WAKE-UP Time for Thrombolysis in Acute Stroke?

By Martina McGrath, MD
October 30, 2018

MRI thrombolysis for stroke of unknown time of onset

Current clinical guidelines recommend thrombolysis in acute stroke where patients present within 4.5 hours of onset of symptoms. However, for up to a quarter of patients, the time of symptom onset is unknown as they wake from sleep with neurological deficits.1 Such patients frequently do not meet criteria for therapies such as thrombolysis or mechanical thrombectomy.

Prior studies have suggested a particular pattern may be seen on an MRI of the brain in the early hours following stroke onset; a visible ischemic lesion on diffusion-weighted imaging along with the lack of a hyperintense signal in the same area on fluid-attenuated inversion recovery (FLAIR). The benefit of aggressive stroke intervention in patients with the combination of unknown time of symptom onset and this particular signal mismatch on MRI brain scans is unknown. Continue reading “WAKE-UP Time for Thrombolysis in Acute Stroke?”

Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis

By Martina M. McGrath, MD
March 2, 2017

Publication of the RAVE and Rituxivas trials ushered in a new era of treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Previously, cyclophosphamide was first-line therapy, but treatment was commonly complicated by infection and malignancy, leading to the search for less toxic alternative regimens. RAVE and Rituxivas demonstrated equivalent efficacy in treatment of AAV with either cyclophosphamide or rituximab, with similar numbers of adverse events.1,2 Unexpectedly, more malignancies were observed in rituximab-treated patients in both studies. However, absolute numbers were small, and the significance of this finding was unclear. Follow-up data and clinical experience would suggest that rituximab is well tolerated for treatment of AAV, including when used as maintenance therapy.3,4 Continue reading “Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis”