Continuum Aloud 29(2) April 2023 Cerebrovascular Disease
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About This Program
Continuum® Aloud is a program of “audiobook style” recordings of issues. Different from Continuum® Audio, these recordings are verbatim readings of the print articles. The audio files of the issues will be available to all Continuum® subscribers in the AAN’s Online Learning Center.
Learning Objectives
Upon completion of this
Continuum: Lifelong Learning in Neurology Cerebrovascular Disease issue, participants will be able to:
- Recognize the appropriate testing for patients to confirm and characterize stroke, gain insights into the pathophysiologic mechanisms of stroke, and optimize prevention of recurrent stroke
- Implement the data supporting the use of IV thrombolysis for the treatment of acute ischemic stroke
- Describe the clinical evidence, patient selection, and treatment considerations for the use of endovascular therapy in patients with acute ischemic stroke
- Perform the diagnostic evaluation and management of patients with cardioembolic stroke
- Recognize the expanded intensive medical therapies and the resulting improved outlook for patients with stroke due to large vessel atherosclerosis
- Discuss various clinical presentations, describe key radiographic characteristics, discuss risk factors associated with primary causes, and identify common and uncommon causes of cerebral small vessel disease
- Define cerebral venous thrombosis, describe the anatomy, pathophysiology, and four common clinical manifestations of the disease, identify radiographic features of the disease, and recognize new evidence regarding the use of direct oral anticoagulants and endovascular therapy to treat cerebral venous thrombosis
- Discuss the pathophysiology, risk factors, presentation, diagnosis, management, and prognosis of cervical artery dissection, including choosing between antiplatelet and anticoagulation therapy for stroke prevention
- Recognize the signs and symptoms of stroke in children, assess candidacy for hyperacute or acute treatment strategies, and evaluate pediatric stroke risk factors
- Describe the natural history of unruptured brain aneurysms and brain arteriovenous malformations, and identify the risk factors for hemorrhage, preventive treatment options, and the risks of treatment
- Recognize the processes of and team members participating in inpatient and outpatient stroke rehabilitation and identify the recent clinical research regarding strategies to enhance motor recovery resulting from exercise following stroke
Core Competencies
Upon completion of this
Continuum: Lifelong Learning in Neurology Cerebrovascular Disease issue, participants will be able to:
- Patient Care and Procedural Skills
- Medical Knowledge
- Practice-Based Learning and Improvement
- Interpersonal and Communication Skills
- Professionalism
- Systems-Based Practice
Contributorsa
Hooman Kamel, MD, MSGuest Editor
Vice Chair for Research, Department of Neurology, Weill Cornell Medicine, New York, New York
Relationship Disclosure: Dr Kamel has received personal compensation in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for the Journal of the American Medical Association Neurology, and in the range of $50,000 to $99,999 for serving on an endpoint adjudication committee for Boehringer-Ingelheim.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Kamel reports no disclosure.
Neil A. Busis, MD, FAAN
Associate Chair, Technology and Innovation, Department of Neurology, NYU Langone Health, New York, New York
Relationship Disclosure: Dr Busis has received personal compensation in the range of $0 to $499 for serving as an editor, associate editor, or editorial advisory board member for Neurology Todayfrom the American Academy of Neurology (AAN) and in the range of $500 to $4999 for serving as a speaker for the AAN and as the AAN’s primary advisor to the American Medical Association’s CPT Editorial Panel.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Busis reports no disclosure.
Seemant Chaturvedi, MD, FAAN, FAHA
Stewart J. Greenebaum Endowed Professor of Stroke Neurology, University of Maryland School of Medicine, Baltimore, Maryland
Relationship Disclosure: Dr Chaturvedi has received personal compensation in the range of $500 to $4999 for serving as a consultant for AstraZeneca and on a scientific advisory or data safety monitoring board for the University of Calgary, and in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for the American Heart Association and as an expert witness for Ramar & Paradiso (Troy, MI) and Cole, Scott, & Kissane (Palm Beach, FL). The institution of Dr Chaturvedi has received research support from the National Institute of Neurological Disorders and Stroke.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Chaturvedi reports no disclosure.
Luana Ciccarelli, CPC, CRC
Associate Director, Medical Economics and Practice, American Academy of Neurology, Minneapolis, Minnesota
Relationship Disclosure: Ms Ciccarelli reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Ms Ciccarelli reports no disclosure.
Bruce H. Cohen, MD, FAAN
Director, The NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio
Relationship Disclosure: Dr Cohen has received personal compensation in the range of $500 to $4999 for serving as a speaker for the American Academy of Neurology (AAN) and as an AAN advisor to the American Medical Association’s CPTEditorial Panel. Dr Cohen has received personal compensation in the range of $0 to $499 for serving as a consultant for CoA Therapeutics/BridgeBio and Neuroene Therapeutics; in the range of $500 to $4999 for serving as a consultant for Abliva AB, Astellas Pharma Inc, Modis/Zogenix, PTC Therapeutics, and Reneo Pharmaceuticals, Inc. The institution of Dr Cohen has received research support from Abliva, BioElectron Technologies/ PTC Therapeutics, Astellas Pharma Inc, Reneo Pharmaceuticals, Inc., and Stealth BioTherapeutics, Inc. Dr Cohen has received publishing royalties from a publication relating to health care and has noncompensated relationships as the president of the board of directors of the Child Neurology Society and as a member of the board of directors of the Child Neurology Foundation that are relevant to the American Academy of Neurology interests or activities.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Cohen reports no disclosure.
Christine Fox, MD
Associate Professor of Neurology and Pediatrics, University of California San Francisco, San Francisco, California
Relationship Disclosure: The institution of Dr Fox has received personal compensation in the range of $500 to $4999 for serving as a consultant for Competitive Drug Development International Ltd, research support from the American Heart Association/Bugher Foundation, and from the National Institutes of Health/National Institute of Neurological Disorders and Stroke, and has received publishing royalties from a publication relating to health care.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Fox discusses the use of thrombolysis and thrombectomy for the treatment of stroke in children.
James C. Grotta, MD, FAAN
Director of Stroke Research and Mobile Stroke Unit at the Memorial Hermann Hospital, Texas Medical Center in Houston, Texas
Relationship Disclosure: Dr Grotta has received personal compensation in the range of $5000 to $9999 for serving on a scientific advisory or data safety monitoring board for Haemonetics and Prolong Pharmaceuticals and in the range of $10,000 to $49,999 for serving as a consultant for Frazer Ltd and on a scientific advisory or data safety monitoring board for Acticor Biotech. The institution of Dr Grotta has received research support from Chiesi, CSL Behring, and Genentech. Dr Grotta has received publishing royalties from publications relating to health care.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Grotta reports no disclosure.
Ava L. Liberman, MD
Assistant Professor, Weill Cornell Medicine, New York, New York
Relationship Disclosure: The institution of Dr Liberman has received research support from the National Institutes of Health.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Liberman reports no disclosure.
James F. Meschia, MD, FAAN
Professor of Neurology; Frances Bartlett Binne Professor, Mayo Clinic, Jacksonville, Florida
Relationship Disclosure: The institution of Dr Meschia has received research support from National Institute of Neurological Disorders and Stroke.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Meschia reports no disclosure.
Thanh Ngoc Nguyen, MD
Director of Interventional Neurology and Neuroradiology, Boston Medical Center; Professor of Neurology, Neurosurgery, and Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
Relationship Disclosure: Dr Nguyen has received personal compensation in the range of $0 to $499 for serving on a scientific advisory or data safety monitoring board for the National Institutes of Health, and in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for Avania, Idorsia Pharmaceuticals, and Vesalio, and as an editor, associate editor, or editorial advisory board member for the American Heart Association. The institution of Dr Nguyen has received research support from Medtronic and the Society of Vascular and Interventional Neurology.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Nguyen reports no disclosure.
Michael W. O’Dell, MD
Professor Emeritus of Rehabilitation Medicine, Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
Relationship Disclosure: Dr O’Dell has received personal compensation in the range of $0 to $499 for serving as an officer or member of the board of directors for Franklin College of Indiana, and in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for Merz Pharmaceuticals, LLC.
Unlabeled Use of Products/Investigational Use Disclosure: Dr O’Dell discusses several clinical trials involving the use of investigational drugs, none of which are US Food and Drug Administration (FDA) approved for use in people with stroke.
Setareh Salehi Omran, MD
Assistant Professor of Neurology, University of Colorado School of Medicine, Aurora, Colorado
Relationship Disclosure: Dr Salehi Omran reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Salehi Omran reports no disclosure.
Anjail Sharrief, MD, MPH, FAHA
Associate Professor of Neurology, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas
Relationship Disclosure: The institution of Dr Sharrief has received research support from the National Institutes of Health and from the University of Houston. Dr Sharrief has a non-compensated relationship as a consultant with Abbot Laboratories that is relevant to the American Academy of Neurology interests or activities.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Sharrief reports no disclosure.
Sunil Sheth, MD
Associate Professor, Department of Neurology; Director, Division of Vascular and Interventional Neurology, University of Texas Health Sciences Center, Houston, Texas
Relationship Disclosure: Dr Sheth has received personal compensation in the range of $500 to $4999 for serving as a consultant for CERENOVUS and Imperative Care, and in the range of $100,000 to $499,999 for serving as a consultant for Penumbra Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Sheth reports no disclosure.
Raissa Villanueva MD, MPH, FAAN
Division Chief, General Neurology Division, University of Rochester Medical Center, Rochester, New York
Shadi Yaghi, MD
Associate Professor of Neurology; Brown University, Providence, Rhode Island
Relationship Disclosure: Dr Yaghi reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Yaghi reports no disclosure.
Self-Assessment and CME Test Writers
Douglas J. Gelb, MD, PhD, FAANProfessor of Neurology, University of Michigan, Ann Arbor, Michigan
Relationship Disclosure: Dr Gelb has received personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writers for Continuum with the American Academy of Neurology. Dr Gelb has received publishing royalties from a publication relating to health care.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.
Allyson R. Zazulia, MD
Professor of Neurology and Radiology and Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri
Relationship Disclosure: Dr Zazulia reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.
AAll relevant financial relationships have been mitigated.
Accreditation
Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.
AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Methods of Participation and Instructions for Use
Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.
The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.
Each
Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings.
The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of
Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.
The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.