Continuum: Lifelong Learning in Neurology—Cerebrovascular Disease, Volume 23, Issue 1, February 2017
Cerebrovascular Disease February 2017;23(1)
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.
Upon completion of this Continuum: Lifelong Learning in Neurology Cerebrovascular Disease issue, participants will be able to:
• Describe the epidemiology of ischemic stroke and its associated risk factors and summarize the best evidence for managing stroke risk factors for prevention of recurrent stroke
• Perform key elements in the bedside evaluation of the patient with acute stroke, including the focused stroke history, essential aspects of the bedside examination, and initial brain imaging, and recognize anatomic stroke syndromes and common mimics
• Discuss the main indications and contraindications of acute reperfusion therapies for ischemic stroke
• Diagnose and manage transient ischemic attack and minor stroke and distinguish high-risk transient ischemic attacks from more benign transient events
• Discuss common early and late medical complications following acute ischemic stroke
• Discuss the comprehensive evaluation of cardioembolic stroke and outline current management options
• Evaluate and manage patients with large artery atherosclerotic occlusive disease of the head and neck
• Discuss the risk factors, recurrence risk, evaluation, and outcomes of arterial ischemic stroke in children and young adults
• Discuss the natural history of and general management and treatment options for unruptured intracranial aneurysms and vascular malformations of the brain
• Recognize key historical and clinicoradiographic features of inherited and uncommon causes of stroke
• Discuss the natural history of stroke as well as established pharmacologic and nonpharmacologic rehabilitative strategies in the acute, subacute, and chronic phases of stroke
• List recommended steps for practical conflict mediation in situations in which surrogates of patients with severe stroke request life-prolonging treatment thatclinicians believe I s potentially inappropriate
• Recognize the usefulness of telestroke and its potential to improve acute stroke care in underserved communities
This Continuum: Lifelong Learning in Neurology Cerebrovascular Disease issue covers the following core competencies:
• Patient Care
• Medical Knowledge
• Practice-Based Learning and Improvement
• Interpersonal and Communication Skills
• Systems-Based Practice
Kevin M. Barrett, MD, MSc, Guest Editor
Associate Professor, Vice Chair, Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
aDr Barrett serves on the editorial board of Neurology, has received research/grant support from the National Institute of Neurological Disorders and Stroke for serving on the executive committees of the CREST-2 and SHINE clinical trials, and receives publishing royalties from Wiley Blackwell.
bDr Barrett reports no disclosure.
Samir R. Belagaje, MD
Assistant Professor of Neurology and Rehabilitation Medicine, Emory University School of Medicine; Director of Stroke Rehabilitation, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia
aDr Belagaje reports no disclosure.
bDr Belagaje discusses the unlabeled/investigational use of fluoxetine for poststroke motor recovery treatment, cholinesterase inhibitors and memantine for the treatment of aphasia, and dopaminergic agents to aid in the treatment of poststroke depression.
Cheryl Bushnell, MD, MHS
Professor of Neurology, Director, Wake Forest Baptist Comprehensive Stroke Center, Wake Forest Baptist Health, Winston Salem, North Carolina
aDr Bushnell receives research/grant support from the Patient-Centered Outcomes Research Institute (PCS-1403-14532).
bDr Bushnell reports no disclosure.
John W. Cole, MD, MS
Staff Physician, Neurology, Baltimore Veterans Affairs Medical Center; Associate Professor, Neurology, University of Maryland School of Medicine, Baltimore, Maryland
aDr Cole receives research/grant support from the American Heart Association (15GPSPG23770000) and the National Institutes of Health (1U01NS069208), which partially funded the writing of this article.
bDr Cole reports no disclosure.
Shelagh B. Coutts, MD, MSc, FRCPC
Stroke Neurologist; Associate Professor, Departments of Clinical Neuroscience, Radiology, Community Health Sciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada
aDr Coutts receives research/grant support from the Canadian Institutes of Health Research, (CRH-112319), the Heart and Stroke Foundation of Canada (G-16-00012585), and Genome Canada (143TIA-Penn).
bDr Coutts reports no disclosure.
Bart M. Demaerschalk, MD, MSc, FAHA, FRCPC
Professor of Neurology, Mayo College of Medicine, Phoenix, Arizona
aDr Demaerschalk has received personal compensation as editor-in-chief of The Neurologist and has received publishing royalties from Springer Publishing Company and John Wiley & Sons, Inc.
bDr Demaerschalk reports no disclosure.
Kelly D. Flemming, MD
Consultant in Department of Neurology; Associate Professor of Medicine, Mayo Clinic, Rochester, Minnesota
aDr Flemming reports no disclosure.
bDr Flemming discusses the unlabeled/investigational use of statins and fasudil for the treatment of cavernous malformation.
Amy Guzik, MD
Assistant Professor, Neurology, Wakeforest Baptist Medical Center, Winston Salem, North Carolina
a,bDr Guzik reports no disclosures.
Josephine F. Huang, MD
Instructor of Neurology, Mayo Clinic, Jacksonville, Florida
aDr Huang reports no disclosure.
bDr Huang discusses the unlabeled/investigational use of tranexamic acid and ε-aminocaproic acid for intracranial hemorrhage.
David Y. Hwang, MD
Assistant Professor, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine; Neurointensivist, Yale-New Haven Hospital, New Haven, Connecticut
aDr Hwang has received personal compensation for speaking engagements for the Mayo Clinic and The Pennsylvania State University and research/grant support from the American Brain Foundation, the Apple Pickers Foundation, the Neurocritical Care Society, and the National Institute on Aging, via its Loan Repayment Program.
bDr Hwang reports no disclosure.
William Jones, MD
Associate Professor of Neurology; Division Chief, Neurohospitalist and Vascular Neurology, University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado
a,bDr Jones reports no disclosures
Pearce J. Korb, MD
Assistant Professor of Neurology, University of Colorado, Anschutz Medical Campus, Department of Neurology, Aurora, Colorado
a,bDr Korb reports no disclosures.
Riten Kumar, MD, MSc
Assistant Professor of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
aDr Kumar serves on the medical advisory board of Bayer Corporation and receives research/ grant support from the Hemostasis and Thrombosis Research Society (HTRS Mentored Research Award) and the International Society on Thrombosis and Haemostasis.
bDr Kumar discusses the unlabeled/investigational use of antithrombotic and thrombolytic agents in children with stroke.
Giuseppe Lanzino, MD
Professor of Neurosurgery, Mayo Clinic, Rochester, Minnesota
aDr Lanzino serves as a consultant for Medtronic.
bDr Lanzino discusses the unlabeled/investigational use of statins and fasudil for the treatment of cavernous malformation.
Warren D. Lo, MD
Clinical Professor, Departments of Pediatrics and Neurology, Ohio State University; Pediatric Neurologist, Nationwide Children’s Hospital, Columbus, Ohio
aDr Lo receives research/grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R01HD068345, 1R01HD074574, R01HD083384) and the National Institute of Neurological Disorders and Stroke (U10NS086484, U54 NS065705) and receives publishing royalties from Springer.
bDr Lo discusses the unlabeled/investigational use of antithrombotic and thrombolytic agents in children with stroke.
Jennifer Juhl Majersik, MD, MS
Associate Professor of Neurology; Director, Stroke Center and Telestroke Services; Chief, Division of Vascular Surgery, University of Utah, Salt Lake City, Utah
aDr Majersik receives research/grant support from the National Institutes of Health (5U10NS086606) and Remedy Pharmaceuticals, Inc. Dr Majersik has served as an expert witness for FAVROS PLLC.
bDr Majersik reports no disclosure.
Cumara B. O’Carroll, MD, MPH
Assistant Professor of Neurology, Mayo Clinic, Phoenix, Arizona
a,bDr O’Carroll reports no disclosures.
Alejandro A. Rabinstein, MD, FAAN
Professor of Neurology, Mayo Clinic, Rochester, Minnesota
aDr Rabinstein serves as an associate editor for Neurocritical Care; on the editorial boards of Continuum: Lifelong Learning in Neurology, the Journal of Stroke and Cerebrovascular Diseases, Neurology, and Stroke; and on the scientific advisory board of Portola Pharmaceuticals, Inc. Dr Rabinstein receives research/grant support from DJO Global, Inc, and royalties from Elsevier, Oxford University Press, and UpToDate, Inc.
bDr Rabinstein reports no disclosure.
Andrew M. Southerland, MD, MSc
Assistant Professor of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
aDr. Southerland serves as deputy editor of the Neurology podcast and receives research/grant support from the American Academy of Neurology, American Board of Psychiatry and Neurology, Health Resources & Services Administration (HRSA GO1RH27869-01-00), and the National Institute of Neurological Disorders and Stroke (U01 NS069498).
bDr Southerland reports no disclosure.
Douglas J. Gelb, MD, PhD, FAAN
Professor of Neurology, University of Michigan, Ann Arbor, Michigan
aDr Gelb receives royalties from Oxford University Press and UpToDate, Inc.
bDr Gelb reports no disclosure.
Adam Kelly, MD
Associate Professor of Neurology, University of Rochester Medical Center; Chief of Neurology, Highland Hospital, Rochester, New York
aDr Kelly has received research support from the Donald W. Reynolds Foundation.
bDr Kelly reports no disclosure.
bUnlabeled Use of Products/Investigational Use Disclosure
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 faculty 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 CME and self-assessment offerings, including a selfassessment pretest, multiple-choice questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.
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. 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.