NEJM â Collection Updates for Stroke

EDITORIAL: Can We Rely on RE-LY?

Brian F. Gage, M.D. — Thu, 17Â SepÂ 2009 00:00:00 -05:00

In patients with atrial fibrillation, warfarin prevents 64% of strokes.1 Thus, warfarin has become the recommended treatment for candidates for anticoagulation therapy who have atrial fibrillation and at least one...

ORIGINAL ARTICLE: Dabigatran versus Warfarin in Patients with Atrial Fibrillation

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Background: Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin...

CORRESPONDENCE: Mirror Therapy for Chronic Complex Regional Pain Syndrome Type 1 and Stroke

Thu, 06Â AugÂ 2009 00:00:00 -05:00

To the Editor: Complex regional pain syndrome type 1 is characterized by pain, sensory disturbances (e.g., pain evoked by light brushing of the skin [allodynia]), motor impairment (e.g., weakness), and...

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

Thu, 18Â JunÂ 2009 00:00:00 -05:00

More than 3 million Americans have atrial fibrillation, which increases their risk of stroke by a factor of 5.12 Patients with atrial fibrillation account for one of every six strokes,...

EDITORIAL: The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation

Alan S. Go, M.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

Approximately 1% of Americans have atrial fibrillation, and the prevalence of this arrhythmia increases sharply with older age (being approximately 10% among persons 80 years of age or older).1 Worldwide...

ORIGINAL ARTICLE: Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation

The ACTIVE Investigators — Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis...

ORIGINAL ARTICLE: Genomewide Association Studies of Stroke

Thu, 23Â AprÂ 2009 00:00:00 -05:00

Background: The genes underlying the risk of stroke in the general population remain undetermined.

Methods: We carried out an analysis of genomewide association data generated from four large cohorts composing the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2009 â A 46-Year-Old Man with Migraine, Aphasia, and Hemiparesis and Similarly Affected Family Members

Thu, 16Â AprÂ 2009 00:00:00 -05:00

A 46-year-old man was seen in the neurology clinic because of hemiparesis, aphasia, and abnormalities on neuroimaging studies.

The patient had been well, except for migraine headaches, until 4 years earlier,...

REVIEW ARTICLE: Moyamoya Disease and Moyamoya Syndrome

R. Michael Scott, M.D., and Edward R. Smith, M.D. — Thu, 19Â MarÂ 2009 00:00:00 -05:00

The moyamoya syndrome is a cerebrovascular condition that predisposes affected patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches. Reduced blood...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Dr. W. Taylor Kimberly: A 36-year-old woman was admitted to the hospital because of headaches, hypertension, and seizures.

Nineteen days before the current admission, she delivered healthy twins at 35.6 weeks...

BOOK REVIEW:

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Despite major advances in the treatment of stroke in the past 20 years â particularly in stroke units and in thrombolysis â fear of stroke and its consequences remains deeply...

EDITORIAL: Expanding the Orbit of Primary Prevention â Moving beyond JUPITER

Mark A. Hlatky, M.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

The aphorism âprevention is better than cureâ makes perfect sense when applied to healthy habits such as following a sensible diet, maintaining an ideal body weight, exercising regularly, and not...

ORIGINAL ARTICLE: Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Background: Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with...

EDITORIAL: Thrombolytic Therapy for Acute Stroke â Not a Moment to Lose

Patrick Lyden, M.D. — Thu, 25Â SepÂ 2008 00:00:00 -05:00

Stroke, the most common cause of disability in the world among adults, remains the only neurologic disorder for which physicians are potentially able to completely reverse disabling deficits.1 Thrombolytic therapy,...

ORIGINAL ARTICLE: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Thu, 25Â SepÂ 2008 00:00:00 -05:00

Background: Intravenous thrombolysis with alteplase is the only approved treatment for acute ischemic stroke, but its efficacy and safety when administered more than 3 hours after the onset of symptoms...

EDITORIAL: Stroke Prevention â Insights from Incoherence

David M. Kent, M.D., and David E. Thaler, M.D., Ph.D. — Thu, 18Â SepÂ 2008 00:00:00 -05:00

If clinical trials were sporting contests, then it would be fair to say that low-dose aspirin plus extended-release dipyridamole (Aggrenox) was the clear favorite against clopidogrel going into the Prevention...

ORIGINAL ARTICLE: Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke

Thu, 18Â SepÂ 2008 00:00:00 -05:00

Background: Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared the efficacy and safety of two antiplatelet regimens â aspirin plus extended-release dipyridamole (ASAâERDP) versus clopidogrel.

Methods:...

ORIGINAL ARTICLE: Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

Thu, 18Â SepÂ 2008 00:00:00 -05:00

Background: Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the reninâangiotensin system in high-risk patients reduces the rate of subsequent...

BOOK REVIEW:

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Stroke is the third leading cause of death worldwide. In industrialized countries it accounts for 10 to 12% of all deaths, but two thirds of deaths from stroke now occur...

EDITORIAL: Intracerebral Hemorrhage â Improving Outcome by Reducing Volume?

Stanley Tuhrim, M.D. — Thu, 15Â MayÂ 2008 00:00:00 -05:00

Intracerebral hemorrhage accounts for 10 to 15% of all strokes. It is the type of stroke with the highest mortality, with a 1-year survival rate of less than 50%.1 Most...

ORIGINAL ARTICLE: Efficacy and Safety of Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage

Thu, 15Â MayÂ 2008 00:00:00 -05:00

Background: Intracerebral hemorrhage is the least treatable form of stroke. We performed this phase 3 trial to confirm a previous study in which recombinant activated factor VII (rFVIIa) reduced growth...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

Thu, 17Â AprÂ 2008 00:00:00 -05:00

A 1-day-old female infant was admitted to the neonatal intensive care unit of this hospital because of intermittent apnea and cyanosis. The day before admission, the patient was born at...

IMAGES IN CLINICAL MEDICINE: Cerebral Embolism of Probable Aortic Origin

Ronald E. Oppenheim, M.D. and Gary J. Felsberg, M.D. — Thu, 10Â AprÂ 2008 00:00:00 -05:00

A 70-year-old woman was hospitalized for intermittent, reversible cerebral ischemia causing weakness of the right side for several days, before resolving. A computed tomographic (CT) scan showed no intracranial abnormalities....

ORIGINAL ARTICLE: Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients

Thu, 10Â AprÂ 2008 00:00:00 -05:00

Background: We previously reported that, in a randomized trial, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy for the treatment of carotid artery...

CLINICAL PRACTICE: Acute Ischemic Stroke

H. Bart van der Worp, M.D., Ph.D., and Jan van Gijn, F.R.C.P. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

A 62-year-old man has sudden weakness of the left arm and leg and slurred speech. Except for untreated hypertension, his medical history is unremarkable. He is a current smoker with...

ORIGINAL ARTICLE: NXY-059 for the Treatment of Acute Ischemic Stroke

Thu, 09Â AugÂ 2007 00:00:00 -05:00

Background: The free-radicalâtrapping agent NXY-059 showed promise as a neuroprotectant in the StrokeâAcute Ischemic NXY Treatment I (SAINT I) trial, reducing disability when given to patients who had acute ischemic...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Dr. Kevin N. Sheth (Neurology): A 58-year-old right-handed woman with type 1 diabetes was admitted to the hospital because of a 2-week history of increasing fatigue and word-finding difficulties and...

REVIEW ARTICLE: Perioperative Stroke

Magdy Selim, M.D., Ph.D. — Thu, 15Â FebÂ 2007 00:00:00 -05:00

Stroke is one of the most feared complications of surgery. to provide adequate preventive and therapeutic measures, physicians need to be knowledgeable about the risk factors for stroke during the...

EDITORIAL: Stroke â An Equal Opportunity for the Initiation of Statin Therapy

David M. Kent, M.D. — Thu, 10Â AugÂ 2006 00:00:00 -05:00

Given the disparity in the numbers of cerebrovascular and cardiovascular clinical trials and the similarities in the interventions tested, it seems that stroke neurologists have had to peer at clinical-trial...

ORIGINAL ARTICLE: High-Dose Atorvastatin after Stroke or Transient Ischemic Attack

Thu, 10Â AugÂ 2006 00:00:00 -05:00

Background: Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2006 â A 72-Year-Old Woman Admitted to the Emergency Department because of a Sudden Change in Mental Status

Stephen H. Thomas, M.D., M.P.H., Lee H. Schwamm, M.D., and Michael H. Lev, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

Dr. Emily Senecal (Emergency Medicine): A 72-year-old left-handed woman was transported by helicopter from her home to the emergency department of this hospital because of a sudden change in mental...

ORIGINAL ARTICLE: Role of COL4A1 in Small-Vessel Disease and Hemorrhagic Stroke

Thu, 06Â AprÂ 2006 00:00:00 -05:00

Small-vessel diseases of the brain underlie 20 to 30 percent of ischemic strokes and a larger proportion of intracerebral hemorrhages. In this report, we show that a mutation in the...

PERSPECTIVE: Small Vessels, Big Problems

Thu, 06Â AprÂ 2006 00:00:00 -05:00

The impressive gains in stroke prevention and treatment seen over the past decade have not been evenly distributed across all types of stroke. Most advances have pertained to the approximately...

ORIGINAL ARTICLE: NXY-059 for Acute Ischemic Stroke

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: NXY-059 is a free-radicalâtrapping agent that is neuroprotective in animal models of stroke. We tested whether it would reduce disability in humans after acute ischemic stroke.

Methods: We conducted a...

PERSPECTIVE: Stroke and Neurovascular Protection

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Neurons are extremely sensitive cells, whose function, like that of all cells, can be influenced by changes in their environment. Using pumps to regulate the internal and external electrolyte milieu,...

ORIGINAL ARTICLE: Discontinuing Prophylactic Transfusions Used to Prevent Stroke in Sickle Cell Disease

Thu, 29Â DecÂ 2005 00:00:00 -05:00

Background: Prophylactic transfusion prevents strokes in children with sickle cell anemia who have abnormalities on transcranial Doppler ultrasonographic examination. However, it is not known how long transfusion should be continued...

PERSPECTIVE: Preventing Stroke in Sickle Cell Anemia

Thu, 29Â DecÂ 2005 00:00:00 -05:00

In the late 1930s, William Bosworth Castle and his colleague Thomas Hale Ham were studying blood samples obtained from patients with sickle cell anemia and found that the viscosity of...

CLINICAL PRACTICE: Patent Foramen Ovale in Young Adults with Unexplained Stroke

Jorge R. Kizer, M.D., and Richard B. Devereux, M.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

A 38-year-old man notes abrupt loss of vision in his right visual field while reading. He has no significant medical history and reports that he neither smokes nor uses alcohol...

ORIGINAL ARTICLE: Obstructive Sleep Apnea as a Risk Factor for Stroke and Death

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Background: Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently...

ORIGINAL ARTICLE: Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: Statins reduce the incidence of cardiovascular events in persons with type 2 diabetes mellitus. However, the benefit of statins in such patients receiving hemodialysis, who are at high risk...

REVIEW ARTICLE: Vertebrobasilar Disease

Sean I. Savitz, M.D., and Louis R. Caplan, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

Eighty percent of strokes are ischemic. Twenty percent of ischemic events involve tissue supplied by the posterior (vertebrobasilar) circulation (Figure 1). The paralysis of vertebrobasilar stroke can be devastating, and...

CLINICAL PRACTICE: Rehabilitation after Stroke

Bruce H. Dobkin, M.D. — Thu, 21Â AprÂ 2005 00:00:00 -05:00

A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech...

EDITORIAL: Stopping the Bleeding in Intracerebral Hemorrhage

Devin L. Brown, M.D., and Lewis B. Morgenstern, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

Beyond aggressive supportive care, clinicians have not had specific treatments to offer patients with intracerebral hemorrhage. The article by Mayer et al.1 in this issue of the Journal offers new...

ORIGINAL ARTICLE: Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage

Thu, 24Â FebÂ 2005 00:00:00 -05:00

Background: 05022432.xml Intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality. Among patients who undergo computed tomography (CT) within three hours after the onset...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Limiting Stroke-Induced Damage by Targeting an Acid Channel

Morris Benveniste, Ph.D., and Raymond Dingledine, Ph.D. — Thu, 06Â JanÂ 2005 00:00:00 -05:00

Why are brain neurons so much more susceptible to ischemic injury than, say, muscle or skin tissue? A clue is provided by work showing that the activation of neuronal acid-sensing...

ORIGINAL ARTICLE: Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

Thu, 16Â DecÂ 2004 00:00:00 -05:00

Background: There is evidence that chronic inflammation may promote atherosclerotic disease. We tested the hypothesis that acute infection and vaccination increase the short-term risk of vascular events.

Methods: We undertook within-person...

REVIEW ARTICLE: Hypertensive Retinopathy

Tien Y. Wong, M.D., Ph.D., and Paul Mitchell, M.D., Ph.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

Hypertensive retinopathy is a condition characterized by a spectrum of retinal vascular signs in people with elevated blood pressure.1 The detection of hypertensive retinopathy with the use of an ophthalmoscope...

ORIGINAL ARTICLE: Ultrasound-Enhanced Systemic Thrombolysis for Acute Ischemic Stroke

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Background: Transcranial Doppler ultrasonography that is aimed at residual obstructive intracranial blood flow may help expose thrombi to tissue plasminogen activator (t-PA). Our objective was to determine whether ultrasonography can...

EDITORIAL: Stenting for Carotid-Artery Stenosis

Richard P. Cambria, M.D. — Thu, 07Â OctÂ 2004 00:00:00 -05:00

In the context of his original description of the pathoanatomical relationship of plaque at the carotid bifurcation to ipsilateral hemispheric stroke, C. Miller Fisher predicted that âone day surgeons might...

ORIGINAL ARTICLE: Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients

Thu, 07Â OctÂ 2004 00:00:00 -05:00

Background: 04100728.xml 04100728.xml 04100728.xml Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotid-artery stenosis. Stenting with the...

PERSPECTIVE: Mind Reading

Elissa Ely, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

I was called in to see a man I did not know. No one knew him. His usual doctor was on vacation, and the social worker who paged me was...

CLINICAL PROBLEM-SOLVING: A Twist of Fate?

Michael D. Christian, M.D., and Allan S. Detsky, M.D., Ph.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

A 39-year-old Sri Lankan male physiotherapist presented to an emergency department in Toronto with a three-day history of headache, chills, diarrhea, nausea, vomiting, and neck stiffness. He reported having had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2004 â A 66-Year-Old Man with Progressive Neurologic Deficits

Thu, 29Â AprÂ 2004 00:00:00 -05:00

A 66-year-old, right-handed man was admitted to the hospital because of progressive left-sided weakness.

Nineteen years before admission, the patient had received a renal transplant from a living related donor because...

SPECIAL ARTICLE: Impracticability of Informed Consent in the Registry of the Canadian Stroke Network

Thu, 01Â AprÂ 2004 00:00:00 -05:00

Background: Government legislators and research ethics boards in some jurisdictions require all patients to give written informed consent before enrollment in clinical registries. However, the effect of such a requirement...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2004 â A 57-Year-Old Man with Slurred Speech and Left Hemiparesis

Thu, 12Â FebÂ 2004 00:00:00 -05:00

A 57-year-old right-handed man was admitted to the hospital because of the sudden onset of slurred speech and left hemiparesis.

The patient had been well until two days earlier, when he...

IMAGES IN CLINICAL MEDICINE: Giant Lambl's Excrescences

Atul Aggarwal, M.D. and Bruce J. Leavitt, M.D. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

A 66-year-old, previously healthy woman presented with an acute onset of weakness on the left side of the body. A computed tomographic scan of the head revealed a small infarction...

ORIGINAL ARTICLE: Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation

Thu, 11Â SepÂ 2003 00:00:00 -05:00

Background: The incidence of stroke in patients with atrial fibrillation is greatly reduced by oral anticoagulation, with the full effect seen at international normalized ratio (INR) values of 2.0 or...

PERSPECTIVE: Atrial Fibrillation and Stroke Prevention

Robert G. Hart, M.D. — Thu, 11Â SepÂ 2003 00:00:00 -05:00

Atrial fibrillation is a common cardiac arrhythmia whose most serious clinical consequence is stroke. Described in pathological studies in the 1940s, uncoordinated atrial contractions result in sluggish blood flow and...

IMAGES IN CLINICAL MEDICINE: Carotid-Artery Thrombosis Secondary to Basal Skull Fracture

Thomas Santarius, M.R.C.S. and David K. Menon, Ph.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

A 17-year-old boy dove to catch a cricket ball and struck his head on a teammate's knee. On initial assessment, the score on the Glasgow Coma Scale was 7 and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2003 â A 72-Year-Old Man with Repetitive Strokes in the Posterior Circulation

Thu, 10Â JulÂ 2003 00:00:00 -05:00

A 72-year-old, right-handed man was admitted to the hospital because of recurrent neurologic symptoms.

The patient had been well until 10 days earlier, when he briefly had numbness of the right...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Neuronal Regeneration after Stroke

Zurab Nadareishvili, M.D., and John Hallenbeck, M.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

Neurogenesis in the mammalian central nervous system was formerly considered to end shortly after birth. We now know that neural stem cells exist not only in the developing nervous system,...

ORIGINAL ARTICLE: Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly

Thu, 03Â AprÂ 2003 00:00:00 -05:00

Background: Upper respiratory tract illnesses have been associated with an increased risk of ischemic heart disease and stroke. During two influenza seasons, we assessed the influence of vaccination against influenza...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: New Players in the Genetics of Stroke

Thu, 21Â NovÂ 2002 00:00:00 -05:00

Stroke is the second leading cause of death and the most common cause of disability in the world. Its incidence is rising with increasing life expectancy. To relieve the heavy...

CLINICAL PRACTICE: Transient Ischemic Attack

S. Claiborne Johnston, M.D., Ph.D. — Thu, 21Â NovÂ 2002 00:00:00 -05:00

A 72-year-old woman telephones her physician immediately after recovering from a 30-minute episode of difficulty speaking and weakness of the right side of the face and right arm. Her medical...

PERSPECTIVE: Transient Ischemic Attacks

Thu, 21Â NovÂ 2002 00:00:00 -05:00

The occurrence of fleeting episodes of numbness or paralysis was known to early physicians. One referred to them as âstraws which show how the intracranial wind is blowing.â In 1950,...

ORIGINAL ARTICLE: Warfarin, Aspirin, or Both after Myocardial Infarction

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Background: The role of antithrombotic therapy in secondary prevention after myocardial infarction is well established. Although the available literature suggests that warfarin is superior to aspirin, aspirin is currently the...

EDITORIAL: Antithrombotic Therapy after Myocardial Infarction

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Despite encouraging trends over the past three decades, coronary heart disease remains the leading cause of death in the United States and other industrialized countries. Recent data from the National...

ORIGINAL ARTICLE: Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke

Thu, 08Â AugÂ 2002 00:00:00 -05:00

Background: Spasticity is a disabling complication of stroke, and it is uncertain whether intramuscular injections of botulinum toxin type A reduce disability in persons with spasticity of the wrist and...

PERSPECTIVE: Stroke, Spasticity, and Botulinum Toxin

Thu, 08Â AugÂ 2002 00:00:00 -05:00

Botulinum toxin is in the news these days. First came September 11 and fears of chemical terrorism. One gram of this âmost poisonous poisonâ could kill a million people were...

ORIGINAL ARTICLE: Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both

Thu, 13Â DecÂ 2001 00:00:00 -05:00

Background: Patent foramen ovale and atrial septal aneurysm have been identified as potential risk factors for stroke, but information about their effect on the risk of recurrent stroke is limited....

EDITORIAL: Oral Anticoagulant Therapy for the Prevention of Stroke

Thu, 15Â NovÂ 2001 00:00:00 -05:00

This year in the United States, 450,000 people will have a first ischemic stroke.123 For these patients (including those receiving thrombolytic therapy), the primary therapeutic goals will be rehabilitation and...

ORIGINAL ARTICLE: A Comparison of Warfarin and Aspirin for the Prevention of Recurrent Ischemic Stroke

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Background: Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin,...

ORIGINAL ARTICLE: A Clinical Trial of Estrogen-Replacement Therapy after Ischemic Stroke

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Background: Observational studies have suggested that estrogen-replacement therapy may reduce a woman's risk of stroke and death.

Methods: We conducted a randomized, double-blind, placebo-controlled trial of estrogen therapy (1 mg of...

CLINICAL PRACTICE: Extracranial Carotid Stenosis

Ralph L. Sacco, M.D. — Thu, 11Â OctÂ 2001 00:00:00 -05:00

A 64-year-old man with a history of smoking and hypercholesterolemia has a sudden, transient loss of vision in his left eye. He reports a prior episode during which he had...

ORIGINAL ARTICLE: Prognosis after Transient Monocular Blindness Associated with Carotid-Artery Stenosis

Thu, 11Â OctÂ 2001 00:00:00 -05:00

Background: Transient monocular blindness associated with internal-carotid-artery stenosis is a risk factor for stroke. The effect of carotid endarterectomy in patients who present with transient monocular blindness has not been...

ORIGINAL ARTICLE: Cerebral Sinovenous Thrombosis in Children

Thu, 09Â AugÂ 2001 00:00:00 -05:00

Background: Cerebral sinovenous thrombosis in children is a serious disorder, and information is needed about its prevention and treatment.

Methods: The Canadian Pediatric Ischemic Stroke Registry was initiated in 1992 at...

REVIEW ARTICLE: Spontaneous Dissection of the Carotid and Vertebral Arteries

Wouter I. Schievink, M.D. — Thu, 22Â MarÂ 2001 00:00:00 -05:00

When a tear occurs in one of the major arteries in the neck and allows blood to enter the wall of the artery and split its layers, the result is...

EDITORIAL: The FDA, Regulation, and the Risk of Stroke

Thu, 21Â DecÂ 2000 00:00:00 -05:00

When Jane Henney, commissioner of the Food and Drug Administration (FDA), announced on October 10, 2000, the agency's intention to have products containing phenylpropanolamine withdrawn from the market, another chapter...

ORIGINAL ARTICLE: Phenylpropanolamine and the Risk of Hemorrhagic Stroke

Thu, 21Â DecÂ 2000 00:00:00 -05:00

Background: Phenylpropanolamine is commonly found in appetite suppressants and cough or cold remedies. Case reports have linked the use of products containing phenylpropanolamine to hemorrhagic stroke, often after the first...

REVIEW ARTICLE: Treatment of Acute Ischemic Stroke

Thomas Brott, M.D., and Julien Bogousslavsky, M.D. — Thu, 07Â SepÂ 2000 00:00:00 -05:00

Ischemic stroke exacts a heavy toll in death and disability worldwide. In the United States, where it is the third leading cause of death and the leading cause of serious...

ORIGINAL ARTICLE: Pravastatin Therapy and the Risk of Stroke

Thu, 03Â AugÂ 2000 00:00:00 -05:00

Background: Several epidemiologic studies have concluded that there is no relation between total cholesterol levels and the risk of stroke. In some studies that classified strokes according to cause, there...

EDITORIAL: Carotid Endarterectomy Revisited

Thu, 08Â JunÂ 2000 00:00:00 -05:00

The importance of understanding the pathophysiologic basis of transient cerebral ischemia or ischemic stroke became clear with Fisher's original description of stroke in patients with atherothrombotic âocclusion of the internal...

ORIGINAL ARTICLE: The Causes and Risk of Stroke in Patients with Asymptomatic Internal-Carotid-Artery Stenosis

Thu, 08Â JunÂ 2000 00:00:00 -05:00

Background: The causes of stroke in patients with asymptomatic carotid-artery stenosis have not been carefully studied. Information about causes might influence decisions about the use of carotid endarterectomy in such...

ORIGINAL ARTICLE: Effects of Physiologic Pacing versus Ventricular Pacing on the Risk of Stroke and Death Due to Cardiovascular Causes

Thu, 11Â MayÂ 2000 00:00:00 -05:00

Background: Evidence suggests that physiologic pacing (dual-chamber or atrial) may be superior to single-chamber (ventricular) pacing because it is associated with lower risks of atrial fibrillation, stroke, and death. These...

EDITORIAL: ACE Inhibition in Cardiovascular Disease

Thu, 20Â JanÂ 2000 00:00:00 -05:00

An important article in this issue of the Journal describes the results of the Heart Outcomes Prevention Evaluation (HOPE) study, which are likely to have important implications for the treatment...

ORIGINAL ARTICLE: Effects of an Angiotensin-ConvertingâEnzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients

The Heart Outcomes Prevention Evaluation Study Investigators — Thu, 20Â JanÂ 2000 00:00:00 -05:00

Background: Angiotensin-convertingâenzyme inhibitors improve the outcome among patients with left ventricular dysfunction, whether or not they have heart failure. We assessed the role of an angiotensin-convertingâenzyme inhibitor, ramipril, in patients...

EDITORIAL: Alcohol for Stroke Prevention?

Thu, 18Â NovÂ 1999 00:00:00 -05:00

Cerebrovascular disease accounts for a substantial worldwide burden of death and disability. In addition to well-established risk factors such as hypertension, myocardial infarction, diabetes mellitus, and smoking,1 an increasing body...

ORIGINAL ARTICLE: Light-to-Moderate Alcohol Consumption and the Risk of Stroke among U.S. Male Physicians

Thu, 18Â NovÂ 1999 00:00:00 -05:00

Background: Several studies have shown U- or J-shaped relations between alcohol consumption and the risk of stroke. We evaluated the effect of light-to-moderate alcohol intake on the risk of stroke,...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Reducing Calcium Overload in the Ischemic Brain

Thu, 11Â NovÂ 1999 00:00:00 -05:00

The development of effective treatments for stroke has focused on two general strategies. The first, thrombolysis, became available in 1996, when the Food and Drug Administration approved alteplase (tissue plasminogen...

ORIGINAL ARTICLE: Lack of Evidence of an Association between Mitral-Valve Prolapse and Stroke in Young Patients

Thu, 01Â JulÂ 1999 00:00:00 -05:00

Background: Previous studies have reported a high prevalence of mitral-valve prolapse among patients with embolic stroke (28 to 40 percent), especially among young patients (those â¤45 years old); this finding...

ORIGINAL ARTICLE: Effects of Tissue Plasminogen Activator for Acute Ischemic Stroke at One Year

Thu, 10Â JunÂ 1999 00:00:00 -05:00

Background: In 1995, the two-part National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Study found that patients who were treated with tissue plasminogen activator (t-PA)...

IMAGES IN CLINICAL MEDICINE: Circumferential Dissection of the Aorta

Daniel J. PiÃ±eiro, M.D. and Claudio A. Bellido, M.D. — Thu, 20Â MayÂ 1999 00:00:00 -05:00

Figure 1. A 68-year-old woman was admitted to the emergency room with sudden left hemiparesis. A computed tomographic scan of the brain showed an image consistent with infarction of the...

ORIGINAL ARTICLE: Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults

Thu, 07Â JanÂ 1999 00:00:00 -05:00

Background: The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the...

SPECIAL ARTICLE: The Fall and Rise of Carotid Endarterectomy in the United States and Canada

Thu, 12Â NovÂ 1998 00:00:00 -05:00

Background: Randomized clinical trials have demonstrated the efficacy of carotid endarterectomy in the prevention of stroke when the procedure is performed in regional centers of surgical excellence. However, the relative...

ORIGINAL ARTICLE: Prevention of a First Stroke by Transfusions in Children with Sickle Cell Anemia and Abnormal Results on Transcranial Doppler Ultrasonography

Thu, 02Â JulÂ 1998 00:00:00 -05:00

Background: Blood transfusions prevent recurrent stroke in children with sickle cell anemia, but the value of transfusions in preventing a first stroke is unknown. We used transcranial Doppler ultrasonography to...

ORIGINAL ARTICLE: High Risk of Cerebral-Vein Thrombosis in Carriers of a Prothrombin-Gene Mutation and in Users of Oral Contraceptives

Thu, 18Â JunÂ 1998 00:00:00 -05:00

Background: Idiopathic cerebral-vein thrombosis can cause serious neurologic disability. We evaluated risk factors for this disorder, including genetic risk factors (mutations in the genes encoding factor V and prothrombin) and...

ORIGINAL ARTICLE: Cumulative Effects of High Cholesterol Levels, High Blood Pressure, and Cigarette Smoking on Carotid Stenosis

Thu, 21Â AugÂ 1997 00:00:00 -05:00

Background: Single measurements of cardiovascular risk factors may not accurately reflect a person's past exposure to those risk factors. We therefore studied the long-term associations of cardiovascular risk factors such...

ORIGINAL ARTICLE: Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men

Thu, 03Â AprÂ 1997 00:00:00 -05:00

Background: Inflammation may be important in the pathogenesis of atherothrombosis. We studied whether inflammation increases the risk of a first thrombotic event and whether treatment with aspirin decreases the risk.

Methods:...

EDITORIAL: Inflammation, Atherosclerosis, and Ischemic Events â Exploring the Hidden Side of the Moon

Thu, 03Â AprÂ 1997 00:00:00 -05:00

Cardiac and cerebral ischemic events develop unpredictably in patients with widely varying degrees of atherosclerotic disease. Thus, a major area of research is the study of the stimuli that provoke...

ORIGINAL ARTICLE: Ventricular Dysfunction and the Risk of Stroke after Myocardial Infarction

Thu, 23Â JanÂ 1997 00:00:00 -05:00

Background: In patients who have had a myocardial infarction, the long-term risk of stroke and its relation to the extent of left ventricular dysfunction have not been determined. We studied...

ORIGINAL ARTICLE: Pregnancy and the Risk of Stroke

Thu, 12Â SepÂ 1996 00:00:00 -05:00

Background: It is widely believed that pregnancy increases the risk of stroke, but there are few data available to quantify that risk.

Methods: We identified all female patients 15 through 44...

EDITORIAL: The Scylla and Charybdis of Oral Anticoagulant Treatment

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Treatment with oral anticoagulant drugs (i.e., coumarin derivatives such as warfarin) is effective in the prevention of venous and arterial thromboembolism. In patients with atrial fibrillation, anticoagulation reduces the risk...

ORIGINAL ARTICLE: An Analysis of the Lowest Effective Intensity of Prophylactic Anticoagulation for Patients with Nonrheumatic Atrial Fibrillation

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Background: To avert major hemorrhage, physicians need to know the lowest intensity of anticoagulation that is effective in preventing stroke in patients with atrial fibrillation. Since the low rate of...

ORIGINAL ARTICLE: Postmenopausal Estrogen and Progestin Use and the Risk of Cardiovascular Disease

Thu, 15Â AugÂ 1996 00:00:00 -05:00

Background: Estrogen therapy in postmenopausal women has been associated with a decreased risk of heart disease. There is little information, however, about the effect of combined estrogen and progestin therapy...

ORIGINAL ARTICLE: Thrombolytic Therapy with Streptokinase in Acute Ischemic Stroke

The Multicenter Acute Stroke Trial â Europe Study Group — Thu, 18Â JulÂ 1996 00:00:00 -05:00

Background: In patients with acute ischemic stroke, early treatment with thrombolytic agents is thought to permit reperfusion of ischemic neurons and to promote recovery of function. The Multicenter Acute Stroke...

ORIGINAL ARTICLE: Stroke in Users of Low-Dose Oral Contraceptives

Thu, 04Â JulÂ 1996 00:00:00 -05:00

Background: Previous studies have linked the use of oral contraceptive agents to an increased risk of stroke, but those studies have been limited to oral contraceptives containing more estrogen than...

EDITORIAL: Low-Dose Oral Contraceptives and Stroke

Thu, 04Â JulÂ 1996 00:00:00 -05:00

For decades it has been known that oral contraceptive drugs are one of the most effective forms of birth control. Despite their clear and substantial benefits, concern has remained about...

ORIGINAL ARTICLE: Atherosclerotic Disease of the Aortic Arch as a Risk Factor for Recurrent Ischemic Stroke

The French Study of Aortic Plaques in Stroke Group — Thu, 09Â MayÂ 1996 00:00:00 -05:00

Background: Atherosclerotic disease of the aortic arch is found in 60 percent of patients 60 years of age or older who have had brain infarction. The aim of this study...

NEJM â Collection Updates for Stroke

EDITORIAL: Can We Rely on RE-LY?

ORIGINAL ARTICLE: Dabigatran versus Warfarin in Patients with Atrial Fibrillation

CORRESPONDENCE: Mirror Therapy for Chronic Complex Regional Pain Syndrome Type 1 and Stroke

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

EDITORIAL: The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation

ORIGINAL ARTICLE: Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation

ORIGINAL ARTICLE: Genomewide Association Studies of Stroke

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2009 â A 46-Year-Old Man with Migraine, Aphasia, and Hemiparesis and Similarly Affected Family Members

REVIEW ARTICLE: Moyamoya Disease and Moyamoya Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

BOOK REVIEW:

EDITORIAL: Expanding the Orbit of Primary Prevention â Moving beyond JUPITER

ORIGINAL ARTICLE: Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein

EDITORIAL: Thrombolytic Therapy for Acute Stroke â Not a Moment to Lose

ORIGINAL ARTICLE: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

EDITORIAL: Stroke Prevention â Insights from Incoherence

ORIGINAL ARTICLE: Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke

ORIGINAL ARTICLE: Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

BOOK REVIEW:

EDITORIAL: Intracerebral Hemorrhage â Improving Outcome by Reducing Volume?

ORIGINAL ARTICLE: Efficacy and Safety of Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

IMAGES IN CLINICAL MEDICINE: Cerebral Embolism of Probable Aortic Origin

ORIGINAL ARTICLE: Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients

CLINICAL PRACTICE: Acute Ischemic Stroke

ORIGINAL ARTICLE: NXY-059 for the Treatment of Acute Ischemic Stroke

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

REVIEW ARTICLE: Perioperative Stroke

EDITORIAL: Stroke â An Equal Opportunity for the Initiation of Statin Therapy

ORIGINAL ARTICLE: High-Dose Atorvastatin after Stroke or Transient Ischemic Attack

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2006 â A 72-Year-Old Woman Admitted to the Emergency Department because of a Sudden Change in Mental Status

ORIGINAL ARTICLE: Role of COL4A1 in Small-Vessel Disease and Hemorrhagic Stroke

PERSPECTIVE: Small Vessels, Big Problems

ORIGINAL ARTICLE: NXY-059 for Acute Ischemic Stroke

PERSPECTIVE: Stroke and Neurovascular Protection

ORIGINAL ARTICLE: Discontinuing Prophylactic Transfusions Used to Prevent Stroke in Sickle Cell Disease

PERSPECTIVE: Preventing Stroke in Sickle Cell Anemia

CLINICAL PRACTICE: Patent Foramen Ovale in Young Adults with Unexplained Stroke

ORIGINAL ARTICLE: Obstructive Sleep Apnea as a Risk Factor for Stroke and Death

ORIGINAL ARTICLE: Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis

REVIEW ARTICLE: Vertebrobasilar Disease

CLINICAL PRACTICE: Rehabilitation after Stroke

EDITORIAL: Stopping the Bleeding in Intracerebral Hemorrhage

ORIGINAL ARTICLE: Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Limiting Stroke-Induced Damage by Targeting an Acid Channel

ORIGINAL ARTICLE: Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

REVIEW ARTICLE: Hypertensive Retinopathy

ORIGINAL ARTICLE: Ultrasound-Enhanced Systemic Thrombolysis for Acute Ischemic Stroke

EDITORIAL: Stenting for Carotid-Artery Stenosis

ORIGINAL ARTICLE: Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients

PERSPECTIVE: Mind Reading

CLINICAL PROBLEM-SOLVING: A Twist of Fate?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2004 â A 66-Year-Old Man with Progressive Neurologic Deficits

SPECIAL ARTICLE: Impracticability of Informed Consent in the Registry of the Canadian Stroke Network

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2004 â A 57-Year-Old Man with Slurred Speech and Left Hemiparesis

IMAGES IN CLINICAL MEDICINE: Giant Lambl's Excrescences

ORIGINAL ARTICLE: Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation

PERSPECTIVE: Atrial Fibrillation and Stroke Prevention

IMAGES IN CLINICAL MEDICINE: Carotid-Artery Thrombosis Secondary to Basal Skull Fracture

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2003 â A 72-Year-Old Man with Repetitive Strokes in the Posterior Circulation

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Neuronal Regeneration after Stroke

ORIGINAL ARTICLE: Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly

CLINICAL IMPLICATIONS OF BASIC RESEARCH: New Players in the Genetics of Stroke

CLINICAL PRACTICE: Transient Ischemic Attack

PERSPECTIVE: Transient Ischemic Attacks

ORIGINAL ARTICLE: Warfarin, Aspirin, or Both after Myocardial Infarction

EDITORIAL: Antithrombotic Therapy after Myocardial Infarction

ORIGINAL ARTICLE: Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a Stroke

PERSPECTIVE: Stroke, Spasticity, and Botulinum Toxin

ORIGINAL ARTICLE: Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both

EDITORIAL: Oral Anticoagulant Therapy for the Prevention of Stroke

ORIGINAL ARTICLE: A Comparison of Warfarin and Aspirin for the Prevention of Recurrent Ischemic Stroke

ORIGINAL ARTICLE: A Clinical Trial of Estrogen-Replacement Therapy after Ischemic Stroke

CLINICAL PRACTICE: Extracranial Carotid Stenosis

ORIGINAL ARTICLE: Prognosis after Transient Monocular Blindness Associated with Carotid-Artery Stenosis

ORIGINAL ARTICLE: Cerebral Sinovenous Thrombosis in Children

REVIEW ARTICLE: Spontaneous Dissection of the Carotid and Vertebral Arteries

EDITORIAL: The FDA, Regulation, and the Risk of Stroke

ORIGINAL ARTICLE: Phenylpropanolamine and the Risk of Hemorrhagic Stroke

NEJM â Collection Updates for Stroke

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2009 â A 46-Year-Old Man with Migraine, Aphasia, and Hemiparesis and Similarly Affected Family Members

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2009 â A 36-Year-Old Woman with Headache, Hypertension, and Seizure 2 Weeks Post Partum

EDITORIAL: Expanding the Orbit of Primary Prevention â Moving beyond JUPITER

EDITORIAL: Thrombolytic Therapy for Acute Stroke â Not a Moment to Lose

EDITORIAL: Stroke Prevention â Insights from Incoherence

EDITORIAL: Intracerebral Hemorrhage â Improving Outcome by Reducing Volume?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2008 â A Newborn Infant with Intermittent Apnea and Seizures

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

EDITORIAL: Stroke â An Equal Opportunity for the Initiation of Statin Therapy

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2006 â A 72-Year-Old Woman Admitted to the Emergency Department because of a Sudden Change in Mental Status

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 14-2004 â A 66-Year-Old Man with Progressive Neurologic Deficits

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2004 â A 57-Year-Old Man with Slurred Speech and Left Hemiparesis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2003 â A 72-Year-Old Man with Repetitive Strokes in the Posterior Circulation

ORIGINAL ARTICLE: Effects of an Angiotensin-ConvertingâEnzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients

EDITORIAL: Inflammation, Atherosclerosis, and Ischemic Events â Exploring the Hidden Side of the Moon