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Article ; Online: Asymmetric cerebral edema presenting with severe neurologic impairment and seizures after cardiac and thoracic interventions.

Migdady, Ibrahim / Rae-Grant, Alexander

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2020 Volume 29, Issue 8, Page(s) 105003

Abstract: Introduction: A syndrome of focal neurologic deficits with characteristic imaging features, acute encephalopathy, and seizures after cardiac and thoracic interventions has been previously briefly reported in the literature. In a retrospective ... ...

Abstract	Introduction: A syndrome of focal neurologic deficits with characteristic imaging features, acute encephalopathy, and seizures after cardiac and thoracic interventions has been previously briefly reported in the literature. In a retrospective observational study, we aim to identify the prevalence and characteristics of this syndrome, in addition to discussing the possible underlying pathophysiology. Methods: In a retrospective study, we reviewed records of consecutive adult patients (≥18 years old) who underwent cardiac and thoracic procedures at a single institution between September 2014 to September 2019 and found to have evidence of focal cerebral edema following their procedure. We included and reported clinical course of patients who developed post-operative neurologic dysfunction and underwent magnetic resonance imaging (MRI) showing (1) asymmetric cerebral edema with (2) cortical diffusion restriction and (3) T2 cortical or subcortical hyperintensity and (4) no proximal vascular occlusion. Results: Three out of 107 patients (2.8%) met our inclusion criteria. These represented one male and two females with age at presentation of 63, 81 and 69, respectively. All patients developed severe neurologic impairment on the same day following their procedure (sternotomy with valve or bypass surgery in 2 patients; esophageal dilatation procedure in 1 patient). All patients underwent MRI of the brain and vessel imaging qualifying our inclusion criteria. Two patients improved neurologically prior to discharge, and one patient expired after family elected to withdraw care. Conclusion: We present a series of cases with a rare syndrome after cardiac and thoracic interventions. Although the exact mechanism of this syndrome remains unclear, we believe it to be related to relative cerebral hyperperfusion and cerebral dysautoregulation following anesthesia and thoracic manipulation. Future studies should focus on understanding the true prevalence and pathophysiology of this syndrome.
MeSH term(s)	Aged ; Aged, 80 and over ; Brain/diagnostic imaging ; Brain/physiopathology ; Brain Edema/diagnosis ; Brain Edema/epidemiology ; Brain Edema/physiopathology ; Brain Edema/therapy ; Cardiac Surgical Procedures/adverse effects ; Cerebrovascular Disorders/diagnosis ; Cerebrovascular Disorders/epidemiology ; Cerebrovascular Disorders/physiopathology ; Cerebrovascular Disorders/therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurologic Examination ; Ohio/epidemiology ; Prevalence ; Recovery of Function ; Retrospective Studies ; Risk Factors ; Seizures/diagnosis ; Seizures/epidemiology ; Seizures/physiopathology ; Seizures/therapy ; Syndrome ; Thoracic Surgical Procedures/adverse effects ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2020-06-13
Publishing country	United States
Document type	Case Reports ; Journal Article ; Observational Study
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2020.105003
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Article: Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke.

Migdady, Ibrahim / Johnson-Black, Phoebe H / Leslie-Mazwi, Thabele / Malhotra, Rishi

Journal of clinical medicine

2023 Volume 12, Issue 20

Abstract: The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core ... ...

Abstract	The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core infarcts, even when large volumes of salvageable brain tissue were present, due to the high risk of hemorrhagic transformation and reperfusion injury. However, recent retrospective and prospective studies have shown improved outcomes with endovascular thrombectomy, and several clinical trials were recently published to evaluate the efficacy of endovascular management of patients presenting with large-core infarcts. With or without thrombectomy, patients with large-core infarcts remain at high risk of in-hospital complications such as hemorrhagic transformation, malignant cerebral edema, seizures, and others. Expert neurocritical care management is necessary to optimize blood pressure control, mitigate secondary brain injury, manage cerebral edema and elevated intracranial pressure, and implement various neuroprotective measures. Herein, we present an overview of the current and emerging evidence pertaining to endovascular treatment for large-core infarcts, recent advances in neurocritical care strategies, and their impact on optimizing patient outcomes.
Language	English
Publishing date	2023-10-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12206641
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Article ; Online: Atrial Fibrillation and Ischemic Stroke: A Clinical Review.

Migdady, Ibrahim / Russman, Andrew / Buletko, Andrew B

Seminars in neurology

2021 Volume 41, Issue 4, Page(s) 348–364

Abstract: Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was ...

Abstract	Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of undetermined source may require long-term monitoring to detect silent or paroxysmal AF. Stroke prevention in patients at risk, assessed by the CHA
MeSH term(s)	Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Brain Ischemia/diagnosis ; Brain Ischemia/prevention & control ; Humans ; Ischemic Stroke ; Risk Factors ; Stroke/diagnosis ; Stroke/etiology ; Stroke/prevention & control
Chemical Substances	Anticoagulants
Language	English
Publishing date	2021-04-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0041-1726332
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Article ; Online: Clinical and radiographic resolution of multifocal brain abscesses secondary to Fusobacterium.

Mulpur, Bhageeradh / Migdady, Ibrahim / Mays, MaryAnn

Neurology

2020 Volume 95, Issue 16, Page(s) 749–750

MeSH term(s)	Aged ; Anti-Bacterial Agents/therapeutic use ; Brain Abscess/diagnostic imaging ; Brain Abscess/microbiology ; Brain Abscess/pathology ; Fusobacterium/genetics ; Fusobacterium/isolation & purification ; Fusobacterium Infections/complications ; Fusobacterium Infections/diagnosis ; Fusobacterium Infections/genetics ; Humans ; Male ; Meropenem/therapeutic use ; Polymerase Chain Reaction
Chemical Substances	Anti-Bacterial Agents ; Meropenem (FV9J3JU8B1)
Language	English
Publishing date	2020-09-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000010732
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Article ; Online: Brain death evaluation during the pandemic.

Migdady, Ibrahim / Rae-Grant, Alexander / Greer, David M

Neurology

2020 Volume 95, Issue 15, Page(s) 693–694

Abstract: Coronavirus disease 2019 (COVID-19) may pose unique challenges to clinicians attempting to diagnose brain death in patients infected with the SARS-CoV-2. Among these challenges is the risk of aerosol generation during the traditional apnea testing using ... ...

Abstract	Coronavirus disease 2019 (COVID-19) may pose unique challenges to clinicians attempting to diagnose brain death in patients infected with the SARS-CoV-2. Among these challenges is the risk of aerosol generation during the traditional apnea testing using the insufflation technique in addition to the risk of complications due to SARS-CoV-2-related lung disease. In this article, we discuss these challenges and provide further guidance to minimize such risks to ensure safety of healthcare professionals and other patients. We also emphasize the importance of maintaining the standards of brain death determination in this critical time.
MeSH term(s)	Betacoronavirus ; Brain Death/diagnosis ; COVID-19 ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Insufflation/methods ; Neurologic Examination/methods ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-07-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000010544
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Ui II Zs.153: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: A 69-year-old woman with double vision and lower-extremity weakness.

Migdady, Ibrahim / Mays, MaryAnn / Levin, Kerry H

Cleveland Clinic journal of medicine

2019 Volume 86, Issue 6, Page(s) 374–379

MeSH term(s)	Aged ; Central Nervous System Diseases/complications ; Central Nervous System Diseases/diagnosis ; Diagnosis, Differential ; Diplopia/diagnosis ; Diplopia/etiology ; Female ; Humans ; Lower Extremity/physiopathology ; Muscle Weakness/diagnosis ; Muscle Weakness/etiology ; Waldenstrom Macroglobulinemia/complications ; Waldenstrom Macroglobulinemia/diagnosis
Language	English
Publishing date	2019-06-16
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.86a.18113
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Article: Atrial Fibrillation and Ischemic Stroke: A Clinical Review

Migdady, Ibrahim / Russman, Andrew / Buletko, Andrew B.

Seminars in Neurology

(Neurology of Cardiovascular Disease)

2021 Volume 41, Issue 04, Page(s) 348–364

Series title	Neurology of Cardiovascular Disease
Abstract	Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of undetermined source may require long-term monitoring to detect silent or paroxysmal AF. Stroke prevention in patients at risk, assessed by the CHA 2 DS 2 -VASc score, was traditionally achieved with warfarin; however, direct oral anticoagulants have solidified their role as safe and effective alternatives. Additionally, left atrial appendage exclusion has emerged as a viable option in patients intolerant of anticoagulation. When patients with AF have an acute stroke, the timing of initiation or resumption of anticoagulation for secondary stroke prevention has to be balanced against the risk of hemorrhagic conversion. Multiple randomized clinical trials are currently underway to determine the best timing for administration of anticoagulants following acute ischemic stroke.
Keywords	ischemic stroke ; atrial fibrillation ; thromboembolism ; anticoagulation ; left atrial appendage closure
Language	English
Publishing date	2021-04-13
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0041-1726332
Database	Thieme publisher's database

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Zs.A 1737: Show issues

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Article ; Online: Cerebral Hyperperfusion and Delayed Coma Recovery after Subdural Hematoma Evacuation.

Migdady, Ibrahim / Chen, Patrick / Loza, Alejandra Márquez / Cashman, Christopher R / Izzy, Saef

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2021 Volume 30, Issue 12, Page(s) 106165

Abstract: Acute subdural hematoma is a devastating neurological injury with significant morbidity and mortality. In patients with large subdural hematoma resulting in compression of the underlying brain and lateral brain shift, severe neurological deficits and ... ...

Abstract	Acute subdural hematoma is a devastating neurological injury with significant morbidity and mortality. In patients with large subdural hematoma resulting in compression of the underlying brain and lateral brain shift, severe neurological deficits and coma can occur. Emergent neurosurgical decompression is a life-saving intervention which improves mortality and neurological function. Persistent coma despite subdural hematoma evacuation is often the result of persistent midline shift, cerebral infarctions related to initial elevated intracranial pressure and herniation, nonconvulsive seizures, and other metabolic and infectious causes; however, a subset of patients remains comatose without a discernable etiology. In this report, we describe an elderly patient who remained comatose without a known cause for several weeks after subdural hematoma evacuation and was found to have delayed cerebral hyperperfusion on brain imaging. After several days, there was marked recovery of consciousness which occurred in a timeframe that matched improvement in brain imaging findings. Cerebral hyperperfusion following subdural hematoma evacuation requires further investigation, and should be considered as a cause of persistent but potentially recoverable coma.
MeSH term(s)	Aged ; Brain/diagnostic imaging ; Brain/physiopathology ; Coma/etiology ; Coma/rehabilitation ; Hematoma, Subdural/surgery ; Humans ; Postoperative Complications
Language	English
Publishing date	2021-10-16
Publishing country	United States
Document type	Case Reports
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2021.106165
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Article ; Online: Cannabis Use and Stroke: Does a Risk Exist?

Swetlik, Carol / Migdady, Ibrahim / Hasan, Leen Z / Buletko, Andrew Blake / Price, Carrie / Cho, Sung-Min

Journal of addiction medicine

2021 Volume 16, Issue 2, Page(s) 208–215

Abstract: Aims: Cannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use.: Methods: We searched MEDLINE and 6 other databases from inception to January 2020 for ... ...

Abstract	Aims: Cannabis use has been reported as a risk factor for stroke. We systematically review the prevalence and outcomes of stroke in people with cannabis use. Methods: We searched MEDLINE and 6 other databases from inception to January 2020 for studies on the relationship between cannabis use and stroke. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Two independent reviewers extracted the data. Study quality was assessed by the Newcastle-Ottawa Scale for cohort and case-control studies. Results: Seventeen studies involving 3,185,560 people with cannabis use were included. Descriptive statistics demonstrated 18,676 (median 1.1%, interquartile range [IQR] 0.3%-1.3%) experienced stroke compared with 0.8% of those without use (Odds Ratio 1.17, 95% CI 1.10-1.25). Among people with cannabis use, median age was 26.2 years (IQR 25.2-34.3 years) and mostly male (median 57.8%). Of stroke subtypes, ischemic stroke was most prevalent (median 1.2%, IQR 0.4%-1.9%), followed by undefined stroke subtype (median 1.2%, IQR 1.1%-1.2%) and hemorrhagic stroke (median 0.3%, IQR 0.1%-0.6%). The majority of people with cannabis use who experienced stroke survived (median: 85.1%, IQR 83%-87.5%) and 64.0% of people experienced a good neurologic outcome, defined as modified Rankin Scale of 0 to 3. Few studies included outcomes of vasospasm or seizure. Conclusions: In people with cannabis use, the prevalence of ischemic stroke and hemorrhagic stroke was 1.2% and 0.3%, respectively, higher than the prevalence of people without use (0.8% and 0.2%). There is insufficient information on timing, exposure, duration, and dose-responsive relationship.
MeSH term(s)	Adult ; Cannabis ; Case-Control Studies ; Cohort Studies ; Female ; Humans ; Male ; Risk Factors ; Stroke/epidemiology
Language	English
Publishing date	2021-05-17
Publishing country	Netherlands
Document type	Journal Article ; Systematic Review
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000000870
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Determination of Brain Death in Patients Undergoing Short-Term Mechanical Circulatory Support Devices.

Migdady, Ibrahim / Shoskes, Aaron / Amin, Moein / Cho, Sung-Min / Rae-Grant, Alexander / George, Pravin

Heart, lung & circulation

2021 Volume 31, Issue 2, Page(s) 239–245

Abstract: Objective: To describe apnoea test (AT) and ancillary study performance for brain death (BD) determination among patients undergoing short-term mechanical circulatory support (MCS) devices, including extracorporeal membrane oxygenation (ECMO) and intra- ... ...

Abstract	Objective: To describe apnoea test (AT) and ancillary study performance for brain death (BD) determination among patients undergoing short-term mechanical circulatory support (MCS) devices, including extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP). Methods: We retrospectively analysed data regarding use of AT and ancillary study in consecutive adult patients who were diagnosed with BD while on MCS devices (including ECMO and IABP) over a 10-year period. Results: Out of 140 patients, eight were on MCS devices at the time of BD (four ECMO, two ECMO and IABP, two IABP). The most common aetiology of BD was hypoxic ischaemic brain injury (6/8, 75%). In four patients (50%), the AT was not attempted because of haemodynamic instability and ECMO; in the remaining four (50%), both AT and ancillary studies were used. In three patients on ECMO, AT was performed by reducing the ECMO sweep flow rate to a range 0.5-2.7 L/min in order to achieve hypercarbia. One patient underwent AT while on IABP which was complicated by hypotension. All patients underwent ancillary tests, most commonly transcranial Doppler ultrasonography (TCD) (7/8, 88%); among those, cerebral circulatory arrest was confirmed in six of seven patients (86%), all of whom had left ventricular ejection fracture (LVEF) ≥20% and/or were supported with IABP. Conclusions: There are multiple uncertainties regarding BD diagnosis while on MCS, prompting the need for ancillary studies in most patients. Our study shows that TCD can be used to support BD diagnosis in patients on ECMO who have sufficient cardiac contractility and/or IABP to produce pulsatile flow. TCD use in ECMO patients low LVEF needs further study.
MeSH term(s)	Adult ; Brain Death ; Extracorporeal Membrane Oxygenation ; Heart-Assist Devices ; Humans ; Intra-Aortic Balloon Pumping ; Retrospective Studies ; Shock, Cardiogenic/therapy
Language	English
Publishing date	2021-06-29
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2020980-0
ISSN	1444-2892 ; 1443-9506
ISSN (online)	1444-2892
ISSN	1443-9506
DOI	10.1016/j.hlc.2021.05.100
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