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Article ; Online: Sixth Nerve Palsy: Takayasu Arteritis on Digital Subtraction Angiography.

Yi, Cameron / Fara, Michael G

2024 Volume 55, Issue 4, Page(s) e115–e116

MeSH term(s)	Humans ; Angiography, Digital Subtraction ; Takayasu Arteritis/complications ; Takayasu Arteritis/diagnostic imaging ; Magnetic Resonance Angiography ; Abducens Nerve Diseases/diagnostic imaging ; Abducens Nerve Diseases/etiology
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.123.046078
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Article ; Online: A Remote Consult Retinal Artery Occlusion Diagnostic Protocol.

Lema, Gareth M C / De Leacy, Reade / Fara, Michael G / Ginsburg, Robin N / Barash, Alexander / Banashefski, Bryana / Tsai, James C / Rosen, Richard B

Ophthalmology

2024

Abstract: Purpose: To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model.: Design: Retrospective case series and evaluation of a diagnostic test or technology.: Participants: Adult ... ...

Abstract	Purpose: To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model. Design: Retrospective case series and evaluation of a diagnostic test or technology. Participants: Adult patients who presented with painless monocular vision loss and were diagnosed with a nonarteritic retinal artery occlusion. Methods: OCT machines were placed in the stroke center or emergency department at 3 hospitals within our health system. Patients who presented with painless monocular vision loss were evaluated by the stroke neurology service and an OCT was acquired. The images were interpreted remotely by the retina service. An in-house ophthalmology consult was not required to make the final treatment decision. Eligible patients were treated with intra-arterial tissue plasminogen activator (IA-tPA). Patients were followed by ophthalmology during their admission when an in-house consultation service was available or otherwise evaluated immediately after discharge. Main outcome measures: Visual acuity (VA) before and after treatment with IA-tPA; time from last known well (LKW) to treatment; and time from presentation to treatment. Results: In the first 18 months since the protocol went live, 59 patients were evaluated. Twenty-five patients (42%) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients were eligible for treatment, and 9 patients received treatment with IA-tPA. There was a statistically significant improvement in mean VA from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 hours after treatment (P = 0.0001) and logMAR 1.04 after 4 weeks (P = 0.01). Clinically significant improvement was noted in 66% of patients within 24 hours and maintained through 1 month in 56% of all treated patients. The mean time to treatment from LKW was 543 minutes and from presentation at the stroke center was 146 minutes. Conclusions: We report the successful implementation of a remote consult protocol using point-of-care automated OCT. This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies. Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	392083-5
ISSN	1549-4713 ; 0161-6420
ISSN (online)	1549-4713
ISSN	0161-6420
DOI	10.1016/j.ophtha.2023.11.031
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Article ; Online: Teaching NeuroImages: Magnetic resonance perfusion and diffusion findings in hemiplegic migraine.

Thaler, Alison Ilana / Kim, Brian D / Fara, Michael G

Neurology

2020 Volume 95, Issue 12, Page(s) 554–555

MeSH term(s)	Child ; Diffusion Magnetic Resonance Imaging/methods ; Humans ; Male ; Migraine with Aura/diagnostic imaging ; Migraine with Aura/pathology ; Perfusion Imaging/methods
Language	English
Publishing date	2020-07-09
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.0000000000010249
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Article: Ethical Challenges in Acute Evaluation of Suspected Psychogenic Stroke Mimics.

Sequeira, Alexandra J / Fara, Michael G / Lewis, Ariane

The Journal of clinical ethics

2018 Volume 29, Issue 3, Page(s) 185–190

Abstract: Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, ... ...

Abstract	Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology.
MeSH term(s)	Aged ; Cocaine-Related Disorders/complications ; Diagnosis, Differential ; Ethics, Clinical ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Hemiplegia/etiology ; Humans ; Male ; Malingering/diagnosis ; Middle Aged ; Sinus Thrombosis, Intracranial/complications ; Somatoform Disorders/diagnosis ; Stroke/diagnosis ; Stroke/psychology ; Tissue Plasminogen Activator/administration & dosage ; Tissue Plasminogen Activator/adverse effects
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2018-09-18
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1122655-9
ISSN	1046-7890
ISSN	1046-7890
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Article ; Online: Creating ophthalmology experiences in undergraduate medical education: pilot of a cased-based learning ophthalmology tool.

Tran, Jessica H / Loebel, Emma / Edouard, Mark / Quehl, Thomas / Walsh, Erin / Ginsburg, Robin / Frempong, Tameisha / Fredrick, Douglas / Stein, Laura K / Fara, Michael G / Farouk, Samira S / Chadha, Nisha

BMC medical education

2023 Volume 23, Issue 1, Page(s) 559

Abstract: Purpose: To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum.: Methods: We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, ... ...

Abstract	Purpose: To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum. Methods: We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, adapted from NephSIM (www.nephsim.com). The tool was first piloted with the internal medicine (IM) residents. After confirming a need, we focused on undergraduate medical education (UME) by expanding the 20/20 SIM content and partnering with the neurology (pilot academic year [AY] 2020-2021) and pediatric clerkships (pilot AY 2021-2022) to deliver a facilitated one-hour ophthalmology workshop within each clerkship's didactic curriculum. We evaluated the tool using pre- and post-surveys and knowledge assessments. Results: Of 80 IM residents, 33 (41.3%) completed the needs assessment. Of the 25 residents who attended the workshop, 23 (92.0%) completed the exit survey. IM residents reported discomfort in several ophthalmology domains (9 of 14 rated mean score < 3.0), confirming a need. Most (n = 21/23, 91.3%) rated the tool as good/excellent. Of 145 neurology clerkship students, 125 (86.2%) and at least 88 (60.7%) students completed the pre- and post-test/exit surveys, respectively. On average, participants highly rated the tool, perceiving 20/20 SIM to be relevant to their education [4.1 (0.8)]. Mean pre- to post-test knowledge scores increased from 7.5 to 8.5/10.0 points (p < 0.001). Of the 136 pediatric clerkship students, 67 (49.3%) and 51 (37.5%) completed the pre- and post-surveys, respectively. Respondents perceived increased comfort with ophthalmology topics after the facilitated workshop [3.8 (0.8)]. Mean pre- to post-test knowledge scores trended from 1.8 to 2.0/5.0 points (p = 0.30). Collectively, 20/139 (14.4%) of exit survey respondents visited www.2020sim.com within 1 month after the workshop. Conclusion: After identifying areas of greatest need with residents, we partnered with core clerkships to deliver cross-disciplinary ophthalmology content in UME. We found high engagement with 20/20 SIM, with trends toward increased knowledge.
MeSH term(s)	Humans ; Child ; Education, Medical, Undergraduate ; Ophthalmology ; Clinical Clerkship ; Curriculum ; Students, Medical
Language	English
Publishing date	2023-08-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-023-04514-8
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Article ; Online: Macrothrombosis and stroke in patients with mild Covid-19 infection.

Fara, Michael G / Stein, Laura K / Skliut, Maryna / Morgello, Susan / Fifi, Johanna T / Dhamoon, Mandip S

Journal of thrombosis and haemostasis : JTH

2020 Volume 18, Issue 8, Page(s) 2031–2033

Abstract: Coronavirus disease 2019 (COVID-19) is a pandemic disease currently affecting millions of people worldwide. Its neurological implications are poorly understood, and further study is urgently required. A hypercoagulable state has been reported in patients ...

Abstract	Coronavirus disease 2019 (COVID-19) is a pandemic disease currently affecting millions of people worldwide. Its neurological implications are poorly understood, and further study is urgently required. A hypercoagulable state has been reported in patients with severe COVID-19, but nothing is known about coagulopathy in patients with milder disease. We describe cases of patients in New York City presenting with stroke secondary to large vessel thrombosis without occlusion, incidentally found to have COVID-19 with only mild respiratory symptoms. This is in contrast to the venous thrombosis and microangiopathy that has been reported in patients with severe COVID-19. Our cases suggest that even in the absence of severe disease, patients with COVID-19 may be at increased risk of thrombus formation leading to stroke, perhaps resulting from viral involvement of the endothelium. Further systematic study is needed because this may have implications for primary and secondary stroke prevention in patients with COVID-19.
MeSH term(s)	Adult ; Aged ; Anticoagulants/therapeutic use ; Betacoronavirus/isolation & purification ; Biomarkers ; C-Reactive Protein/analysis ; COVID-19 ; Carotid Artery Thrombosis/blood ; Carotid Artery Thrombosis/diagnostic imaging ; Carotid Artery Thrombosis/drug therapy ; Carotid Artery Thrombosis/etiology ; Cerebral Angiography ; Computed Tomography Angiography ; Coronavirus Infections/blood ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Hemiplegia/etiology ; Humans ; Infarction, Middle Cerebral Artery/blood ; Infarction, Middle Cerebral Artery/diagnostic imaging ; Infarction, Middle Cerebral Artery/drug therapy ; Infarction, Middle Cerebral Artery/etiology ; Magnetic Resonance Angiography ; Male ; Middle Aged ; New York City/epidemiology ; Pandemics ; Pneumonia, Viral/blood ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Thrombophlebitis/complications
Chemical Substances	Anticoagulants ; Biomarkers ; Fibrin Fibrinogen Degradation Products ; fibrin fragment D ; C-Reactive Protein (9007-41-4)
Keywords	covid19
Language	English
Publishing date	2020-06-25
Publishing country	England
Document type	Case Reports
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1111/jth.14938
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Article: Controversies in Cardiopulmonary Death.

Fara, Michael G / Chancellor, Breehan / Lord, Aaron S / Lewis, Ariane

The Journal of clinical ethics

2017 Volume 28, Issue 2, Page(s) 97–101

Abstract: We describe two unusual cases of cardiopulmonary death in mechanically ventilated patients in the neurological intensive care unit. After cardiac arrest, both patients were pulseless for a protracted period. Upon extubation, both developed agonal ... ...

Abstract	We describe two unusual cases of cardiopulmonary death in mechanically ventilated patients in the neurological intensive care unit. After cardiac arrest, both patients were pulseless for a protracted period. Upon extubation, both developed agonal movements (gasping respiration) resembling life. We discuss these cases and the literature on the ethical and medical controversies associated with determining time of cardiopulmonary death. We conclude that there is rarely a single moment when all of a patient's physiological functions stop working at once. This can pose a challenge for determining the exact moment of death.
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	1122655-9
ISSN	1046-7890
ISSN	1046-7890
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Article ; Online: Macrothrombosis and stroke in patients with mild Covid‐19 infection

Fara, Michael G. / Stein, Laura K. / Skliut, Maryna / Morgello, Susan / Fifi, Johanna T. / Dhamoon, Mandip S.

Journal of Thrombosis and Haemostasis

2020 Volume 18, Issue 8, Page(s) 2031–2033

Keywords	Hematology ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1111/jth.14938
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Article: Macrothrombosis and stroke in patients with mild Covid-19 infection

Fara, Michael G / Stein, Laura K / Skliut, Maryna / Morgello, Susan / Fifi, Johanna T / Dhamoon, Mandip S

J Thromb Haemost

Abstract	Coronavirus disease 2019 (COVID-19) is a pandemic disease currently affecting millions of people worldwide. Its neurological implications are poorly understood, and further study is urgently required. A hypercoagulable state has been reported in patients with severe COVID-19, but nothing is known about coagulopathy in patients with milder disease. We describe cases of patients in New York City presenting with stroke secondary to large vessel thrombosis without occlusion, incidentally found to have COVID-19 with only mild respiratory symptoms. This is in contrast to the venous thrombosis and microangiopathy that has been reported in patients with severe COVID-19. Our cases suggest that even in the absence of severe disease, patients with COVID-19 may be at increased risk of thrombus formation leading to stroke, perhaps resulting from viral involvement of the endothelium. Further systematic study is needed because this may have implications for primary and secondary stroke prevention in patients with COVID-19.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #401717
Database	COVID19

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Article ; Online: Exceptional fossil assemblages confirm the existence of complex Early Triassic ecosystems during the early Spathian.

Smith, Christopher P A / Laville, Thomas / Fara, Emmanuel / Escarguel, Gilles / Olivier, Nicolas / Vennin, Emmanuelle / Goudemand, Nicolas / Bylund, Kevin G / Jenks, James F / Stephen, Daniel A / Hautmann, Michael / Charbonnier, Sylvain / Krumenacker, L J / Brayard, Arnaud

Scientific reports

2021 Volume 11, Issue 1, Page(s) 19657

Abstract: The mass extinction characterizing the Permian/Triassic boundary (PTB; ~ 252 Ma) corresponds to a major faunal shift between the Palaeozoic and the Modern evolutionary fauna. The temporal, spatial, environmental, and ecological dynamics of the associated ...

Abstract	The mass extinction characterizing the Permian/Triassic boundary (PTB; ~ 252 Ma) corresponds to a major faunal shift between the Palaeozoic and the Modern evolutionary fauna. The temporal, spatial, environmental, and ecological dynamics of the associated biotic recovery remain highly debated, partly due to the scarce, or poorly-known, Early Triassic fossil record. Recently, an exceptionally complex ecosystem dated from immediately after the Smithian/Spathian boundary (~ 3 myr after the PTB) was reported: the Paris Biota (Idaho, USA). However, the spatiotemporal representativeness of this unique assemblage remained questionable as it was hitherto only reported from a single site. Here we describe three new exceptionally diverse assemblages of the same age as the Paris Biota, and a fourth younger one. They are located in Idaho and Nevada, and are taxonomic subsets of the Paris Biota. We show that the latter covered a region-wide area and persisted at least partially throughout the Spathian. The presence of a well-established marine fauna such as the Paris Biota, as soon as the early Spathian, indicates that the post-PTB biotic recovery and the installation of complex ecosystems probably took place earlier than often assumed, at least at a regional scale.
Language	English
Publishing date	2021-10-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-99056-8
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