Cerebral Microbleeds and Thrombolysis-Associated Intracerebral Hemorrhage: Cause for Concern, or Just a Distraction? David J. Werring, PhD...

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1 Stroke AN AHA/ASA JO U R N A L Volume 46 Number 9 September 2015 This article contains online supplementary information that is available at In Memoriam Dan Adams Bugher Foundation Champion for Training and Collaboration Ralph L. Sacco, MS, MD; Jaime Aron, BJ Editorial Cerebral Microbleeds and Thrombolysis-Associated Intracerebral Hemorrhage: Cause for Concern, or Just a Distraction? David J. Werring, PhD Stroke: Highlights of Selected Articles Original Contributions Clinical Sciences Genetic Architecture of Lacunar Stroke Matthew Traylor, PhD; Steve Bevan, PhD; Jean-Claude Baron, ScD; Ahamad Hassan, MD; Cathryn M. Lewis, PhD; Hugh S. Markus, DM Long-Term Blood Brain Barrier Permeability Changes in Binswanger Disease Branko N. Huisa, MD; Arvind Caprihan, PhD; Jeffrey Thompson, BS; Jillian Prestopnik, PhD; Clifford R. Qualls, PhD; Gary A. Rosenberg, MD Elevated Total Homocysteine Levels in Acute Ischemic Stroke Are Associated With Long-Term Mortality Zhihong Shi, MD, PhD; Yalin Guan, MD, MS; Ya Ruth Huo, BA, MD; Shuling Liu, RN, MS; Meilin Zhang, PhD; Hui Lu, MD, MS; Wei Yue, MD, MS; Jinhuan Wang, MD, PhD; Yong Ji, MD, PhD Copeptin Levels in Patients With Acute Ischemic Stroke and Stroke Mimics Matthias Wendt, MD; Martin Ebinger, MD; Alexander Kunz, MD; Michal Rozanski, MD; Carolin Waldschmidt, MD; Joachim E. Weber, MD; Benjamin Winter, MD; Peter M. Koch, MD; Christian H. Nolte, MD; Sabine Hertel, PhD; Tim Ziera, PhD; Heinrich J. Audebert, MD; for the STEMO Consortium Patients With Ischemic Stroke and Incident Atrial Fibrillation: A Nationwide Cohort Study Laurent Fauchier, MD; Nicolas Clementy, MD; Christele Pelade, PhD; Cecile Collignon, PharmD; Emmanuelle Nicolle, MD, MSc; Gregory Y.H. Lip, MD Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes Ona Wu, PhD; Lisa Cloonan, BA; Steven J.T. Mocking, MS; Mark J.R.J. Bouts, PhD; William A. Copen, MD; Pedro T. Cougo-Pinto, MD; Kaitlin Fitzpatrick, BS; Allison Kanakis, MD; Pamela W. Schaefer, MD; Jonathan Rosand, MD, MSc; Karen L. Furie, MD, MPH; Natalia S. Rost, MD, MPH STROKE (ISSN ) is published monthly by Lippincott Williams & Wilkins, at Hunters Green Parkway, Hagerstown, MD Business offices are located at Two Commerce Square, 2001 Market Street, Philadelphia, PA Production offices are located at 351 West Camden Street, Baltimore, MD In the US, individuals may subscribe in print for their personal use at the following annual rates: $249 for members of any American Heart Association (AHA) scientific council or $528 for non-members. International: $329 for AHA members or $654 for non-members. Online-only and other additional rates can be found online at AHA membership information can be found online at Periodicals postage paid at Hagerstown, MD, and additional mailing offices. POSTMASTER: Send address changes to STROKE, American Heart Association, Lippincott Williams & Wilkins, Hunters Green Parkway, Hagerstown, MD

2 Remote Ischemic Conditioning Alters Methylation and Expression of Cell Cycle Genes in Aneurysmal Subarachnoid Hemorrhage Elina Nikkola, BS; Azim Laiwalla, MS; Arthur Ko, BS; Marcus Alvarez, BS; Mark Connolly, BS; Yinn Cher Ooi, MD; William Hsu, PhD; Alex Bui, PhD; Päivi Pajukanta, MD, PhD; Nestor R. Gonzalez, MD Clipping and Coiling of Unruptured Intracranial Aneurysms Among Medicare Beneficiaries, 2000 to 2010 Jessica J. Jalbert, PhD; Abby J. Isaacs, MSc; Hooman Kamel, MD; Art Sedrakyan, MD, PhD Microbleed Status and 3-Month Outcome After Intravenous Thrombolysis in 717 Patients With Acute Ischemic Stroke Guillaume Turc, MD; Asmaa Sallem, MD; Solène Moulin, MD; Marie Tisserand, MD; Alexandre Machet, MD; Myriam Edjlali, MD; Jean-Claude Baron, ScD; Xavier Leclerc, PhD; Didier Leys, PhD; Jean-Louis Mas, MD; Charlotte Cordonnier, PhD; Catherine Oppenheim, PhD CME High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage Federico Magni, MD; Matteo Pozzi, MD; Matteo Rota, PhD; Alessia Vargiolu, PhD; Giuseppe Citerio, MD Accuracy of the ABC/2 Score for Intracerebral Hemorrhage: Systematic Review and Analysis of MISTIE, CLEAR-IVH, and CLEAR III Alastair J.S. Webb, DPhil; Natalie L. Ullman, BS; Tim C. Morgan, MPH; John Muschelli, ScM; Joshua Kornbluth, MD; Issam A. Awad, MD; Stephen Mayo, MD; Michael Rosenblum, PhD; Wendy Ziai, MD; Mario Zuccarrello, MD; Francois Aldrich, MD; Sayona John, MD; Sagi Harnof, MD; George Lopez, MD; William C. Broaddus, MD; Christine Wijman, MD; Paul Vespa, MD; Ross Bullock, MD, PhD; Stephen J. Haines, MD; Salvador Cruz-Flores, MD; Stan Tuhrim, MD; Michael D. Hill, MD; Raj Narayan, MD; Daniel F. Hanley, MD; for the MISTIE and CLEAR Investigators Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis Mark D. Findlay, MBChB, MRCP; Peter C. Thomson, MD; Rachael L. Fulton, PhD; Marit D. Solbu, PhD; Alan G. Jardine, MD; Rajan K. Patel, PhD, MRCP; Kathryn K. Stevens, PhD, MRCP; Colin C. Geddes, MBChB; Jesse Dawson, MD; Patrick B. Mark, PhD Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke: Systematic Review Lisa S. Manning, MBChB; Peter M. Rothwell, FMedSci; John F. Potter, DM; Thompson G. Robinson, MD Recurrent Stroke: The Value of the CHA 2 DS 2 VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort Søren Due Andersen, MD; Anders Gorst-Rasmussen, MSc, PhD; Gregory Y.H. Lip, MD; Flemming W. Bach, MD, DMSc; Torben Bjerregaard Larsen, MD, PhD Rate of Contrast Extravasation on Computed Tomographic Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage H. Bart Brouwers, MD, PhD; Thomas W.K. Battey, BS; Hayley H. Musial, BA; Viesha A. Ciura, MD; Guido J. Falcone, MD, PhD, MPH; Alison M. Ayres, BA; Anastasia Vashkevich, BA; Kristin Schwab, BA; Anand Viswanathan, MD, PhD; Christopher D. Anderson, MD; Steven M. Greenberg, MD, PhD; Stuart R. Pomerantz, MD; Claudia J. Ortiz, MD; Joshua N. Goldstein, MD, PhD; R. Gilberto Gonzalez, MD, PhD; Jonathan Rosand, MD, MSc; Javier M. Romero, MD Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke Deepak Subedi, FRCR; Umme Sara Zishan, MBBS; Francesca Chappell, PhD; Maria-Lena Gregoriades, FRCR; Cathie Sudlow, DPhil; Robin Sellar, FRCR; Joanna Wardlaw, FRCR, MD Younger Stroke Patients With Large Pretreatment Diffusion-Weighted Imaging Lesions May Benefit From Endovascular Treatment Marc D. Gilgen, MSc; Dariusz Klimek; Kai T. Liesirova, MD; Julia Meisterernst; Pascal P. Klinger-Gratz, MD; Gerhard Schroth, MD; Pasquale Mordasini, MD; Kety Hsieh, MD; Johannes Slotboom, PhD; Mirjam R. Heldner, MD; Anne Broeg-Morvay; Marie-Luise Mono, MD; Urs Fischer, MD; Heinrich P. Mattle, MD; Marcel Arnold, MD; Jan Gralla, MD; Marwan El-Koussy, MD; Simon Jung, MD Combined Multimodal Computed Tomography Score Correlates With Futile Recanalization After Thrombectomy in Patients With Acute Stroke Mariano Espinosa de Rueda, MD; Guillermo Parrilla, PhD; Sergio Manzano-Fernández, PhD; Blanca García-Villalba, MD; Joaquín Zamarro, MD; Francisco Hernández-Fernández, PhD; Cristina Sánchez-Vizcaino, MD; Ester Carreón, MD; Ana Morales, PhD; Antonio Moreno, MD

3 Residual Risk of Stroke and Death in Anticoagulated Patients According to the Type of Atrial Fibrillation: AMADEUS Trial Keitaro Senoo, MD; Gregory Y.H. Lip, MD; Deirdre A. Lane, PhD; Harry R. Büller, PhD; Dipak Kotecha, PhD Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke-Full Dose Regimen Stroke Trial Opeolu Adeoye, MD, MS; Heidi Sucharew, PhD; Jane Khoury, PhD; Achala Vagal, MD, MS; Pamela A. Schmit, RN, BSN; Irene Ewing, RN, BSN; Steven R. Levine, MD; Stacie Demel, DO, PhD; Bryan Eckerle, MD; Brian Katz, MD; Dawn Kleindorfer, MD; Brian Stettler, MD; Daniel Woo, MD, MS; Pooja Khatri, MD, MSc; Joseph P. Broderick, MD; Arthur M. Pancioli, MD Clinical Implications of Changes in Individual Platelet Reactivity to Aspirin Over Time in Acute Ischemic Stroke Joon-Tae Kim, MD, PhD; Suk-Hee Heo, MD; Kang-Ho Choi, MD; Tai-Seung Nam, MD; Seong-Min Choi, MD; Seung-Han Lee, MD; Man-Seok Park, MD; Byeong C. Kim, MD; Myeong-Kyu Kim, MD; Jeffrey L. Saver, MD, PhD; Ki-Hyun Cho, MD Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours: A Comparative Effectiveness and Safety Study Beom Joon Kim, MD; Moon-Ku Han, MD; Tai Hwan Park, MD; Sang-Soon Park, MD; Kyung Bok Lee, MD; Byung-Chul Lee, MD; Kyung-Ho Yu, MD; Mi Sun Oh, MD; Jae Kwan Cha, MD; Dae-Hyun Kim, MD; Jun Lee, MD; Soo Joo Lee, MD; Youngchai Ko, MD; Jong-Moo Park, MD; Kyusik Kang, MD; Yong-Jin Cho, MD; Keun-Sik Hong, MD; Joon-Tae Kim, MD; Jay Chol Choi, MD; Dong-Eog Kim, MD; Dong-Ick Shin, MD; Wook-Joo Kim, MD; Juneyoung Lee, PhD; Ji Sung Lee, PhD; Byung-Woo Yoon, MD; Philip B. Gorelick, MD, MPH; Hee-Joon Bae, MD, PhD Safety and Tolerability of Desmoteplase Within 3 to 9 Hours After Symptoms Onset in Japanese Patients With Ischemic Stroke Etsuro Mori, MD, PhD; Kazuo Minematsu, MD, PhD; Jyoji Nakagawara, MD, PhD; Yasuhiro Hasegawa, MD, PhD; Shinji Nagahiro, MD, PhD; Yasushi Okada, MD, PhD; Thomas Truelsen, MD, DMSc; Annika Lindsten, BSc; Akira Ogawa, MD, PhD; Takenori Yamaguchi, MD; on behalf of DIAS-J Investigators Non Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation: Meta-Analysis Kang-Ling Wang, MD; Gregory Y.H. Lip, MD; Shing-Jong Lin, MD, PhD; Chern-En Chiang, MD, PhD Do Patient Characteristics Explain the Differences in Outcome Between Medically Treated Patients in SAMMPRIS and WASID? Seemant Chaturvedi, MD; Tanya N. Turan, MD; Michael J. Lynn, MS; Colin P. Derdeyn, MD; David Fiorella, MD, PhD; L. Scott Janis, PhD; Marc I. Chimowitz, MBChB; for the SAMMPRIS Trial Investigators Associations of Circulating Growth Differentiation Factor-15 and ST2 Concentrations With Subclinical Vascular Brain Injury and Incident Stroke Charlotte Andersson, MD, PhD; Sarah R. Preis, ScD; Alexa Beiser, PhD; Charles DeCarli, MD; Kai C. Wollert, MD; Thomas J. Wang, MD; James L. Januzzi Jr, MD; Ramachandran S. Vasan, MD; Sudha Seshadri, MD Deferoxamine, Cerebrovascular Hemodynamics, and Vascular Aging: Potential Role for Hypoxia-Inducible Transcription Factor-1 Regulated Pathways Farzaneh A. Sorond, MD, PhD; Can Ozan Tan, PhD; Sarah LaRose, BA; Andrew D. Monk, BS; Raina Fichorova, MD, PhD; Stanthia Ryan, BS; Lewis A. Lipsitz, MD Spouses of Stroke Survivors Report Reduced Health-Related Quality of Life Even in Long-Term Follow-Up: Results From Sahlgrenska Academy Study on Ischemic Stroke Josefine Persson, MSc; Lukas Holmegaard, MD, MSc; Ingvar Karlberg, MD, PhD; Petra Redfors, MD, PhD; Katarina Jood, MD, PhD; Christina Jern, MD, PhD; Christian Blomstrand, MD, PhD; Gunilla Forsberg-Wärleby, Reg. OT, PhD Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke Jeban Ganesalingam, MBBS, MRCP (Neuro), PhD; Elena Pizzo, PhD; Stephen Morris, PhD; Tom Sunderland, MSc; Diane Ames, MBBS, FRCP; Kyriakos Lobotesis, MBBS, FRCR

4 Basic Sciences Neurorestorative Therapy of Stroke in Type 2 Diabetes Mellitus Rats Treated With Human Umbilical Cord Blood Cells Tao Yan, PhD; Poornima Venkat, BS; Michael Chopp, PhD; Alex Zacharek, MS; Ruizhuo Ning, MD; Yisheng Cui, BS; Cynthia Roberts, BS; Nicole Kuzmin-Nichols, BS, MBA; Cyndy Davis Sanberg, PhD; Jieli Chen, MD Role of Neurexin-1β and Neuroligin-1 in Cognitive Dysfunction After Subarachnoid Hemorrhage in Rats Haitao Shen, MM; Zhouqing Chen, MM; Yang Wang, MM; Anju Gao, MM; Haiying Li, PhD; Yonghua Cui, MD; Li Zhang, MD; Xiang Xu, MM; Zhong Wang, MD; Gang Chen, MD, PhD Intravenous Bone Marrow Stem Cell Grafts Preferentially Migrate to Spleen and Abrogate Chronic Inflammation in Stroke Sandra A. Acosta, PhD; Naoki Tajiri, PhD; Jaclyn Hoover, MS; Yuji Kaneko, PhD; Cesar V. Borlongan, PhD Rosiglitazone Promotes White Matter Integrity and Long-Term Functional Recovery After Focal Cerebral Ischemia Lijuan Han, MD; Wei Cai, MD; Leilei Mao, MD, PhD; Jia Liu, MD; Peiying Li, MD, PhD; Rehana K. Leak, PhD; Yun Xu, MD; Xiaoming Hu, MD, PhD; Jun Chen, MD Activation of Dopamine D2 Receptor Suppresses Neuroinflammation Through αb-crystalline by Inhibition of NF-κB Nuclear Translocation in Experimental ICH Mice Model Yang Zhang, MD, PhD; Yujie Chen, MD, PhD; Jiang Wu, MD; Anatol Manaenko, PhD; Peng Yang, MD; Jiping Tang, MD, PhD; Weiling Fu, MD, PhD; John H. Zhang, MD, PhD Recombinant ADAMTS 13 Attenuates Brain Injury After Intracerebral Hemorrhage Ping Cai, PhD; Haiyu Luo, BS; Haochen Xu, BS; Ximin Zhu, MS; Wenfang Xu, BS; Yiqin Dai, MS; Jin Xiao, BS; Yongliang Cao, BS; Yuwu Zhao, MD; Bing-Qiao Zhao, MD, PhD; Wenying Fan, MD, PhD Brief Reports Vascular Neurologists as Directors of Stroke Centers in the United States Lucas Ramirez, MD; Aaron Krug, BS; Heng Nhoung, BS; Suzie Kazaryan, BS; Gregory Gasparian, BA; Joshua Perese, BA; Ali Razmara, MD; David S. Liebeskind, MD; Jennifer J. Majersik, MD, MS; Nerses Sanossian, MD Cavernous Sinus Thrombosis in Children: Imaging Characteristics and Clinical Outcomes Craig A. Press, MD, PhD; Aaron Lindsay, MD; Nicholas V. Stence, MD; Laura Z. Fenton, MD; Timothy J. Bernard, MD; David M. Mirsky, MD White Matter Hyperintensities Relate to Clinical Progression in Subjective Cognitive Decline Marije R. Benedictus, MSc; Argonde C. van Harten, PhD; Annebet E. Leeuwis, MSc; Teddy Koene, MSc; Philip Scheltens, PhD; Frederik Barkhof, PhD; Niels D. Prins, PhD; Wiesje M. van der Flier, PhD Altered Fibrin Clot Properties in Patients With Cerebral Venous Sinus Thrombosis: Association With the Risk of Recurrence Jakub Siudut, MSc; Maciej Świat, MD, PhD; Anetta Undas, MD, PhD Increase in [ 18 F]-Fluoroacetate Uptake in Patients With Chronic Hemodynamic Cerebral Ischemia Hiroshi Yamauchi, MD, PhD; Shinya Kagawa, MS; Yoshihiko Kishibe, RT; Masaaki Takahashi, RT; Ryuichi Nishii, MD, PhD; Hiroshi Mizuma, PhD; Kazuhiro Takahashi, PhD; Hirotaka Onoe, PhD; Tatsuya Higashi, MD, PhD Stroke and Neurodegeneration Induce Different Connectivity Aberrations in the Insula Indira García-Cordero, PhD; Lucas Sedeño, PhD; Daniel Fraiman, PhD; Damian Craiem, PhD; Laura Alethia de la Fuente, MSc; Paula Salamone, PhD; Cecilia Serrano, MD; Luciano Sposato, PhD; Facundo Manes, PhD; Agustín Ibañez, PhD Hypotension During Endovascular Treatment of Ischemic Stroke Is a Risk Factor for Poor Neurological Outcome Pia Löwhagen Hendén, MD; Alexandros Rentzos, MD; Jan-Erik Karlsson, MD, PhD; Lars Rosengren, MD, PhD; Henrik Sundeman, MD, PhD; Björn Reinsfelt, MD, PhD; Sven-Erik Ricksten, MD, PhD Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke Georgios Tsivgoulis, MD, PhD; Pavla Kadlecová, MS; Adam Kobayashi, MD, PhD; Anna Czlonkowska, MD, PhD; Miroslav Brozman, MD, PhD; Viktor Švigelj, MD; Laszlo Csiba, MD, PhD; Janika Kõrv, MD, PhD; Vida Demarin, MD, PhD; Aleksandras Vilionskis, MD; Dalius Jatuzis, MD, PhD; Aristeidis H. Katsanos, MD; Jobst Rudolf, MD, PhD; Yakup Krespi, MD; Robert Mikulik, MD, PhD

5 Dabigatran Therapy in Acute Ischemic Stroke Patients Without Atrial Fibrillation Mahesh Kate, DM; Laura Gioia, MD; Brian Buck, MD; Leka Sivakumar, MSc; Thomas Jeerakathil, MD; Ashfaq Shuaib, MD; Kenneth Butcher, MD, PhD Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study Lisbeth Rosenbek Minet, PhD; Elizabeth Peterson, PhD; Lena von Koch, PhD; Charlotte Ytterberg, PhD Effects of Postconditioning on Neurogenesis and Angiogenesis During the Recovery Phase After Focal Cerebral Ischemia Elga Esposito, PhD; Kazuhide Hayakawa, PhD; Takakuni Maki, MD, PhD; Ken Arai, PhD; Eng H. Lo, PhD Comments and Opinions Outcome Following Decompressive Hemicraniectomy for Malignant Cerebral Infarction: Ethical Considerations Stephen Honeybul, FRCS (SN), FRACS; Kwok Ming Ho, FCICM, PhD; Grant Gillett, MSc, MB ChB(Auck), DPhil(Oxf), FRACS, FRSNZ Topical Reviews Minimally Invasive Microsurgery for Cerebral Aneurysms Johnny Ho Yin Wong, PhD; Rachel Tymianski; Ivan Radovanovic, PhD; Michael Tymianski, MD, PhD Treatment Concepts for Wake-Up Stroke and Stroke With Unknown Time of Symptom Onset Götz Thomalla, MD; Christian Gerloff, MD Palliative Care: A Core Competency for Stroke Neurologists Claire J. Creutzfeldt, MD; Robert G. Holloway, MD, MPH; J. Randall Curtis, MD, MPH State-of-the-Science Nursing Review Temperature Management and Nursing Care of the Patient With Acute Ischemic Stroke Pimen Kurashvili, MD; DaiWai Olson, PhD, RN Web Site Feature... Stroke Literature Synopses: Clinical Science Michelle P. Lin, MD, MPH; Amytis Towfighi, MD Web Site Feature... Illustrative Teaching Cases Inflammatory Cerebral Amyloid Angiopathy, Amyloid-β Related Angiitis, and Primary Angiitis of the Central Nervous System: Similarities and Differences Aimen Moussaddy, MD; Ariel Levy, MD, FRCP; Daniel Strbian, MD, PhD; Sophia Sundararajan, MD, PhD; France Berthelet, MD, FRCP; Sylvain Lanthier, MD, OD, CSPQ Web Site Feature... Organizational Update Organizational Update: Report From the European Stroke Organisation 2015 Kennedy R. Lees, MD; Valeria Caso, MD; Urs Fischer, MD Web Site Feature... e205 e208 e210 e214 Letters to the Editor Letter by van Klei and Dieleman Regarding Article, Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke Wilton A. van Klei, MD, PhD; Jan M. Dieleman, MD Web Site Feature... e216 Letter by Campbell and Short Regarding Article, Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke Doug Campbell, MD, FRCA, FANZCA; Timothy G. Short, MB, ChB, MD, FANZCA Web Site Feature... e217 Response to Letter Regarding Article, Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke Lucie A. van den Berg, MD; Yvo B.W.E.M. Roos, MD, PhD Web Site Feature... e218

6 Letter by Rebello et al Regarding Article, Cryptic Loss of Consciousness in a 36-Year-Old Woman Letícia C. Rebello, MD; Diogo C. Haussen, MD; Raul G. Nogueira, MD Web Site Feature... e219 Response to Letter Regarding Article, Cryptic Loss of Consciousness in a 36-Year-Old Woman Nicolas Martinez-Majander, MD; Jukka Putaala, MD, PhD, MSc (Stroke Med) Web Site Feature... e220 Letter by Spence Regarding Article, Diet and Stroke: Recent Evidence Supporting a Mediterranean-Style Diet and Food in the Primary Prevention of Stroke J. David Spence, MD Web Site Feature... e221 Corrections Web Site Feature... e222 e223 On the cover: The image is taken from an article in this issue, Minimally Invasive Microsurgery for Cerebral Aneurysms by Wong et al (Stroke. 2015;46: ). The image is Figure 2D.