Talk:Stroke

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Citation under Pathophysiology: Ischemic Subheading, last sentence of paragraph two[edit]

Study found "Even though the change in [Ca2+]c was if anything enhanced, cell viability was improved, arguing that mitochondrial Ca2+ uptake plays a critical role in driving cell death. " (Duchen 2012) Name of journal article: "Mitochondria, calcium-dependent neuronal death and neurodegenerative disease"; Published online 2012 May 22. doi: 10.1007/s00424-012-1112-0

Semi-protected edit request on 13 March 2017[edit]

Please add the following female-specific risk factors: Hypertensive disorders during pregnancy increase the risk of ischemic stroke. Late menopause and gestational hypertension increase the risk of hemorrhagic stroke. Oophorectomy, hypertensive disorders during pregnancy, preterm delivery, and stillbirth increase the risk of any stroke. Hysterectomy is possibly protective against any stroke.

Please add the following male-specific risk factors: Medical androgen deprivation therapy increases the risk of ischemic stroke. Medical androgen deprivation therapy and erectile dysfunction increase the risk of any stroke.

Source: PMID: 27842176 194.151.7.238 (talk) 13:57, 13 March 2017 (UTC)

Will have a look at some point. If anyone wants to beat me to it the article is a recent (Jan 2017) systematic review that is bound to meet WP:MEDRES. PriceDL (talk) 15:27, 13 March 2017 (UTC)
Not done: please provide reliable sources that support the change you want to be made. —MRD2014 📞 contribs 15:00, 18 April 2017 (UTC)

Definition[edit]

This is a definition "is when poor blood flow to the brain results in cell death"

This is the cause "is the result of poor blood flow to the brain, resulting in cell death."

IMO the first sentence should be used. Others thoughts? Doc James (talk · contribs · email) 02:35, 23 June 2017 (UTC)

Interventional neuroradiology and mechanical thrombectomy[edit]

A new paragraph explaining mechanical thrombectomy should be added in the "Management" section, in addition to thrombolysis and surgery/craniectomy. After the publication of five major trials appeared in NEJM in 2015, it became the standard therapy for AIS (acute ischemic stroke) with LVO (large vessel occlusion, e.g. internal carotid or middle cerebral or basilar artery) in all the major hospitals with an interventional neuroradiology unit.

It is important to update the page because this treatment is really a game-changer. I can provide text and sources if you want. Here's the semplification of the procedure: https://www.youtube.com/watch?v=7gn96se6j00&feature=youtu.be

Some sources: 1^ Main trials and European guidelines (ESO-ESNR-ESMINT): https://www.swissneuroradiology.ch/tl_files/events/Consensus_thrombectomy_ESO_Karolinska_ESMINT_ESNR.PDF 2^ Availability in the USA: https://www.ncbi.nlm.nih.gov/pubmed/27895242 3^ AHA-ASA on stroke treatment: http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatment_UCM_492017_SubHomePage.jsp 4^ AHA "new approach urged": http://news.heart.org/guidelines-urge-new-approach-to-treating-worst-strokes/ 5^ NHS on thrombectomy: https://www.theguardian.com/society/2017/apr/11/nhs-england-stroke-treatment-mechanical-thrombectomy — Preceding unsigned comment added by PaoloMD (talkcontribs) 10:48, 22 July 2017 (UTC)

We already have such as section Stroke#Surgery Doc James (talk · contribs · email) 14:56, 22 July 2017 (UTC)
Hello Doc James. The section linked is about surgical prevention (i.e. carotid TEA, even if stenting is also cited); but also in the "Treatment:Surgery" section, endovascular and surgical treatments are confused and mixed because the word "thrombectomy" is not present at all and the "removal of the clot" is described as "surgical" (it is not).
There are also more errors: AHA recommends administration of tPA within 4.5h (not 3h); endovascular intervention within 6h (not 7h); the meta-analysis published on JAMA supporting the statement "It however does not change the risk of death" is 2 years old and takes into accounts methods that are not used anymore in the clinical practice; actually thrombectomy does change mortality if patients are correctly selected: [1]. On the other side intra-arterial fibrinolysis, cited as a procedure that improves the outcome, is not performed anymore at all! — Preceding unsigned comment added by PaoloMD (talkcontribs) 16:38, 22 July 2017 (UTC)
It is the second "surgery section" you are looking for. SPecifically it says
"Surgical removal of the blood clot causing the ischemic stroke may improve outcomes if done within 7 hours of the start of symptoms in those with an anterior circulation large artery clot."Doc James (talk · contribs · email) 23:50, 22 July 2017 (UTC)
You wrote about "surgical prevention", but I answered about "surgical treatment". The removal of the clot is not surgical, but that's not the main point (it is matter of definitions): the main point is that endovascular therapy is today the standard treatment in the western world and the argument is way underestimated in the article. Also there are many errors concerning guidelines, as I already mentioned.
It would be interesting to read opinions from other users on this topic. — Preceding unsigned comment added by PaoloMD (talkcontribs) 16:47, 25 July 2017 (UTC)
I did write about surgical treatment. Agree surgical removal is now a well accepted treatment. We even include a picture of the device. Doc James (talk · contribs · email) 17:52, 25 July 2017 (UTC)

References