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Article: Carotid Web as a Source of Thromboembolism in a Young African American Female.

Assid, Eric / Hall, Chad / Samad, Mawadah / Zweifler, Richard

Ochsner journal

2024 Volume 24, Issue 1, Page(s) 87–89

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Case Reports
ISSN	1524-5012
ISSN	1524-5012
DOI	10.31486/toj.23.0082
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Article ; Online: Initial Assessment and Triage of the Stroke Patient.

Zweifler, Richard M

Progress in cardiovascular diseases

2017 Volume 59, Issue 6, Page(s) 527–533

Abstract: Nearly 800,000 strokes occur in the United States each year, and stroke is the leading cause of preventable permanent disability. Timely recognition and treatment are imperative to reduce stroke-related morbidity and mortality. Given the evidence ... ...

Abstract	Nearly 800,000 strokes occur in the United States each year, and stroke is the leading cause of preventable permanent disability. Timely recognition and treatment are imperative to reduce stroke-related morbidity and mortality. Given the evidence supporting intravenous thrombolysis and mechanical thrombectomy for ischemic stroke, stroke symptoms must be rapidly identified and mimics quickly excluded prior to therapeutic decisions. Intravenous tissue plasminogen activator is recommended for all qualified patients and patients with presentations suggesting large vessel occlusion should be evaluated for mechanical thrombectomy. Time to treatment is the most important prognostic factor for clinical outcome, highlighting the importance of reliable and efficient local and regional systems of care.
MeSH term(s)	Algorithms ; Critical Pathways ; Decision Support Techniques ; Delivery of Health Care, Integrated ; Early Diagnosis ; Fibrinolytic Agents/administration & dosage ; Humans ; Infusions, Intravenous ; Predictive Value of Tests ; Stroke/diagnosis ; Stroke/mortality ; Stroke/therapy ; Thrombectomy ; Thrombolytic Therapy/methods ; Time Factors ; Time-to-Treatment ; Tissue Plasminogen Activator/administration & dosage ; Treatment Outcome ; Triage
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1873-1740 ; 1532-8643 ; 0033-0620
ISSN (online)	1873-1740 ; 1532-8643
ISSN	0033-0620
DOI	10.1016/j.pcad.2017.04.004
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Article: Diagnostic accuracy of telestroke consultation: a Louisiana based tele-network experience.

Poongkunran, Mugilan / Ulep, Robin D / Stuntz, Gage A / Mitchell, Sara / Gaines, Kenneth J / Vidal, Gabriel / Chehebar, Daniel / Iwuchukwu, Ifeanyi O / McGrade, Harold / Mohammed, Alaa E / Zweifler, Richard M

Frontiers in neurology

2023 Volume 14, Page(s) 1141059

Abstract: Background and purpose: Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to ... ...

Abstract	Background and purpose: Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics. Methods: We conducted a retrospective study of all the consultations in our Ochsner Health's TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis. Results: Eight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR- were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749-0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3-2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis. Conclusion: We report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.
Language	English
Publishing date	2023-06-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1141059
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Article: Management of acute stroke.

Zweifler, Richard M

Southern medical journal

2003 Volume 96, Issue 4, Page(s) 380–385

Abstract: Stroke ranks as the third leading cause of death and the most common cause of permanent disability in adults. Timely recognition and treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be ... ...

Abstract	Stroke ranks as the third leading cause of death and the most common cause of permanent disability in adults. Timely recognition and treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be evaluated for administration of intravenous tissue plasminogen activator (t-PA); those who do not qualify for t-PA should receive aspirin therapy in the absence of a contraindication. In all stroke patients, intravenous hydration with normal saline should be administered, hypoxia should be corrected with supplemental oxygen, and hyperglycemia and fever should be treated aggressively. Blood pressure management should be individualized on the basis of stroke pathophysiology and specific treatment plan (e.g., planned thrombolysis) following published guidelines. Evaluation of stroke etiology should be undertaken, and the results should be used to guide secondary stroke prevention efforts.
MeSH term(s)	Algorithms ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Contraindications ; Diagnosis, Differential ; Fibrinolytic Agents/therapeutic use ; Humans ; Stroke/diagnosis ; Stroke/drug therapy ; Stroke/physiopathology ; Tissue Plasminogen Activator/therapeutic use ; United States/epidemiology
Chemical Substances	Antihypertensive Agents ; Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2003-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	185329-6
ISSN	1541-8243 ; 0038-4348
ISSN (online)	1541-8243
ISSN	0038-4348
DOI	10.1097/01.SMJ.0000063467.75456.7A
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Article: Membrane stabilizer: citicoline.

Zweifler, Richard M

Current medical research and opinion

2002 Volume 18 Suppl 2, Page(s) s14–7

Abstract: Brain ischaemia leads to a cascade of biochemical events, many of which ultimately cause cell membrane injury. Therefore, measures aimed at protecting neuronal membranes could be useful treatment strategies following stroke. Citicoline (cytidine-5- ... ...

Abstract	Brain ischaemia leads to a cascade of biochemical events, many of which ultimately cause cell membrane injury. Therefore, measures aimed at protecting neuronal membranes could be useful treatment strategies following stroke. Citicoline (cytidine-5-diphosphocholine; CDP-choline) is a naturally occurring nucleotide derivative that may reduce central nervous system (CNS) ischaemic injury by stabilizing cell membranes and reducing free radical generation. Several animal models of ischaemic stroke or hypoxia have shown beneficial effects of citicoline treatment. Randomized clinical stroke treatment trials performed outside of the United States (US) have shown promising results but several recent US trials have failed to support the use of citicoline following middle cerebral artery (MCA) stroke. It remains possible that more specific subgroups of patients may benefit from this well tolerated therapy, but these subgroups have yet to be determined. In addition, there remains the possibility that efficacy may be seen when citicoline is administered in combination with other neuroprotectants with complementary mechanisms of action.
MeSH term(s)	Animals ; Cell Membrane/drug effects ; Cytidine Diphosphate Choline/pharmacology ; Cytidine Diphosphate Choline/therapeutic use ; Europe ; Humans ; Japan ; Nootropic Agents/pharmacology ; Nootropic Agents/therapeutic use ; Randomized Controlled Trials as Topic ; Stroke/drug therapy ; United States
Chemical Substances	Nootropic Agents ; Cytidine Diphosphate Choline (536BQ2JVC7)
Language	English
Publishing date	2002
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80296-7
ISSN	1473-4877 ; 0300-7995
ISSN (online)	1473-4877
ISSN	0300-7995
DOI	10.1185/030079902125000679
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Article ; Online: Neurological Impact of Coronavirus Disease of 2019: Practical Considerations for the Neuroscience Community.

Werner, Cassidy / Scullen, Tyler / Mathkour, Mansour / Zeoli, Tyler / Beighley, Adam / Kilgore, Mitchell D / Carr, Christopher / Zweifler, Richard M / Aysenne, Aimee / Maulucci, Christopher M / Dumont, Aaron S / Bui, Cuong J / Keen, Joseph R

World neurosurgery

2020 Volume 139, Page(s) 344–354

Abstract: Background: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million ... ...

Abstract	Background: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement. Methods: We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines. Results: Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings. Conclusions: The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.
MeSH term(s)	Adult ; Aged ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/therapy ; Female ; Humans ; Male ; Middle Aged ; Nervous System Diseases/diagnosis ; Nervous System Diseases/etiology ; Nervous System Diseases/therapy ; Neurosciences/trends ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/therapy ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-05-06
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2020.04.222
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Article: Progress in shivering control.

Mahmood, M Asim / Zweifler, Richard M

Journal of the neurological sciences

2007 Volume 261, Issue 1-2, Page(s) 47–54

Abstract: Hypothermia is a potent neuroprotectant and induced hypothermia holds great promise as a therapy for acute neuronal injury. Thermoregulatory responses, most notably shivering, present major obstacles to therapeutic temperature management. A review of ... ...

Abstract	Hypothermia is a potent neuroprotectant and induced hypothermia holds great promise as a therapy for acute neuronal injury. Thermoregulatory responses, most notably shivering, present major obstacles to therapeutic temperature management. A review of thermoregulatory physiology and strategies aimed at controlling physiologic responses to hypothermia is presented.
MeSH term(s)	Adrenergic alpha-Agonists/pharmacology ; Analgesics, Opioid/pharmacology ; Anesthetics/pharmacology ; Body Temperature Regulation/physiology ; Humans ; Hypothermia/prevention & control ; Muscle Relaxation/physiology ; Serotonin Antagonists/pharmacology ; Serotonin Receptor Agonists/pharmacology ; Serotonin Uptake Inhibitors/pharmacology ; Shivering/drug effects ; Shivering/physiology
Chemical Substances	Adrenergic alpha-Agonists ; Analgesics, Opioid ; Anesthetics ; Serotonin Antagonists ; Serotonin Receptor Agonists ; Serotonin Uptake Inhibitors
Language	English
Publishing date	2007-10-15
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2007.04.038
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Article: Neurological Impact of Coronavirus Disease of 2019: Practical Considerations for the Neuroscience Community

World Neurosurg

Abstract: BACKGROUND: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million ... ...

Abstract	BACKGROUND: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement. METHODS: We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines. RESULTS: Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings. CONCLUSIONS: The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #438350
Database	COVID19

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Article ; Online: Neurological Impact of Coronavirus Disease of 2019

Werner, Cassidy / Scullen, Tyler / Mathkour, Mansour / Zeoli, Tyler / Beighley, Adam / Kilgore, Mitchell D. / Carr, Christopher / Zweifler, Richard M. / Aysenne, Aimee / Maulucci, Christopher M. / Dumont, Aaron S. / Bui, Cuong J. / Keen, Joseph R.

Practical Considerations for the Neuroscience Community

2020

Abstract	BACKGROUND: The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement.METHODS: We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines.RESULTS: Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings.CONCLUSIONS: The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.
Keywords	Central-Nervous-System ; Infection ; Sars ; Receptor ; covid19
Subject code	610
Language	English
Publishing date	2020-07-01
Publisher	ELSEVIER SCIENCE INC
Publishing country	au
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Description of a novel telemedicine-enabled comprehensive system of care: drip and ship plus drip and keep within a system of stroke care delivery.

Commiskey, Patricia / Afshinnik, Arash / Cothren, Elizabeth / Gropen, Toby / Iwuchukwu, Ifeanyi / Jennings, Bethany / McGrade, Harold C / Mora-Guillot, Julia / Sabharwal, Vivek / Vidal, Gabriel A / Zweifler, Richard M / Gaines, Kenneth

Journal of telemedicine and telecare

2017 Volume 23, Issue 3, Page(s) 428–436

Abstract: United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines "drip and ship" and "drip ... ...

Abstract	United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines "drip and ship" and "drip and keep" models with a comprehensive stroke center primary hub at Ochsner Medical Center in New Orleans, advanced stroke-capable regional hubs, and geographically-aligned, "stroke-ready" spokes. The primary hub provides vascular neurology expertise via telemedicine and monitors care for patients remaining at regional hubs and spokes using a multidisciplinary team approach. By 2014, primary hub telestroke consults grew to ≈1000/year with 16 min average door to consult initiation and 20 min to completion, and 29% of ischemic stroke patients received recombinant tissue-type plasminogen activator (rtPA), increasing 275%. Most patients remained in hospitals close to home, but neurointensive care and interventional procedures were common reasons for primary hub transfer. Given the time sensitivity and expert consultation needed for complex acute stroke care delivery paradigms, telestroke programs are effective for fulfilling unmet care needs. Combining drip and ship and drip and keep management allows more patients to stay "local," limiting primary hub transfer unless more advanced services are required. Post admission telestroke management at spokes increases personnel efficiency and can positively impact stroke outcomes.
MeSH term(s)	Emergency Service, Hospital ; Fibrinolytic Agents/therapeutic use ; Humans ; Stroke/drug therapy ; Telemedicine/methods ; Thrombolytic Therapy/methods ; Tissue Plasminogen Activator/therapeutic use
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2017-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1340281-x
ISSN	1758-1109 ; 1357-633X
ISSN (online)	1758-1109
ISSN	1357-633X
DOI	10.1177/1357633X16637967
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