Jesse Weinberger

Icahn School of Medicine at Mount Sinai | MSSM · Department of Neurology

Occipital or posterior steal syndrome is a constellation of signs and symptoms that arise from abnormal shunting of blood flow from the posterior cerebral circulation into its anterior counterpart leading to transient episodes of neurological deficits due to posterior circulation ischemia. A 45-year-old woman who experienced transient visual phenom...

Importance The STROKE AF study found that in patients with prior ischemic stroke attributed to large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD), 12% developed AF over 1 year when monitored with an insertable cardiac monitor (ICM). The occurrence over subsequent years is unknown. Objectives To compare the rates of...

Importance The Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful...

Importance Patients with ischemic stroke attributed to large- or small-vessel disease are not considered at high risk for atrial fibrillation (AF), and the AF incidence rate in this population is unknown. Objectives To determine whether long-term cardiac monitoring is more effective than usual care for AF detection in patients with stroke attribut...

Background and Purpose Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. Methods We conducted a retrospective observational study of risk factors, stroke characteristics, and short-ter...

Background and Purpose Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center...

The plasminogen activator inhibitor-1 (PAI-1) 4G/4G homozygous genotype represents a genetic thrombophilia that has been associated with enhanced risk of arterial and venous thrombotic events. The optimal anticoagulation strategy for PAI-1 4G homozygous patients is unclear. Herein we present a case of a patient with PAI-1 4G/4G homozygosity who was...

Background and purpose: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COV...

BACKGROUND: Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combin...

Background and purpose: While the majority of cerebral ischemic events due to carotid occlusive disease result from atherosclerotic plaque rupture, intraluminal carotid artery thrombus occasionally occurs in patients without preexisting carotid atherosclerosis. Identification of nonatherosclerotic thrombus as the cause of the carotid occlusive dis...

Objective: To describe a case of recurrent calcified cerebral emboli (CCE)-related acute ischemic stroke (AIS) and the diagnostic utility of plaque morphology characterization on carotid ultrasound. Background: CCE are a rare cause of AIS. CCE-related AIS has been previously reported only in high vascular-risk patients such as those with severe...

Diabetes is a strong risk factor for ischemic stroke, and stroke in diabetes is both more severe in presentation and outcome and more recalcitrant to acute treatment. Although many etiologies of stroke are made more common by diabetes, the most common type of stroke found in persons with diabetes is lacunar microvascular infarction. Prevention of s...

Introduction: Carpal tunnel syndrome (CTS) is a common clinical syndrome seen in the outpatient setting that is easily confirmed by electrodiagnostic testing. Methods: We present a case of a patient who presented with the classic symptoms and neurological examination for CTS but had a normal nerve conduction study and EMG. Results: Neuromuscul...

This study assesses demographic and clinical variables associated with perioperative and late stroke in diabetes mellitus patients following multivessel coronary artery bypass grafting (CABG). FREEDOM is the largest randomized trial of diabetic patients undergoing multivessel CABG. FREEDOM patients had improved survival free of death, myocardial in...

Background: Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke. Methods: In this randomised open-label trial, eligible patients lived in North America, L...

The SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial ([1][1]) was designed to determine whether treatment of complex coronary artery disease with percutaneous coronary intervention (PCI) with a drug-eluting stent was noninferior to treatment with coronary bypass surgery (CABG). The

Background: In some randomized trials comparing revascularization strategies for patients with diabetes, coronary-artery bypass grafting (CABG) has had a better outcome than percutaneous coronary intervention (PCI). We sought to discover whether aggressive medical therapy and the use of drug-eluting stents could alter the revascularization approac...

Common carotid artery dissection (CCAD) is a rare and poorly characterized cause of ischemic stroke. We describe a case of multiple cerebral infarcts in a patient with CCAD initially detected by carotid duplex ultrasonography, and review the literature on CCAD. A Medline search from 1960 to the present for cases of CCAD yielded 46 cases. We extract...

The majority (>80%) of the three-quarters of a million strokes that will occur in the United States this year are ischemic in nature. The treatment of acute ischemic stroke is very similar to acute myocardial infarction, which requires timely reperfusion therapy for optimal results. The majority of patients with acute ischemic stroke do not receive...

Transcatheter arterial chemoembolization (TACE) is a widely used form of therapy in advanced hepatocellular carcinoma. We report the first pathological data from an autopsy case of multiple cerebral emboli occurring during TACE. A Medline search for previous cases of cerebral embolism and TACE revealed 11 other cases. Multiple microscopic subacute...

Epidemiology of stroke in generalDiabetes as a risk factor for strokeStroke in patients with diabetesIntermediate hyperglycemia and other risk factorsPathophysiology of ischemic stroke in diabetesPrimary prevention of stroke in the patient with diabetesTreatment of acute stroke in the patient with diabetesSecondary prevention of stroke in diabetesC...

Young patients with migraine are at increased risk for stroke, particularly patients with an aura of focal neurologic deficits. Other causes of ischemia are often identified in patients with migraine, including patent foramen ovale, lupus anticoagulant, cervical carotid dissection, arteriovenous malformation, and hyperactivity of the clotting syste...

Regardless of extent or duration of acute effects, transient ischemic attack (TIA) is a marker for cerebrovascular ischemia and carries risk for secondary stroke comparable to that associated with ischemic stroke. Pharmacologic and nonpharmacologic interventions aimed at reducing risk of secondary stroke should be implemented as soon as possible af...

Background and Purpose—In hypertensive stroke patients, for the same level of blood pressure control, eprosartan will be more effective than nitrendipine in reducing cerebrovascular and cardiovascular morbidity and mortality. Methods—A total of 1405 well-defined, high-risk hypertensives with cerebral event during the last 24 months (proven by cereb...

Young patients with migraine are at increased risk for stroke, particularly patients with an aura of focal neurologic deficits. Other causes of ischemia are often identified in patients with migraine, including patent foramen ovale, lupus anticoagulant, cervical carotid dissection, arteriovenous malformation, and hyperactivity of the clotting syste...

Currently, intracerebral hemorrhage (ICH) has the highest mortality rate of all stroke subtypes (Counsell et al 1995; Qureshi et al 2005). Hematoma growth is a principal cause of early neurological deterioration. Prospective and retrospective studies indicate that up to 38% hematoma expansion is noted within three hours of ICH onset and that hemato...

When a patient with migraine has a stroke, all other causes of stroke should be ruled out before the stroke is attributed to migraine. Migraine mimics that present with headaches and stroke, including arteriovenous malformation and cervical carotid artery dissection, should be considered. Patent foramen ovale is a risk factor for both migraine and...

Stroke contributes significantly to death, disability, and healthcare costs; however, recombinant tissue plasminogen activator (rt-PA) is the only approved thrombolytic therapy for acute ischemic stroke. One area of development for new ischemic stroke treatment options is focused on neuroprotection of viable tissue in the ischemic vascular bed. The...

Ischemic stroke was induced in the Mongolian gerbil by left common carotid ligation. No change in uptake of [3H]dopamine, [3H]γ-aminobutyric acid ([3H]GABA), or [14C]glutamate in synaptosomes obtained from the ischemic hemisphere was observed for up to 8 h. At 16 h after ligation, marked decrements in uptake were observed in animals showing hemipar...

methods We randomly assigned patients with transient ischemic attack or stroke caused by an- giographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin (target international normalized ratio, 2.0 to 3.0) or aspirin (1300 mg per day) in a double-blind, multicenter clinical trial. The primary end point was is...

Diabetes is a major risk factor for stroke and is associated with an increase in overall stroke mortality. The metabolic syndrome associated with insulin resistance is also a significant risk factor for stroke. The etiology of stroke in diabetics is frequently microvascular disease from fibrinoid necrosis, which causes small subcortical infarcts de...

It is well established that strict glycemic control for the hospitalized stroke patient is associated with improved outcome compared with poor control. This is particularly true for the stroke patients because hyperglycemia can adversely affect ischemic damage. A blood sugar level of less than 110 mg/dL is recommended for critically ill patients an...

Transesophageal echocardiography (TEE) has been used to visualize aortic arch plaques. TEE is moderately invasive. We employed a new non-invasive method for visualization of the aortic arch to assess the correlation of the extent of plaque in the aortic arch as visualized by non-invasive ultrasound with the prevalence of coronary artery disease (CA...

Atherosclerotic disease accounts for approximately 25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patient...

This study sought to compare the effects of aggressive and conventional lipid lowering by two different dosages of the same statin on early human atherosclerotic lesions using serial noninvasive magnetic resonance imaging (MRI). Regression of atherosclerotic lesions by lipid-lowering therapy has been reported. Using a double-blind design, newly dia...

The most common presentation of ischemic stroke related to pregnancy is arterial occlusion, occurring during the third trimester or postpartum. The authors present the first successful administration of intra-arterial cerebral tissue plasminogen activator to treat an embolic cerebral vascular accident in a 37-week parturient resulting in complete r...

Stroke is the third most common cause of death in the US. Primary prevention of stroke can be achieved by control of risk factors including hypertension, diabetes mellitus, elevated cholesterol levels and smoking. Approximately one-third of all ischaemic strokes occur in patients with a history of stroke or transient ischaemic attack (TIA). The mai...

Lyme disease, a multisystem illness caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. There are 3 clinical stages of Lyme disease: early localized, early disseminated, and late persistent disease. Neuroborreliosis, infection of the nervous system by B. burgdorferi, may occur during early di...

To investigate the prevalence of asymptomatic intracranial stenosis using transcranial Doppler ultrasonography in patients with evidence of asymptomatic carotid stenosis. Symptomatic atherosclerotic intracranial largeartery stenosis accounts for approximately 10% of ischemic strokes annually. It is unknown whether a significant risk for stroke is a...

Recent advances in the prevention and pharmacotherapy of cerebrovascular disease have provided more favorable clinical outcomes. For the treatment of an acute ischemic stroke, the early use of thrombolytic agents can reduce the degree of brain damage while improving functional outcomes. However, trials evaluating various classes of other neuroprote...

Statins are widely used to treat hypercholesterolemia and atherosclerotic disease. Noninvasive MRI allows serial monitoring of atherosclerotic plaque size changes. Our aim was to investigate the effects of lipid lowering with simvastatin on atherosclerotic lesions. A total of 44 aortic and 32 carotid artery plaques were detected in 21 asymptomatic...

The primary risk factors for stroke are known, and attention to primary care of these disorders should reduce the incidence of stroke significantly. Control of hypertension, diabetes, and hyperlipidemia have all been shown to reduce the rate of stroke. Identification of potential cardioembolic sources of stroke, particularly atrial fibrillation, ca...

Atherosclerotic plaque at the arch of the aorta has been identified as a potential source for atheroembolic stroke. Imaging of aortic arch plaque can be performed with transesophageal echocardiography (TEE), but TEE is an invasive procedure. A new noninvasive method has been developed to image aortic arch plaque employing transcutaneous real time B...

Stroke is a major cause of death and disability in the United States. Control of risk factors--particularly hypertension, diabetes, elevated serum lipids, and atrial fibrillation--can significantly reduce the incidence of stroke. Platelet antiaggregant therapy has a role in primary and secondary stroke prevention. Patients with transient ischemic a...

The primary risk factors for stroke are known, and attention to primary care of these disorders should reduce the incidence of stroke significantly. Control of hypertension, diabetes, and hyperlipidemia have all been shown to reduce the rate of stroke. Identification of potential cardioembolic sources of stroke, particularly atrial fibrillation, ca...

It has been suggested that the combination of intravascular brachytherapy and coronary stent implantation may result in further reduction of restenosis after percutaneous balloon angioplasty. The use of an angioplasty balloon filled with a 188Re liquid beta source for intravascular brachytherapy provides the advantage of accurate source positioning...

Recent data indicate that intravascular betaa-irradiation from centrally located sources at the time of balloon angioplasty or stenting reduces proliferation of smooth muscle cells, neointima formation, and restenosis. In an effort to simplify radiation delivery, a novel beta-radiation source was developed based on the adsorption of 32P (phosphoric...

Aortic artery dissection is a rare but well-recognized complication of Turner's syndrome. Isolated carotid or vertebral artery dissection has not previously been reported. The authors report the clinical and magnetic resonance imaging findings in a 30-year-old woman with Turner's syndrome who developed a high cervical spinal cord infarction with a...

Restenosis after percutaneous interventions in coronary and peripheral arteries leads to repeat procedures and surgery in a significant number of patients. We have previously demonstrated that irradiation of an arterial site using an endovascular source (brachytherapy) is highly effective in preventing the restenotic process. To this end, a novel b...

To define the natural history of aortic arch plaque, we used B-mode ultrasonography to perform sequential study of the aortic arch. Eighty-nine patients were studied for up to 18 months. There was no change in 67% of total plaques; 77% of simple plaque (<4 mm) and 48% of complex plaque (> or =4 mm) did not progress. Atherosclerosis of the aortic ar...

Studies of aortic arch plaques with transesophageal echocardiography have demonstrated that complex aortic arch plaques (CAPs) greater than or equal to 4 mm in thickness are associated with ischemic stroke. Recent studies have demonstrated that the morphological features of plaques may aid in the identification of aortic plaques that are more likel...

Background and Purpose-GV150526, a selective glycine site antagonist, reduces infarct volume in rats with focal cerebral ischemia. Safety and efficacy in humans with acute stroke are being investigated, We sought to further explore the safety. pharmacokinetics, and preliminary outcome of GV150526 treatment in patients with a clinical diagnosis of a...

To determine whether elevated titers of antiphosphatidyl serine antibodies (aPS) are associated with an increased risk of ischemic stroke in a general stroke population. aPS are members of the family of antiphospholipid antibodies that has been associated with increased stroke risk. Although aPS have been demonstrated to occur in 18% of a group of...

Previous studies have produced conflicting results regarding the putative association between anticardiolipin antibodies (aCL) and infarction in the general stroke population. These inconsistencies may be a function of sample size and methodological differences among the studies. The purpose of the present study, the largest case-control study of t...

The goal of therapy for acute stroke is immediate treatment to reduce the risk of permanent neurologic disability and death. For ischemic stroke, it is imperative to reestablish brain perfusion while at the same time trying to preserve neuronal function. Early treatment of hemorrhagic stroke, particularly subarachnoid hemorrhage, also may improve c...

Intracoronary gamma or beta radiation from centrally located sources at the time of overstretch balloon injury inhibits neointimal proliferation. In an effort to deliver homogeneous, centered radiation fields in a technically straightforward fashion, we studied the effects of a beta-emitting solution used as a balloon inflation fluid to deliver rad...

A 60-year-old man with intractable congestive heart failure (CHF) had an intra-aortic balloon pump placed to augment coronary artery perfusion. During the evaluation prior to heart transplant, carotid and transcranial Doppler ultrasonography (TCD) was performed. The authors report the findings of Doppler waveform analysis and the presence of balloo...

Irradiation of the arterial wall with beta particles has been shown to be effective in inhibiting neointimal hyperplasia following percutaneous transluminal coronary angioplasty (PTCA). In this study, we describe the use of 188W/188Re generators to obtain 188Re (half-life 16.9 h, maximal beta energy of 2.12 MeV) as a new candidate radioisotope for...

Intravascular irradiation with beta-emitters has been proposed for inhibition of restenosis in coronary arteries after balloon angioplasty or stent implantation. Previous studies have shown the effectiveness of gamma-radiation to prevent recurrent restenosis, even in the presence of an implanted stent. The limited range of beta-particles compared w...

A substantial body of experimental evidence suggests that local application of radiation at sites of angioplasty or stent implantation prevents neointima formation. Recent initial clinical studies report a significant reduction in clinical restenosis rates when gamma emitting radiation sources are used to treat the site of coronary intervention. Be...

Aortic arch atherosclerotic plaque is a probable source of atheroembolic stroke. Transesophageal echocardiography (TEE) has been used to image the aorta of patients with stroke to identify atherosclerotic plaque. TEE is moderately invasive and does not always visualize plaques present in the distal ascending aorta and proximal aortic arch. In the c...

This study was designed to measure recurrent stroke rates and identify their determinants in a mixed ethnic population. A cohort of 299 patients (110 black, 57 Hispanic and 132 white) admitted to a large urban hospital with an acute stroke between November 1, 1991, and July 1, 1993, was followed for a mean of 17.8 months. Demographic and historical...

Restenosis after coronary angioplasty is a major limitation of an otherwise highly effective and safe procedure for the treatment of atherosclerotic coronary artery disease. Although the advent of coronary stenting has reduced restenosis rates for selected patients, an overall restenosis rate of 20% to 25% remains. Despite numerous trials, no effec...