C R Gomez

Medical College of Wisconsin, Milwaukee, WI, United States

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Publications (109)393.95 Total impact

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    ABSTRACT: The sole stenting technique has emerged as a new tool for the management of intracranial aneurysms. However, several concerns have emerged about the long-term behavior of intracranial stents, particularly their safety and efficacy. We present the first case of an intracranial aneurysm intentionally treated with the sole stenting technique. After ten years of clinical and imaging follow-up, the lesion has healed and no intrastent stenosis is observed.Several issues concerning this technique are discussed. For instance, the modification of the angle and intra-aneurysmal thrombosis may account as positive effects; negative outcomes include in-stent thrombosis or stenosis. This case report, involving a long clinical and imaging follow-up, provides an example of the effectiveness, safety, durability and simplicity of the sole stenting technique in the management of intracranial aneurysms.
    Journal of Medical Case Reports 02/2010; 4:64.
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    Osama O Zaidat, Camilo R Gomez
    Frontiers in Neurology 01/2010; 1:13.
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    ABSTRACT: Stroke survivors should recognize and control vascular risk factors to prevent recurrent strokes. We therefore assessed the prevalence, treatment, and control of hypertension, diabetes, and dyslipidemia among stroke survivors versus stroke-free control subjects. We conducted cross-sectional analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study cohort, which includes oversampling from the Stroke Belt and African Americans. Patients were interviewed by telephone then visited for blood pressure, glucose, and lipid measurements. There were 2830 participants reporting a past stroke or transient ischemic attack (TIA) (stroke survivors) and 24,886 participants without past stroke or TIA (control subjects). Outcome measures included the recognition, treatment, and control of hypertension, diabetes, and dyslipidemia. Stroke survivors were more likely to have unrecognized hypertension (18.7% v 13.5%, P < .0003), unrecognized stage 2 hypertension (4.4% v 2.2%, P < .0006), and unrecognized diabetes (4.2% v 3.2%, P < .026) versus control subjects. Stroke survivors were more likely to be treated for hypertension (92.4% v 89.0%, P < .0001), diabetes (88.3% v 81.4%, P < .0001), and dyslipidemia (76.3% v 61.9%, P < .0001). However, despite treatment, stroke survivors were more likely to have hypertension (33.3% v 30.4%, P=.0074) and stage 2 hypertension (9.1% v 7.6%, P=.017). Predictors of unrecognized and undertreated risk factors in stroke survivors include increasing body mass index, black race, and lower education. Despite having a past stroke or TIA, stroke survivors had higher rates of unrecognized hypertension, unrecognized diabetes, and undertreated hypertension. Better efforts are needed to help stroke survivors recognize and control vascular risk factors to prevent recurrent stroke.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2010; 19(4):311-20.
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    ABSTRACT: The consensus conference on intracranial atherosclerosis provides a comprehensive review of the existing literature relevant to the epidemiology, diagnosis, prevention, and treatment of intracranial atherosclerosis, and identifies principles of management and research priorities. Patients who have suffered a stroke or transient ischemic attack attributed to stenosis (50-99%) of a major intracranial artery face a 12 to 14% risk for subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk for subsequent stroke may exceed 20% in high-risk groups. In patients with intracranial atherosclerotic disease, short-term and long-term anticoagulation is not superior to antiplatelet treatment. Overall, the subgroup analyses from randomized trials provide evidence about benefit of aggressive atherogenic risk factor management. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic intracranial atherosclerotic disease, particularly those with high-grade stenosis with recurrent ischemic symptoms, medication failure, or both. A multicenter randomized trial is currently under way to compare stent placement with intense medical management for patients with high-grade symptomatic intracranial atherosclerotic disease.
    Annals of Neurology 12/2009; 66(6):730-8. · 11.19 Impact Factor
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    ABSTRACT: The consensus conference on intracranial atherosclerotic disease (ICAD) identifies principles of management, and research priorities in various aspects upon which leading experts can agree (using “Delphi” method). ICAD is more prevalent in Asian, Hispanic, and African-American populations. Patients who have had a stroke or transient ischemic attack (TIA) attributed to stenosis (50-99%) of a major intracranial artery face a 12-14% risk of subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk of subsequent stroke may exceed 20% in high-risk groups. The medical treatment of patients with symptomatic ICAD is directed toward: 1. Prevention of intraluminal thrombo-embolism, 2. plaque stabilization and regression, and 3. management of atherogenic risk factors. In patients with ICAD, short-term and long-term anticoagulation (compared with aspirin) have not shown to be beneficial. The current guidelines recommend that aspirin monotherapy, the combination of aspirin and extended release dipyridamole, and clopidogrel monotherapy (rather than oral anticoagulants) are all acceptable options in patients with non-cardioembolic ischemic stroke and TIA. Overall, the subgroup analysis from randomized trials provides evidence about benefit of aggressive atherogenic risk factor management among patients with ICAD. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic ICAD, particularly those with high-grade stenosis with recurrent ischemic symptoms and/or medication failure. A matched comparison between medical-treated patients in the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) study and stent-treated patients in the National Institutes of Health intracranial stent registry concluded that stent placement may offer benefit in patients with 70-99% stenosis. The 5-year, multicenter, prospective, randomized Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis study supported by the National Institutes of Health is currently comparing stent placement with intense medical management with intense medical management alone in patients with high-grade symptomatic intracranial stenosis. The proceedings of the consensus conference provide a template for standardizing management of patients with ICAD and determining research priorities.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 10/2009; 19(S1):1S - 10S. · 3.36 Impact Factor
  • Camilo R Gomez, Adnan I Qureshi
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    ABSTRACT: The medical treatment of patients with symptomatic intracranial atherosclerotic disease (ICAD) is directed toward reducing the risk of new ischemic events. The overall strategy is divided into: (1) prevention of occurrence of intraluminal thrombus, with or without embolism; (2) plaque stabilization and regression; and (3) management of atherogenic risk factors. In patients with ICAD, short-term and long-term anticoagulation (compared with aspirin) has not shown to be beneficial. The current guidelines recommend that aspirin monotherapy, the combination of aspirin and extended release dipyridamole, and clopidogrel monotherapy (rather than oral anticoagulants) are all acceptable options in patients with noncardioembolic ischemic stroke and transient ischemic attack. The findings of another pilot trial suggest that symptomatic ICAD is a dynamic lesion and cilostazol may prevent its progression. Overall, the subgroup analysis from randomized trials, provide evidence about benefit of aggressive atherogenic risk factor management among patients with ICAD. Current guidelines recommend statin therapy with intensive lipid-lowering effects for patients with atherosclerotic ischemic stroke or transient ischemic attack with or without known coronary artery disease to reduce the risk of stroke and cardiovascular events.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 10/2009; 19 Suppl 1:25S-9S. · 3.36 Impact Factor
  • Rakesh Khatri, Camilo R Gomez, Adnan I Qureshi
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    ABSTRACT: Interventional neuroimaging procedures are becoming more effective and safer. This article discusses the therapeutic benefits of endovascular procedures for commonly encountered clinical situations in cerebrovascular disease and brain tumors and then briefly discusses the advances in interventional neuroimaging modalities. Each topic is subdivided into prevalence/natural course, techniques/interventions, summary of clinical trials, and current guidelines/recommendations from professional organizations, whenever applicable.
    Neurologic Clinics 03/2009; 27(1):109-37, viii. · 1.34 Impact Factor
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    ABSTRACT: The use of intracranial stents in stent-assisted coil embolization is now a current neurosurgical practice worldwide. The clinical utility of these stents in the sole stenting (SS) technique, however, has not been thoroughly described, and the published reports of this experience are scarce. This study was designed to evaluate SS treatment of dissecting and nondissecting aneurysms of the posterior circulation. This prospective and descriptive study was conducted in 20 consecutive patients who harbored single aneurysms of the posterior circulation and who were treated using the SS approach in the last 3 years. The clinical and radiological assessment and follow-up of the patients were evaluated using the modified Rankin scale as well as with computed tomography angiography and digital subtraction angiography at discharge and at 1, 3, 6, and 12 months. Eleven of the 20 patients had subarachnoid hemorrhages, 3 presented with ischemia, 1 presented with brainstem compression, and the remaining 5 patients had incidentally discovered, asymptomatic lesions. Only 1 patient had a complication (occipital infarction) attributable to the SS procedure. One patient died of rebleeding 2 weeks after the procedure. At 1 month, 40% of the patients had a subtotal or total occlusion, which increased to 55% at 3 months and 85% at 6 months, with a final subtotal or total occlusion rate of 80% at 1 year. The SS procedure in 1 case was considered a failure at 6 months because no change had been noted since the 1-month follow-up. One case showed partial occlusion and 1 case showed recanalization. Use of SS for aneurysms in the posterior circulation complex is a safe and effective technique, demonstrating an occlusion rate of 80% at the 1-year follow up.
    Journal of Neurosurgery 06/2008; 108(6):1104-18. · 3.15 Impact Factor
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    ABSTRACT: To assess risk factors associated with care for stroke symptoms. Using data from the population-based national cohort study (REasons for Geographic And Racial Differences in Stroke) conducted January 25, 2003-February 28, 2007 (N = 23,664), we assessed care-seeking behavior among 3,668 participants who reported a physician diagnosis of stroke/transient ischemic attack (n = 647) or stroke symptoms (n = 3,021) during follow-up. Care seeking was defined as seeking medical attention after stroke symptoms or a physician diagnosis. Overall, 58.5% of participants (2,146/3,668) sought medical care. In multivariable models, higher income was associated with greater likelihood of seeking care (p = 0.02): participants with income of > or = $75,000 had odds 1.43 times (95% confidence interval [CI], 1.02-2.02) greater than those with income of less than $20,000. Diabetes and previous heart disease were associated with increased care seeking: odds ratio (OR) of 1.23 (95% CI, 1.04-1.47) and OR of 1.26 (95% CI, 1.06-1.49), respectively. Participants with previous stroke symptoms but no stroke history were less likely to seek care than those with stroke history or without previous symptoms (OR, 0.80; 95% CI, 0.67-0.96). Past smoking was associated with lower likelihood (OR, 0.71; 95% CI, 0.59-0.85; p = 0.0003) of seeking care relative to nonsmokers. Only approximately half of participants with stroke symptoms sought care. This is despite the encouragement of advocacy groups to seek prompt attention for stroke symptoms. Our results highlight the importance of identifying characteristics associated with care-seeking behavior. Recognizing factors that contribute to delays provides opportunities to enhance education on the importance of seeking care for stroke symptoms.
    Annals of Neurology 05/2008; 63(4):466-72. · 11.19 Impact Factor
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    ABSTRACT: Patent foramen ovale (PFO) is a well-recognized risk factor for ischemic strokes. The true prevalence of PFO among stroke patients is still under debate. Transesophageal echocardiography (TEE) is the "gold standard" in diagnosing PFO but the physiology requires right-to-left atrial shunting. In this report, we evaluate the prevalence of PFO in a diverse group of ischemic stroke patients studied by TEE. TEE of 1,663 ischemic stroke patients were reviewed for cardiac source of embolism, including PFO and atrial septal aneurysm (ASA). Agitated saline bubble injection was performed to look for right to left atrial shunting. Success of maneuvers to elevate right atrial pressure (RAP) was noted by looking at the atrial septal bulge. Among 1,435 ischemic stroke patients analyzed, the presence or absence of PFO could not be determined in 32.1% because bulging of the septum could not be demonstrated in patients with negative contrast study despite aggressive maneuvers to elevate RAP. Of the remaining 974 patients, 294 patients (30.2%) had a PFO. The mean age was 61.5 years in both groups, with a bimodal distribution of PFO and the highest prevalence occurring in < or =30-year-old group. Prevalence of PFO was similar in men (32.4%) and women (28.15%, P = 0.15); and in Caucasian (32.1%) and African American (27.7%; P = 0.15). ASA was present in 2.02% and hypermobile septum in 2.49% of the 1,435 patients. PFO was seen in 79.3% of the patients with ASA. Successful elevation of RAP cannot be achieved in a significant number of patients undergoing TEE and determination of PFO may be difficult. In our series, the true prevalence of PFO among ischemic stroke patients was 30.2% taking into account only those patients who showed no shunting despite bulging of the atrium septum into the left atrium (PFO absent group) during the contrast study. There was no gender or racial difference in the prevalence of PFO, but there was a bimodal distribution in prevalence with age.
    Echocardiography 02/2008; 25(2):217-27. · 1.26 Impact Factor
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    ABSTRACT: In the past, clinical decisions regarding treatment of neurovascular disorders leading to ischemia have been guided by the percentage of stenosis of the vessel in question. However, such an approach assumes a predictable and stable relationship between the percentage of stenosis and the degree of flow reduction it causes. Historically, this type of relationship has been difficult to document. Thus, a method for noninvasively measuring the absolute flow of specific cerebral arteries is of potential practical value. We set to quantify the mean blood flow (Qm, in mL/min) in the cerebral arteries using quantitative magnetic resonance angiography (QMRA), and to compare the findings in normal vessels with those found in vessels considered pathologically narrowed. Specific vascular segments were identified, studied, and the results entered into a database. Statistical analyses of the measurements were carried out using StatPlus for Microsoft Excel. It involved comparing of the Qm found in specific vessels, as well as those found in normal and abnormal vessels, using analysis of variance (ANOVA). The abnormal vessels were selected from specifically identified magnetic resonance angiography (MRA) studies. A total of 57 patients, 26 men and 31 women, with ages ranging from 19 to 86 years (mean = 64.5), underwent MRA with subsequent QMRA of 157 arteries. The latter included 72 internal carotid (ICA), 45 vertebral (VA), 18 common carotid (CCA), 13 middle cerebral (MCA), and nine basilar (BA) arteries. The mean Qm obtained were CCA = 313.9 (+/-115.4), ICA = 231.1 (+/-83.7), VA = 90.5 (+/-45.8), MCA = 92.5 (+/-62.3) and BA = 120.1 (+/-64.5). ANOVA showed significant differences between individual vessels (P < .00001). The values obtained were consistent with those predicted mathematically, as derivatives of their proportional contributions to overall cerebral arterial flow (Qbrain) as a product of the normal cardiac output (CO) [ie, Qbrain = CO*.2]. Further ANOVA of the normal and abnormal vessels showed statistically significant differences between the two groups (186.5 +/- 108.6 vs. 117.9 +/- 76.1, respectively; P= .000514). The use of QMRA provides the mean for direct measurement of absolute blood flow within the cerebral arteries in physiologic and pathologic states. This technique may be of future importance in characterizing absolute flow compromise in the cerebral arteries under a variety of clinically relevant circumstances.
    Journal of Neuroimaging 01/2008; 18(1):34-7. · 1.41 Impact Factor
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    ABSTRACT: Stroke symptoms in the absence of recognized stroke are common, but potential associated dysfunctions have not been described. We assessed quality-of-life measures using the Physical and Mental Component Summary scores of the Short Form 12 (PCS-12 and MCS-12) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Differences in mean PCS-12 and MCS-12 scores were assessed among participant groups symptoms-free (n=16 090); history of stroke symptoms but free of stroke/transient ischemic attack (n=3404); history of stroke (n=1491); and history of transient ischemic attack (n=818). Participants with symptoms (but no diagnosis) had average PCS-12 scores 5.5 (95% CI: 5.2 to 5.9) points lower than those without symptoms, a difference similar to transient ischemic attack (6.0; 95% CI: 5.3 to 6.7) and over one half the effect of stroke (8.4; 95% CI: 8.0 to 9.0). MCS-12 scores were 2.7 (95% CI: 2.4 to 3.0) points lower for those with symptoms, -0.5 for transient ischemic attack (95% CI: 0.0 to -1.1), and -1.6 for stroke (95% CI: -1.2 to -2.0). Differences in demographic and vascular risk factors, health behaviors, physiological measures, and indices of socioeconomic status did not fully explain these differences. Those reporting history of weakness or numbness had larger current decrements in physical functioning, and those reporting history of inability to express themselves or understand language had larger current decrements in mental functioning. Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called "silent stroke," there appear to be many individuals with possibly symptomatic cerebrovascular disease-either stroke or transient ischemic attack-who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign.
    Stroke 10/2007; 38(9):2446-52. · 6.16 Impact Factor
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    ABSTRACT: Vascular disorders that increase risk for stroke may be accompanied by decrements in cognitive functioning and by stroke symptoms in the absence of diagnosed stroke or transient ischemic attack. This study evaluates relationships among cognitive status, stroke symptom reports, and cardiovascular and behavioral factors. REasons for Geographic and Racial Differences in Stroke (REGARDS), a prospective population study of stroke incidence, assesses stroke risk with telephone interviews and in-home physicals. Excluding subjects with a history of stroke or transient ischemic attack, this analysis includes 14,566 black and white men and women > or =45 years of age. Incremental logistic models examine baseline relationships among cognitive status (Six-item Screener scores), stroke symptom reports, demographics, health behaviors, cardiovascular indices, and depressive symptoms. A history of stroke symptoms was related to impaired cognitive status after adjusting for age, gender, race, and education but not after adjusting for poor health behaviors, vascular risk factors, and depressive symptoms. Odds of experiencing a stroke symptom increased 35% with each of five modifiable factors (hypertension, diabetes, smoking, lack of exercise, depressive symptoms), and odds of cognitive impairment increased an additional 12% with each modifiable factor. Lifelong abstinence from alcohol, lack of exercise, and depressive symptoms were independently related to impaired cognitive status. The increased likelihood of cognitive impairment among subjects reporting stroke symptoms in the absence of a diagnosed stroke or transient ischemic attack suggests that such symptoms are not benign and may warrant clinical evaluation that includes a cognitive assessment. Future studies that include brain imaging may clarify the etiology of these symptoms.
    Stroke 05/2007; 38(4):1143-7. · 6.16 Impact Factor
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    ABSTRACT: Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms. Three patients (one woman and two men) with vertebrobasilar junction aneurysms were included in this study. Two of the patients presented with subarachnoid hemorrhage. An endovascular procedure was performed under general (two patients) or local (one patient) anesthesia and via a right femoral approach. By use of road map guidance, sole Express (one patient) or Express 2 (two patients) coronary stents (Boston Scientific/Scimed, Maple Grove, MN) were deployed on the diseased vessel. When the stent was in place, an immediate partial thrombosis of the aneurysm was observed, related primarily to an intra-aneurysmal flow pattern modification, possibly facilitated by modification of the angle of the parent vessel. Follow-up angiograms showed complete exclusion of the aneurysms within the circulation. Only one patient presented visual deficit as a thrombotic complication, but it disappeared completely 6 months after treatment. The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.
    Neurosurgery 08/2005; 57(1 Suppl):E208; discussion E208. · 2.53 Impact Factor
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    ABSTRACT: Although not approved by the US Food and Drug Administration for the treatment of status epilepticus (SE), valproic acid (VPA) is an emerging option for this purpose. The authors reviewed 63 patients (30 men) with SE treated with IV VPA (average dose, 31.5 mg/kg). Analysis of demographic, clinical, and treatment information indicated an overall efficacy of 63.3% and favorable tolerance of rapid administration.
    Neurology 02/2005; 64(2):353-5. · 8.25 Impact Factor
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    ABSTRACT: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,000 African-American and white adults aged > or =45 years. The objective is to determine the causes for the excess stroke mortality in the Southeastern US and among African-Americans. Participants are randomly sampled with recruitment by mail then telephone, where data on stroke risk factors, sociodemographic, lifestyle, and psychosocial characteristics are collected. Written informed consent, physical and physiological measures, and fasting samples are collected during a subsequent in-home visit. Participants are followed via telephone at 6-month intervals for identification of stroke events. The novel aspects of the REGARDS study allow for the creation of a national cohort to address geographic and ethnic differences in stroke.
    Neuroepidemiology 01/2005; 25(3):135-43. · 2.37 Impact Factor
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    ABSTRACT: Stroke is the third leading cause of death and a leading cause of disability in the United States, with a particularly high burden on the residents of the southeastern states, a region dubbed the "Stroke Belt." These five states - Alabama, Arkansas, Louisiana, Mississippi, and Tennessee - have formed the Delta States Stroke Consortium to direct efforts to reduce this burden. The consortium is proposing an approach to identify domains where interventions may be instituted and an array of activities that can be implemented in each of the domains. Specific domains include 1) risk factor prevention and control; 2) identification of stroke signs and symptoms and encouragement of appropriate responses; 3) transportation, Emergency Medical Services care, and acute care; 4) secondary prevention; and 5) recovery and rehabilitation management. The array of activities includes 1) education of lay public; 2) education of health professionals; 3) general advocacy and legislative actions; 4) modification of the general environment; and 5) modification of the health care environment. The Delta States Stroke Consortium members propose that together these domains and activities define a structure to guide interventions to reduce the public health burden of stroke in this region.
    Preventing chronic disease 11/2004; 1(4):A19. · 1.82 Impact Factor
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    ABSTRACT: To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis. The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations. TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.
    Neurology 06/2004; 62(9):1468-81. · 8.25 Impact Factor
  • Nita A Limdi, Nancy V Lemons, Camilo R Gomez
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    ABSTRACT: Long-term anticoagulation for stroke prevention is a labor-intensive endeavor, requiring close monitoring of patients to maintain efficacy and avoid toxicity. Theoretically, fixed daily doses of warfarin may facilitate the establishment and maintenance of anticoagulation, with lesser fluctuations of the international normalized ratio (INR), and favor long-term compliance. This pilot project aimed at assessing the potential advantages of fixed daily dosing for chronic anticoagulation. We compared the experiences of two separate practices within the same institution. Clinic A exclusively uses fixed daily doses. Clinic B allows the use of variable doses. The anticoagulation records of 96 patients (47 from clinic A and 49 from Clinic B) were reviewed. The incidences of INRs outside target range, occurrence of dose changes or interventions, and magnitude of dose changes were recorded at 1, 3, 6, 9 and 12 months after the institution of anticoagulation. Data were analyzed using Chi square analysis. The demographic characteristics of both groups were comparable. Of the 576 INRs recorded during a period of 12 months, 316 were outside target range. There were 126 INRs outside target range in group A and 190 in group B (P < .0001). Group B accounted for 103 of the 169 dose changes resulting from an INR outside target range, whereas group A accounted for 66 (P < .05). The number of interventions and magnitude of dose changes were similar in both groups. Fixed daily dosing offers several advantages over variable dosing in maintaining anticoagulation.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2004; 13(3):118-21.
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    ABSTRACT: Neuroimaging plays a major role in the evaluation of patients with neurological disorders. Surveys of neurologists have revealed that most rely on their own readings of images for patient management, and a majority believe that neurologists should be allowed to officially interpret and bill for scan reviews. The importance of neuroimaging training for neurology residents has been stressed by the Association of University Professors of Neurology. Although there is a desire to promote the neuroimaging education of neurologists, no curricula have existed previously. The Neuroimaging Section of the American Academy of Neurology (AAN) developed a task force of practicing neuroimagers to provide a neuroimaging curriculum for neurological trainees and training directors. The resulting curriculum is available on the Web sites of the AAN (http://www.aan.com) and the American Society of Neuroimaging (http://www.asnweb.org/education/curriculum.shtml) and will be updated as the need arises through evolving technology or breadth of applications. This curriculum should help in the design of neurology residency and fellowship programs and subspecialty pathways in which adequate neuroimaging education and training are desired for various reasons, including certification and the demonstration of competency and proficiency.
    Journal of Neuroimaging 08/2003; 13(3):215-7. · 1.41 Impact Factor

Publication Stats

3k Citations
393.95 Total Impact Points

Institutions

  • 2010
    • Medical College of Wisconsin
      • Department of Neurology
      Milwaukee, WI, United States
  • 2008–2010
    • Barrow Neurological Institute
      Phoenix, Arizona, United States
  • 2009
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2000–2009
    • University of Alabama at Birmingham
      • • Department of Epidemiology
      • • Department of Neurology
      • • Division of Cardiothoracic Surgery
      • • Division of Cardiovascular Disease
      Birmingham, Alabama, United States
  • 1996
    • Texas Tech University Health Sciences Center
      • Department of Neurology
      Lubbock, TX, United States
  • 1989–1995
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 1988–1994
    • St Louis University Hospital
      • Department of Neurology
      San Luis, Missouri, United States
  • 1993
    • Boston University
      • Department of Neurology
      Boston, MA, United States
  • 1988–1991
    • Washington University in St. Louis
      • Department of Neurology
      San Luis, Missouri, United States