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    • All Executive Page EAN News EAN Congress news Interviews
      EAN News

      Plans in progress for 30th Anniversary of the European Journal of Neurology (1994-2024)

      December 6, 2023

      Advocacy

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Executive Page

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      Executive Page

      Executive Page: Join or renew your membership now and celebrate 10 years of the EAN

      November 6, 2023

      Executive Page

      Executive Page: Advocacy for brain health gaining momentum across the neurological landscape

      October 1, 2023

      Executive Page Dear EAN members, dear friends, It is my pleasure to give you an update on behalf of the EAN Scientific Committee following a busy year since my appointment as chair. It has been a privilege to be so deeply involved in the scientific activities of the EAN and to work closely with an amazing community of people who are so dedicated to the advancement of neurology. One of the strongest threads within that community is the EAN’s group of Scientific Panels, which are often referred to as the organisation’s ‘scientific backbone’. The panels have a hand in everything the EAN does from a scientific point of view, including coordinating clinical research, disseminating good practice, assisting in planning the EAN annual congress, supporting the EAN’s educational efforts, and producing guidelines that assist neurologists in daily practice. All of this work requires a considerable amount of oversight, and this is why each panel is run by its own Management Group, elected by the panel members. Being a part of one of these Management Groups (PDF) is an opportunity to play a direct part in determining the direction of scientific progress within Europe, and I am excited to say that the call for applications to stand for election will be announced in September. All panel members and EAN individual members are eligible to apply to be candidates, with the vote being held among the existing panel members in autumn. I would like to urge every neurologist with a passion for the scientific future of their special area of interest to consider standing for election to the relevant Management Group and to look out for the call for applications later this month. I can tell you from personal experience that fulfilling a role such as this within the structure of the EAN is a fascinating and extremely rewarding experience. The chance to take on such a unique leadership position should not be missed! The most satisfying aspect of being involved in the EAN’s organisational structure is surely seeing all the hard work and planning come to fruition when a small idea evolves into a newly launched project. One such example is the 1st EAN Science School, taking place in Salzburg next March. The idea of the Science School is to offer early career neurologists with an interest in translational research a new avenue for learning about basic pathomechanisms of neurological disorders. Application for this very first edition, on ‘Pathophysiology of disorders of the nervous system’, closed last week and we have been delighted with the level of interest. It was a pleasure to be part of the task force in charge of planning this new project and I look forward to seeing it officially transferred to the hands of the Scientific Committee after a successful event and evaluation in spring. Of our ongoing activities, one of the most significant is the EAN Neuro-covid Registry, which aims to collate epidemiological data on neurological manifestations in patients with COVID-19 infection reported by neurologists in outpatient services, emergency rooms, and hospital departments. We currently have 1,542 patients entered in the database, from 35 centres across 23 countries. So far, 29 patients have been followed for 12 months and 387 have completed the 6-months follow up. This is a decent start, but I would like to strongly encourage EAN members and their institutions to get involved and contribute cases to what will become an invaluable resource for neurologists and clinicians to improve care for Covid-19 patients. Finally, I would like share a word on a forthcoming collaboration between EAN and the Human Brain Project in December, that I think will interest a lot of EAN members. The EAN-EBRAINS joint workshop on ‘The future of medical data sharing in clinical neurosciences’ will be a three-day virtual event that aims to discuss issues and challenges associated with data sharing in Europe, from ethics to data safety and privacy, including those specific to data federation, such as the development and validation of federated algorithms. The whole workshop is completely free of charge and registration is open until 25 November, so please check out the details and sign up! I wish you all a healthy and pleasant autumn and I look forward to updating you again. Best wishes Thomas Berger Chair of the EAN Scientific Committee

      Executive Page: Management Group elections are coming – run for office and help shape our future!

      September 1, 2023

      EAN News

      Plans in progress for 30th Anniversary of the European Journal of Neurology (1994-2024)

      December 6, 2023

      EAN News

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      EAN News

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      EAN News One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      EAN Congress news

      EAN 2024 – Abstract submission and registration OPEN!

      November 22, 2023

      EAN Congress news

      Burden of Sleep/Wake Disorders Project at EAN Congress 2023

      October 19, 2023

      EAN Congress news

      African Academy of Neurology features in Special Studio Session at EAN 2023

      July 25, 2023

      EAN Congress news

      Find photos, facts, figures and reports in our EAN Congress Review

      July 24, 2023

      Interviews

      Video Interview: Prof. Mary Reilly, Moritz Romberg lecturer at EAN 2023

      July 4, 2023

      Interviews

      Video Interview: Mark Hallett, C. Brown-Séquard lecturer at EAN 2023

      July 3, 2023

      Interviews

      Video Interview: Josep Dalmau, Camillo Golgi Lecturer at EAN 2023

      July 2, 2023

      Interviews

      Video Interview: Dementia & Cognitive Disorders Panel Co-Chairs

      September 8, 2022

  • Research
    • All Paper of the Month Research Highlights
      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Paper of the Month

      Research Paper of the Month: Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH)

      November 6, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – November 2023

      November 6, 2023

      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Paper of the Month

      Research Paper of the Month: Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH)

      November 6, 2023

      Paper of the Month

      Research Paper of the Month: Transdermal Nicotine Treatment and Progression of Early Parkinson’s Disease

      October 1, 2023

      Paper of the Month

      Research Paper of the Month: Soluble Nogo-Receptor-Fc decoy (AXER-204) in patients with chronic cervical spinal cord injury in the USA

      September 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – November 2023

      November 6, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – October 2023

      October 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – September 2023

      September 1, 2023

  • Education
    • All eLearning Student Corner Resident and Research Fellows Fellowship reports
      eLearning

      End 2023 with highlighted content on the eanCampus!

      December 2, 2023

      Resident and Research Fellows

      EAN Spring School 2024 – Apply NOW until 31 January 2024

      December 1, 2023

      Resident and Research Fellows

      EAN Autumn School 2023: Report

      November 30, 2023

      eLearning

      Call for Applications: e-Learning Platform Associate Editors

      November 7, 2023

      eLearning

      End 2023 with highlighted content on the eanCampus!

      December 2, 2023

      eLearning

      Call for Applications: e-Learning Platform Associate Editors

      November 7, 2023

      eLearning

      Kick off the new season with highlights on the eanCampus

      October 13, 2023

      eLearning

      World Brain Day with the European Academy of Neurology

      July 21, 2023

      Student Corner

      Student Teaser Fellowship reports 2022 – Pisa, London, & Lausanne

      September 13, 2023

      Student Corner Illustration of a vertical pencil point on a blue background, with a yellow light bulb above it

      Student Corner: My EAN Congress experience

      September 5, 2023

      Student Corner

      Student Teaser Fellowship reports 2022 – Rotterdam, London, & Paris

      August 22, 2023

      Student Corner

      Student Teaser Fellowship winners 2023

      June 28, 2023

      Resident and Research Fellows

      EAN Spring School 2024 – Apply NOW until 31 January 2024

      December 1, 2023

      Resident and Research Fellows

      EAN Autumn School 2023: Report

      November 30, 2023

      Resident and Research Fellows

      Research Fellowship Report 2022 – Oxford Autoimmune Neurology Group

      September 16, 2023

      Resident and Research Fellows

      Research Fellowship Report 2022 – Centre Hospitalier Universitaire Vaudois, Lausanne

      September 15, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Oxford Autoimmune Neurology Group

      September 16, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Centre Hospitalier Universitaire Vaudois, Lausanne

      September 15, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Department of Neuromuscular Diseases Institute, University College London

      September 14, 2023

      Fellowship reports

      Student Teaser Fellowship reports 2022 – Pisa, London, & Lausanne

      September 13, 2023

  • Other News
    • All EAN Staff EBC News in general Surveys
      EAN Staff

      EAN Head Office Profiles: Ulla & Piyapat

      December 1, 2023

      EAN Staff

      EAN Head Office Profiles: Maria & Immanuel

      November 7, 2023

      Advocacy

      Brain community launches Call to Action during Brain Health & Research Day at UNGA78

      October 19, 2023

      EAN News

      Brain Innovation Days 2023: Meet the speakers!

      October 2, 2023

      EAN Staff

      EAN Head Office Profiles: Ulla & Piyapat

      December 1, 2023

      EAN Staff

      EAN Head Office Profiles: Maria & Immanuel

      November 7, 2023

      EAN Staff

      EAN Head Office Profiles: Kathrin & Sasha

      August 28, 2023

      EAN Staff Anja Sander receiving flowers at the end of EAN Congress 2023

      Celebrating 20 Years of Excellence: Anja Sander, EAN’s Executive Director!

      August 3, 2023

      EBC

      Brain community launches Call to Action during Brain Health & Research Day at UNGA78

      October 19, 2023

      EBC

      Brain Innovation Days 2023: Meet the speakers!

      October 2, 2023

      EBC

      Brain Innovation Days: Discover the early programme and register today!

      July 21, 2023

      EBC

      Join the community’s calls for a European Brain Research and Innovation Plan

      July 21, 2023

      News in general

      WHO’s Intersectoral Global Action Plan on epilepsy and other neurological disorders (IGAP) published in all six UN languages

      August 3, 2023

      News in general

      WHO recognises the public health need for effective and affordable treatments for multiple sclerosis

      August 3, 2023

      News in general

      Brain Innovation Days: Discover the early programme and register today!

      July 21, 2023

      News in general

      Join the community’s calls for a European Brain Research and Innovation Plan

      July 21, 2023

      Surveys

      Neurorehabilitation Across Europe after Ischemic and Traumatic Brain Injuries: a survey to increase knowledge on brain-injury-specific neurorehabilitation

      July 14, 2023

      Surveys

      ILAE survey on genetic testing in the epilepsies

      July 14, 2023

      Surveys

      COVID-19 and neurology: a survey of previous and continued restrictions on clinical practice, professional education and neuroeconomics

      March 3, 2023

      Surveys

      Help EAN contribute towards the development of a European Pain Research strategy

      December 5, 2022

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eanpages

  • EAN News
    • All Executive Page EAN News EAN Congress news Interviews
      EAN News

      Plans in progress for 30th Anniversary of the European Journal of Neurology (1994-2024)

      December 6, 2023

      Advocacy

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Executive Page

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      Executive Page

      Executive Page: Join or renew your membership now and celebrate 10 years of the EAN

      November 6, 2023

      Executive Page

      Executive Page: Advocacy for brain health gaining momentum across the neurological landscape

      October 1, 2023

      Executive Page Dear EAN members, dear friends, It is my pleasure to give you an update on behalf of the EAN Scientific Committee following a busy year since my appointment as chair. It has been a privilege to be so deeply involved in the scientific activities of the EAN and to work closely with an amazing community of people who are so dedicated to the advancement of neurology. One of the strongest threads within that community is the EAN’s group of Scientific Panels, which are often referred to as the organisation’s ‘scientific backbone’. The panels have a hand in everything the EAN does from a scientific point of view, including coordinating clinical research, disseminating good practice, assisting in planning the EAN annual congress, supporting the EAN’s educational efforts, and producing guidelines that assist neurologists in daily practice. All of this work requires a considerable amount of oversight, and this is why each panel is run by its own Management Group, elected by the panel members. Being a part of one of these Management Groups (PDF) is an opportunity to play a direct part in determining the direction of scientific progress within Europe, and I am excited to say that the call for applications to stand for election will be announced in September. All panel members and EAN individual members are eligible to apply to be candidates, with the vote being held among the existing panel members in autumn. I would like to urge every neurologist with a passion for the scientific future of their special area of interest to consider standing for election to the relevant Management Group and to look out for the call for applications later this month. I can tell you from personal experience that fulfilling a role such as this within the structure of the EAN is a fascinating and extremely rewarding experience. The chance to take on such a unique leadership position should not be missed! The most satisfying aspect of being involved in the EAN’s organisational structure is surely seeing all the hard work and planning come to fruition when a small idea evolves into a newly launched project. One such example is the 1st EAN Science School, taking place in Salzburg next March. The idea of the Science School is to offer early career neurologists with an interest in translational research a new avenue for learning about basic pathomechanisms of neurological disorders. Application for this very first edition, on ‘Pathophysiology of disorders of the nervous system’, closed last week and we have been delighted with the level of interest. It was a pleasure to be part of the task force in charge of planning this new project and I look forward to seeing it officially transferred to the hands of the Scientific Committee after a successful event and evaluation in spring. Of our ongoing activities, one of the most significant is the EAN Neuro-covid Registry, which aims to collate epidemiological data on neurological manifestations in patients with COVID-19 infection reported by neurologists in outpatient services, emergency rooms, and hospital departments. We currently have 1,542 patients entered in the database, from 35 centres across 23 countries. So far, 29 patients have been followed for 12 months and 387 have completed the 6-months follow up. This is a decent start, but I would like to strongly encourage EAN members and their institutions to get involved and contribute cases to what will become an invaluable resource for neurologists and clinicians to improve care for Covid-19 patients. Finally, I would like share a word on a forthcoming collaboration between EAN and the Human Brain Project in December, that I think will interest a lot of EAN members. The EAN-EBRAINS joint workshop on ‘The future of medical data sharing in clinical neurosciences’ will be a three-day virtual event that aims to discuss issues and challenges associated with data sharing in Europe, from ethics to data safety and privacy, including those specific to data federation, such as the development and validation of federated algorithms. The whole workshop is completely free of charge and registration is open until 25 November, so please check out the details and sign up! I wish you all a healthy and pleasant autumn and I look forward to updating you again. Best wishes Thomas Berger Chair of the EAN Scientific Committee

      Executive Page: Management Group elections are coming – run for office and help shape our future!

      September 1, 2023

      EAN News

      Plans in progress for 30th Anniversary of the European Journal of Neurology (1994-2024)

      December 6, 2023

      EAN News

      Executive Page: European neurology united as ever heading into milestone year

      December 6, 2023

      EAN News

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      EAN News One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      EAN Congress news

      EAN 2024 – Abstract submission and registration OPEN!

      November 22, 2023

      EAN Congress news

      Burden of Sleep/Wake Disorders Project at EAN Congress 2023

      October 19, 2023

      EAN Congress news

      African Academy of Neurology features in Special Studio Session at EAN 2023

      July 25, 2023

      EAN Congress news

      Find photos, facts, figures and reports in our EAN Congress Review

      July 24, 2023

      Interviews

      Video Interview: Prof. Mary Reilly, Moritz Romberg lecturer at EAN 2023

      July 4, 2023

      Interviews

      Video Interview: Mark Hallett, C. Brown-Séquard lecturer at EAN 2023

      July 3, 2023

      Interviews

      Video Interview: Josep Dalmau, Camillo Golgi Lecturer at EAN 2023

      July 2, 2023

      Interviews

      Video Interview: Dementia & Cognitive Disorders Panel Co-Chairs

      September 8, 2022

  • Research
    • All Paper of the Month Research Highlights
      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Paper of the Month

      Research Paper of the Month: Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH)

      November 6, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – November 2023

      November 6, 2023

      Paper of the Month

      Research Paper of the Month: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

      December 4, 2023

      Paper of the Month

      Research Paper of the Month: Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH)

      November 6, 2023

      Paper of the Month

      Research Paper of the Month: Transdermal Nicotine Treatment and Progression of Early Parkinson’s Disease

      October 1, 2023

      Paper of the Month

      Research Paper of the Month: Soluble Nogo-Receptor-Fc decoy (AXER-204) in patients with chronic cervical spinal cord injury in the USA

      September 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – December 2023

      December 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – November 2023

      November 6, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – October 2023

      October 1, 2023

      Research Highlights One glowing light bulb that stands out from unlit or dim lamps on a blue background

      Research Highlights of the Month – September 2023

      September 1, 2023

  • Education
    • All eLearning Student Corner Resident and Research Fellows Fellowship reports
      eLearning

      End 2023 with highlighted content on the eanCampus!

      December 2, 2023

      Resident and Research Fellows

      EAN Spring School 2024 – Apply NOW until 31 January 2024

      December 1, 2023

      Resident and Research Fellows

      EAN Autumn School 2023: Report

      November 30, 2023

      eLearning

      Call for Applications: e-Learning Platform Associate Editors

      November 7, 2023

      eLearning

      End 2023 with highlighted content on the eanCampus!

      December 2, 2023

      eLearning

      Call for Applications: e-Learning Platform Associate Editors

      November 7, 2023

      eLearning

      Kick off the new season with highlights on the eanCampus

      October 13, 2023

      eLearning

      World Brain Day with the European Academy of Neurology

      July 21, 2023

      Student Corner

      Student Teaser Fellowship reports 2022 – Pisa, London, & Lausanne

      September 13, 2023

      Student Corner Illustration of a vertical pencil point on a blue background, with a yellow light bulb above it

      Student Corner: My EAN Congress experience

      September 5, 2023

      Student Corner

      Student Teaser Fellowship reports 2022 – Rotterdam, London, & Paris

      August 22, 2023

      Student Corner

      Student Teaser Fellowship winners 2023

      June 28, 2023

      Resident and Research Fellows

      EAN Spring School 2024 – Apply NOW until 31 January 2024

      December 1, 2023

      Resident and Research Fellows

      EAN Autumn School 2023: Report

      November 30, 2023

      Resident and Research Fellows

      Research Fellowship Report 2022 – Oxford Autoimmune Neurology Group

      September 16, 2023

      Resident and Research Fellows

      Research Fellowship Report 2022 – Centre Hospitalier Universitaire Vaudois, Lausanne

      September 15, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Oxford Autoimmune Neurology Group

      September 16, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Centre Hospitalier Universitaire Vaudois, Lausanne

      September 15, 2023

      Fellowship reports

      Research Fellowship Report 2022 – Department of Neuromuscular Diseases Institute, University College London

      September 14, 2023

      Fellowship reports

      Student Teaser Fellowship reports 2022 – Pisa, London, & Lausanne

      September 13, 2023

  • Other News
    • All EAN Staff EBC News in general Surveys
      EAN Staff

      EAN Head Office Profiles: Ulla & Piyapat

      December 1, 2023

      EAN Staff

      EAN Head Office Profiles: Maria & Immanuel

      November 7, 2023

      Advocacy

      Brain community launches Call to Action during Brain Health & Research Day at UNGA78

      October 19, 2023

      EAN News

      Brain Innovation Days 2023: Meet the speakers!

      October 2, 2023

      EAN Staff

      EAN Head Office Profiles: Ulla & Piyapat

      December 1, 2023

      EAN Staff

      EAN Head Office Profiles: Maria & Immanuel

      November 7, 2023

      EAN Staff

      EAN Head Office Profiles: Kathrin & Sasha

      August 28, 2023

      EAN Staff Anja Sander receiving flowers at the end of EAN Congress 2023

      Celebrating 20 Years of Excellence: Anja Sander, EAN’s Executive Director!

      August 3, 2023

      EBC

      Brain community launches Call to Action during Brain Health & Research Day at UNGA78

      October 19, 2023

      EBC

      Brain Innovation Days 2023: Meet the speakers!

      October 2, 2023

      EBC

      Brain Innovation Days: Discover the early programme and register today!

      July 21, 2023

      EBC

      Join the community’s calls for a European Brain Research and Innovation Plan

      July 21, 2023

      News in general

      WHO’s Intersectoral Global Action Plan on epilepsy and other neurological disorders (IGAP) published in all six UN languages

      August 3, 2023

      News in general

      WHO recognises the public health need for effective and affordable treatments for multiple sclerosis

      August 3, 2023

      News in general

      Brain Innovation Days: Discover the early programme and register today!

      July 21, 2023

      News in general

      Join the community’s calls for a European Brain Research and Innovation Plan

      July 21, 2023

      Surveys

      Neurorehabilitation Across Europe after Ischemic and Traumatic Brain Injuries: a survey to increase knowledge on brain-injury-specific neurorehabilitation

      July 14, 2023

      Surveys

      ILAE survey on genetic testing in the epilepsies

      July 14, 2023

      Surveys

      COVID-19 and neurology: a survey of previous and continued restrictions on clinical practice, professional education and neuroeconomics

      March 3, 2023

      Surveys

      Help EAN contribute towards the development of a European Pain Research strategy

      December 5, 2022

EAN NewsEAN Congress news

EAN/ESO: Recent advances in acute stroke pathophysiology and treatment

June 22, 2021

by Benedetta Bodini

This interesting session covering updates on acute stroke pathogenesis and treatment started with a lecture by Dr Meinel from Switzerland, who provided a comprehensive description of covert brain infarction. He first focused on incidental covert brain infarctions, underlining that the incidental finding of an asymptomatic brain infarction is very frequent, reaching 30% in 70-year-old patients, and is even higher in patients with cardiovascular risk factors. Covert brain infarctions are mostly localised in the basal ganglia, but they can also be found in cortical and infratentorial regions. Dr Meinel then discussed risk factors for covert brain infarctions, which include carotid arteriosclerosis and atrial fibrillation, but also previous cardiac surgery and carotid endarterectomy. He then underlined that patients with covert brain infarctions are at higher risk for manifest stroke, dementia and mood disorders. Dr Meinel moved onto summarising the ESO guidelines for covert cerebrovascular small vessel disease, and indicated that an ongoing clinical trial is currently investigating whether aspirin might be beneficial for patients with different types of covert brain infarction. In the second part of his lecture, Dr Meinel discussed the interesting topic of covert brain infarctions in patients with manifest stroke, which were found in more than 37% of the patients with first-ever acute stroke included in his most recent study. He then detailed the results of this study, indicating that in his cohort several vascular risk factors were associated with the presence of covert brain infarctions, and that the etiology of the acute ischaemic stroke differed according to the presence, number and imaging phenotype of covert brain infarctions. Dr Meinel concluded by noting that chronic covert brain infarctions might potentially be used to develop individualised diagnostic work-up and specific therapeutic approaches for patients with first-ever acute ischaemic stroke.

In the second lecture of the session, Dr Li from the UK focused on the key role of hypertension in secondary stroke prevention. She first presented the results of one of her studies, where it was found that recent premorbid blood pressure control is strongly temporarily related to acute lacunar events at younger ages, and then showed that hypertension is associated with stroke recurrence specifically in lacunar strokes. Dr Li then underlined that the causal role of hypertension is not limited to lacunar events, but is critical in all major stroke subtypes. She indicated that blood pressure lowering has been shown to reduce the risk of recurrent stroke, vascular death and any other vascular event, and might also be associated with reduced risk of post stroke dementia. While both ESC/ESH and NICE guidelines indicate the need to introduce a treatment for blood pressure control in patients with an acute cerebrovascular event, Dr Li questioned the reliability of clinic blood pressure measurements, showing that her data demonstrate that there is little correlation between clinic blood pressure and home blood pressure readings, with home blood pressure readings being overall more reliable than clinic blood pressure measurements. She indicated that patients with TIA/stroke should be started on blood pressure lowering drugs (ACE inhibitors, thiazide-like diuretics, and calcium-channel blockers) within ideally a couple of days of home monitoring before treatment initiation, and showed the evidence supporting that the target systolic blood pressure is below 130 mmHg. She concluded her lecture mentioning that the results of a clinical study investigating the best timing for lowering blood pressure treatments (morning vs evening) should be available in the next few months.

In the third lecture of this session, Dr Ribo from Spain presented the results of his study which investigated whether stroke subjects with suspicion of large vessel occlusion evaluated by emergency medical services in the field have higher rates of favorable outcome when transferred directly to an endovascular treatment stroke center, despite a greater transfer time and a considerably longer delay to initiate treatment, as compared to the standard transfer to the closest local stroke center for thrombolysis followed by a second transfer to an endovascular treatment center, if needed. Over three years, more than 1,400 stroke patients were included in the study. Dr Ribo first showed that in terms of complications both options could be considered safe for stroke patients, even in the case of severe events. Patients being treated in local stroke centers for thrombolysis and then transferred to an endovascular treatment stroke center received overall a lower proportion of endovascular treatments which were also significantly delayed compared to those who were transferred directly to an endovascular treatment stroke center. Dr Ribo showed that overall, disability at three months post-stroke was not different between the two groups, but suggested that it would be important to identify patient subpopulations who might benefit from direct transfer to an endovascular treatment stroke center. Dr Rubio concluded that the presence of contraindications to thrombolysis should encourage emergency medical services to directly transfer patients to endovascular treatment stroke centers, while if the patient is likely to be a candidate for thrombolysis, and the transfer time to the endovascular treatment center is longer than 200 minutes, the initial transfer to the closest local stroke center should be preferred.

Dr Katan from Switzerland focused the last lecture of this session on the identification of underlying cardiac sources of stroke in the context of secondary stroke prevention. She first gave a reminder that every fourth person will suffer a stroke in their lifetime, and that stroke patients are at higher risk of recurring events. A suboptimal control of risk factors, particularly at younger ages and in male patients, is a major contributor to the high rate of recurring strokes. In addition to risk factor management, key strategies of secondary prevention include specific treatments based on presumed stroke etiology, such as oral anticoagulation in atrial fibrillation patients. In this context, Dr Katan then focused on describing the currently ‘recognized high-risk’ atrial, valvular and ventricular cardiac sources of embolism. She reminded that oral anticoagulation is more effective than antiplatelet treatment in preventing recurrent stroke in patients with atrial fibrillation, and indicated that closure of patent foramen ovale has been shown to be more effective than medical treatment, particularly in patients with large shunts. Dr Katan moved onto reminding that the underlying etiology of a stroke remains unknown in 30% of cases, but several studies have identified undetected atrial fibrillation as the possible underlying cause of many cryptogenic strokes. However, the results of clinical trials testing direct oral anticoagulation versus antiplatelet treatment in patients with embolic stroke of undetermined source were neutral, probably due to the heterogeneity of the underlying cause of cryptogenic strokes. Dr Katan then described the possible sources of currently unrecognised cardiac embolism, and mentioned left atrial fibrosis, endothelial dysfunction and chamber dilatation, impaired contractility with reduced left atrial ejection fraction and parasympathetic dysfunction. To identify atrial myopathy, in addition to echocardiologic biomarkers, cardiac MRI biomarkers should also be employed, such as delayed enhancement and changes in left atrium flow velocities. She then indicated that natriuretic peptides have been shown to be very promising blood biomarkers of undetected atrial fibrillation, and that these peptides may become key factors in guiding secondary prevention in stroke patients in future.

EAN/ESO: Recent advances in acute stroke pathophysiology and treatment was last modified: June 22nd, 2021 by Simon Lee
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