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EDITED BY PROFESSOR YASSER METWALLY

The use of antiplatelet agents for secondary prevention of stroke

Stroke is a leading cause of death and the primary cause of serious, long-term disability in the United States. Joint guidelines from the American Heart Association (AHA) and American Stroke Association (ASA), as well as recent guidelines from the Eighth American College of Chest Physicians (ACCP) Conference on Antithrombotic and Antiplatelet Therapy, recommend aspirin, clopidogrel, or extended-release dipyridamole plus aspirin as acceptable firstline options for secondary prevention of ischemic events in patients with a history of ischemic stroke or transient ischemic attack (TIA).

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The safety of Antiplatelet agents for stroke prevention

Aggressive secondary prevention is critical to improving long-term outcomes in patients with ischemic coronary artery disease, cerebrovascular disease, and peripheral artery disease. An essential component of successful secondary prevention is antiplatelet therapy, which in most patient populations consists of aspirin, clopidogrel, aspirin plus clopidogrel, or aspirin plus extended-release dipyridamole. As is true for any pharmacologic agent, benefits must be balanced with risks. For antiplatelet agents, the most important risk is excess bleeding, especially as emerging evidence suggests that excess bleeding is associated with adverse long-term outcomes; thus prevention and management of excess bleeding is critically important. In addition, recommendations for avoidance and management of minor adverse events are described so that patients maintain drug adherence. Overall, aspirin, clopidogrel, aspirin plus clopidogrel, and aspirin plus extended-release dipyridamole have favorable risk-versus-benefit profiles when used as recommended in appropriate patient populations.

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The role of antiplatelet agents in the management of transient ischemic attacks

As many as 300,000 transient ischemic attacks (TIAs) occur in the United States each year, accounting for 0.3% of all Emergency Department visits. An under-recognized and under-treated problem, TIA is associated with up to a 10% risk of subsequent stroke within 7 days and a 25% risk of death at 1 year. Antiplatelet therapy can result in significant reductions in secondary stroke risk. However, nearly 50% of patients with TIA leave the Emergency Department without any medication. This article discusses recent results from major antiplatelet clinical trials in stroke prevention and highlights the need for appropriate and timely initiation of antiplatelet treatment in patients with TIA.

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Case records

Stroke in children: A study of 4 cases

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Hemorrhagic transformation is common in patients with supratentorial and cerebellar embolic stroke.[1] Embolus migration with a subsequent reestablishment of the blood flow into the infarcted tissue (migratory embolism) probably accounts for most hemorrhagic transformations. Pathological examinations of pontine infarction often show petechial hemorrhages, but massive hemorrhagic infarction is relatively uncommon.

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Downloadable multiple choice questions software

A downloadable software featuring 5 full radiological cases with applied self- checking multiple choice questions on every case, you can email the result to the author for evaluation and discussion. The software is a freeware, a gift not to sold. You are free to use the software for any educational purposes you want and to distribute it on a non-profit basis. A new version of the software is available every month and remains available for one month (The available version now is version 3.4, February 2010), the software version is changed with the monthly update of the bulletin.

>>>Click here to download the current version of the multiple choice questions software>>> ....(Click here to get a better idea about this publication)

Downloadable single case study software

A downloadable software featuring a full radiological study of a single case with a radiological report and a review of literature. You can email the author from within the software. The software is a freeware, a gift not to sold. You are free to use the software for any educational purposes you want and to distribute it on a non-profit basis. A new version of the software is available every month and remains available for one month (The available version now is version 4.3, February 2010), the software version is changed with the monthly update of the bulletin.

>>>Click here to download the current version of the single case study software>>> ....(Click here to get a better idea about this publication)

Case of the week

A downloadable, weekly updated, neurological case with full clinical, radiological and pathological data. You can email the author from within the downloaded software. The software is a freeware, a gift not to sold. You are free to use the software for any educational purposes you want and to distribute it on a non-profit basis. A new version of the software is available every week and remains available for one week, it is updated every Saturday.

>>>Click here to download the case of the week software>>> ....(Click here to get a better idea about this publication).. The PDF version | The Short case version | Archive of long cases | Archive of short case | Case records

Topic of the month

A monthly updated PDF file fully addressing a single topic in the field of neurology, psychiatry or neurosurgery. The PDF file is changed with the monthly update of the bulletin.

>>>Click here to download the current issue of "topic of the month">>>.....(Click for an archive of back issues of "topic of the month) ..(Topic of the month)

Radiological quiz

What is this

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Topic of the month | Thesis section | Research section | Talking psychiatry | Differential diagnosis | Case of the week

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