcare delivery – all with a focus on improving health and making Austin a model healthy city. He is also a neurologist, specializing in stroke care and research.   He is a graduate of Amherst College and Harvard Medical School. He later received a PhD in epidemiology from the University of California, Berkeley, and was a resident in Neurology at UCSF, where he later trained in Vascular Neurology. During his 20 years at UCSF, he rose the academic ranks to Professor of Neurology and Epidemiology, and directed the Stroke Service. Clay has authored more than 300 publications in scientific journals and has won several national awards for his research and teaching. In particular, he has published extensively in the prevention and treatment of stroke and transient ischemic attack. He is perhaps best known for his studies describing the short-term risk of stroke in patients with transient ischemic attack and identifying patients at greatest risk, and also for his work related to measuring the impact of research. Dell Medical School Website: https://dellmed.utexas.edu/  Video about Dell Medical School: https://dellmed.utexas.edu/about  Dell Medical School Facebook Page: https://www.facebook.com/DellMedicalSchool/  Dell Medical School Twitter Page: https://twitter.com/DellMedSchool  Dell Medical School Instagram Page: https://www.instagram.com/dellmedschool/  Clay's Twitter Page: https://twitter.com/ClayDellMed  EDGE Mobility Website: https://edgemobilitysystem.refersion.com/c/e051d 

Stroke awareness- Our guests today are Paul Singh, MD, MPH, BS – Assist. Professor, Neuroendovascular Surgery and Vascular Neurology at Rutgers New Jersey Medical School & Stroke Survivor Patient, Patrick Johnson, Retired Air Force Reserve Colonel. Our 3rd guest is David Richardson of Assumptions Institute Organization. Since 2011, David Richardson organization has led the effort to help Christian leaders engage with their faith in their public lives.This show is broadcast live on Thursday's 2PM ET on W4CY Radio – (www.w4cy.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/

Dr. Kerri Remmel is the Chief of Vascular Neurology at the University of Louisville. She has been recognized both at the state and national levels for her work in creating the first stroke center in Kentucky as well as the quality of care provided for patients with stroke. In this lecture, Dr. Remmel addresses emergency care of patients with stroke. Her faculty profile can be found here: http://louisville.edu/medicine/departments/neurology/faculty/remmel