Bruce M Coull

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Journals/Publications

• Dawod, J., & Coull, B. M. (2021). Chronic Kidney Disease is A Biomarker Rather Than A Risk Factor for Stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 30(9), 105869.
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  Over the last approximate 15 years some have suggested that chronic kidney disease (CKD) is a risk factor for stroke in and of itself. The assertion that CKD is a risk factor for stroke requires more scrutiny. It is possible that CKD is a reflection of severity of conditions such as hypertension and diabetes that are themselves among the most treatable risk factors for stroke or it is possible that the effects of CKD change vascular and related physiological functions and therefor directly contribute to increased risk of stroke and it is also possible that treatments for advance CKD such has hemodialysis could contribute to increased risk of stroke as secondary effects of the treatment methods. To addresses these issues as participant in the Brain & Kidney Conference 2020 debate on this issue we were assigned the task of arguing that "Resolved: CKD is not a risk factor for stroke".
• Fisher, M., Lau, W. L., & Coull, B. (2021). Brain & Kidney 2020: Introduction to Special Issue. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 30(9), 105990.
• Kittner, S. J., Sekar, P., Comeau, M. E., Anderson, C. D., Parikh, G. Y., Tavarez, T., Flaherty, M. L., Testai, F. D., Frankel, M. R., James, M. L., Sung, G., Elkind, M. S., Worrall, B. B., Kidwell, C. S., Gonzales, N. R., Koch, S., Hall, C. E., Birnbaum, L., Mayson, D., , Coull, B., et al. (2021). Ethnic and Racial Variation in Intracerebral Hemorrhage Risk Factors and Risk Factor Burden. JAMA network open, 4(8), e2121921.
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  Black and Hispanic individuals have an increased risk of intracerebral hemorrhage (ICH) compared with their White counterparts, but no large studies of ICH have been conducted in these disproportionately affected populations.
• Krupp, K., Madhivanan, P., Killgore, W. D., Ruiz, J. M., Carvajal, S., Coull, B. M., & Grandner, M. A. (2021). Neurological Manifestations in COVID-19: An Unrecognized Crisis in Our Elderly?. Advances in geriatric medicine and research, 3(3).
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  As of December 2020, there were more than 900,000 COVID-19 hospitalizations in the US with about 414,000 among individuals aged 65 years and older. Recent evidence suggests a growing number of older patients continue to suffer serious neurological comorbidities including polyneuropathy, cerebrovascular disease, central nervous system infection, cognitive deficits, and fatigue following discharge. Studies suggest that complaints manifest late in disease and persist beyond resolution of acute COVID-19 symptoms. Recent research reports that neurocognitive symptoms are correlated with severe disease, older age, male gender, and comorbidities including hypertension, renal failure, and neoplastic disease. The underlying causes are unclear, but current hypotheses include hypoxic-ischemic brain injury, immunopathological mechanisms, and neurotropism of SARS-CoV-2 infection. There is a pressing need for more research into the underlying mechanisms of post-COVID-19 neurological sequela, particularly in the elderly, a population already burdened with neurocognitive disorders.
• Brenner, D. A., Zweifler, R. M., Gomez, C. R., Kissela, B. M., Levine, D., Howard, G., Coull, B., & Howard, V. J. (2020). Awareness, treatment, and control of vascular risk factors among stroke survivors. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 19(4), 311-20.
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  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.
• Taylor-Piliae, R. E., Hepworth, J. T., & Coull, B. M. (2020). Predictors of depressive symptoms among community-dwelling stroke survivors. The Journal of cardiovascular nursing, 28(5), 460-7.
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  Depression is a common yet often unrecognized consequence of stroke, affecting between 25% and 70% of all survivors. Untreated depression post-stroke leads to a poorer prognosis and increased mortality. However, the pattern and profile of post-stroke depression in chronic stroke are poorly understood.
• Chinthammit, C., Coull, B. M., Nimworapan, M., & Bhattacharjee, S. (2017). Co-occurring Chronic Conditions and Economic Burden among Stroke Survivors in the United States: A Propensity Score-Matched Analysis. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 26(2), 393-402.
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  This study examined the impact of co-occurring chronic conditions on healthcare expenditures among noninstitutionalized older adults (age ≥50 years) with stroke in comparison to non-stroke-matched controls.
• Coull, B. M., Barreto, A. D., Ford, G. A., Shen, L., Pedroza, C., Tyson, J., Cai, C., Rahbar, M. H., & Grotta, J. C. (2017). Randomized, Multicenter Trian of ARTSS-2 (Argatroban With Recomninant Tissue Plasminogen Activator for Acute Stroke). American Heart Association.
• Grams, R. W., Kidwell, C. S., Doshi, A. H., Drake, K., Becker, J., Coull, B. M., & Nael, K. (2016). Tissue-Negative Transient Ischemic Attack: Is There a Role for Perfusion MRI?. AJR. American journal of roentgenology, 207(1), 157-62.
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  Approximately 60% of patients with a clinical transient ischemic attack (TIA) do not have DWI evidence of cerebral ischemia. The purpose of this study was to assess the added diagnostic value of perfusion MRI in the evaluation of patients with TIA who have normal DWI findings.
• Grams, R., Kidwell, S. M., Drake, K. W., Becker, J., Coull, B. M., & Nael, K. (2016). Tissue Negative-Transient Ischemic Attack: Is There a Role for MRI Perfusion?. American Journal of Roentgenology.
• Kernan, W. N., Viscoli, C. M., Furie, K. L., Young, L. H., Inzucchi, S. E., Gorman, M., Guarino, P. D., Lovejoy, A. M., Peduzzi, P. N., Conwit, R., Brass, L. M., Schwartz, G. G., Adams, H. P., Berger, L., Carolei, A., Clark, W., Coull, B., Ford, G. A., Kleindorfer, D., , O'Leary, J. R., et al. (2016). Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. The New England journal of medicine, 374(14), 1321-31.
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  Patients with ischemic stroke or transient ischemic attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a risk factor for stroke and myocardial infarction raised the possibility that pioglitazone, which improves insulin sensitivity, might benefit patients with cerebrovascular disease.
• Koch, S., Elkind, M. S., Testai, F. D., Brown, W. M., Martini, S., Sheth, K. N., Chong, J. Y., Osborne, J., Moomaw, C. J., Langefeld, C. D., Sacco, R. L., Woo, D., & , E. S. (2016). Racial-ethnic disparities in acute blood pressure after intracerebral hemorrhage. Neurology, 87(8), 786-91.
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  To assess race-ethnic differences in acute blood pressure (BP) following intracerebral hemorrhage (ICH) and the contribution to disparities in ICH outcome.
• Taylor-Piliae, R. E., Mohler, M. J., Najafi, B., & Coull, B. M. (2016). Objective fall risk detection in stroke survivors using wearable sensor technology: a feasibility study. Topics in stroke rehabilitation, 23(6), 393-399.
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  Stroke survivors often have persistent neural deficits related to motor function and sensation, which increase their risk of falling, most of which occurs at home or in community settings. The use of wearable technology to monitor fall risk and gait in stroke survivors may prove useful in enhancing recovery and/or preventing injuries.
• Williams, S. R., Hsu, F. C., Keene, K. L., Chen, W. M., Nelson, S., Southerland, A. M., Madden, E. B., Coull, B., Gogarten, S. M., Furie, K. L., Dzhivhuho, G., Rowles, J. L., Mehndiratta, P., Malik, R., Dupuis, J., Lin, H., Seshadri, S., Rich, S. S., Sale, M. M., , Worrall, B. B., et al. (2016). Shared genetic susceptibility of vascular-related biomarkers with ischemic and recurrent stroke. Neurology, 86(4), 351-9.
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  To investigate the genetic contributors to cerebrovascular disease and variation in biomarkers of ischemic stroke.
• Martinez, M., Prabhakar, N., Drake, K. W., Coull, B. M., Chong, J., Ritter, L., & Kidwell, S. M. (2015). Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics. International Journal of Environmental Researh and Public Health.
• Martinez, M., Prabhakar, N., Drake, K., Coull, B., Chong, J., Ritter, L., & Kidwell, C. (2015). Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics. International journal of environmental research and public health, 13(1), ijerph13010023.
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  Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the "powerful others" sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.
• Nokes, B., Sim, Y., Gibson, B., Byreddy, S., Labiner, D. M., Coull, B., & Chong, J. (2015). Assessment of stroke risk in southern Arizona, the pairing of acculturation and stroke risk factor development. Journal of immigrant and minority health, 17(2), 513-8.
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  Stroke is a leading cause of mortality in the United States. Hispanics have the same incidence of stroke, but are more likely to have subsequent strokes than non-Hispanic whites. This difference in outcome may be attributable to differences in stroke risk factor awareness. Patients at a community health center in Tucson, AZ completed an anonymous survey regarding existing and perceived health issues. Patient responses were compared in terms of ethnicity and acculturation, as indicated by language preference. Patient responses (n = 301, Spanish: 150, English: 151) indicated that proportionately fewer non-acculturated Hispanics than acculturated Hispanic and non-Hispanic patients indicated that they were at risk for stroke. Acculturated Hispanics and non-Hispanics displayed similar morbidity trends, including increased obesity, hypertension, diabetes, heart problems, depression, and previous stroke. These findings suggest that Hispanics become less healthy and more at risk for stroke and stroke risk factors as they become acculturated.
• Nael, K., Khan, R., Choudhary, G., Meshksar, A., Villablanca, P., Tay, J., Drake, K., Coull, B. M., & Kidwell, C. S. (2014). Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke, 45(7), 1985-91.
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  If magnetic resonance imaging (MRI) is to compete with computed tomography for evaluation of patients with acute ischemic stroke, there is a need for further improvements in acquisition speed.
• Sim, Y., Nokes, B., Byreddy, S., Chong, J., Coull, B. M., & Labiner, D. M. (2014). Healthcare utilization of patients with epilepsy in Yuma County, Arizona: do disparities exist?. Epilepsy & behavior : E&B, 31, 307-11.
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  The aim of this study was to describe the disparities in healthcare utilization and costs between Hispanic and non-Hispanic patients with seizures or epilepsy. We reviewed the insurance status and healthcare resource utilization data from 2005 to 2008 for all patients with seizures and epilepsy seen at the Yuma Regional Medical Center (YRMC). Charges for medical services provided to Hispanic patients with epilepsy between the ages of 18 and 49 were significantly less than those for non-Hispanic patients with epilepsy (Hispanic: $3167.63 versus non-Hispanic: $5154.36, P
• Taylor-Piliae, R. E., Boros, D., & Coull, B. M. (2014). Strategies to improve recruitment and retention of older stroke survivors to a randomized clinical exercise trial. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 23(3), 462-8.
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  Relatively few exercise randomized clinical trials (RCTs) among stroke survivors have reported the effectiveness of recruitment and retention strategies, despite its central importance to study integrity.
• Taylor-Piliae, R. E., Hoke, T. M., Hepworth, J. T., Latt, L. D., Najafi, B., & Coull, B. M. (2014). Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors. Archives of physical medicine and rehabilitation, 95(5), 816-24.
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  To examine the effect of a 12-week Tai Chi (TC) intervention on physical function and quality of life.
• Lin, T. P., Thompson, R., & Coull, B. (2013). A 28-year-old i.v. drug user with bilateral basal ganglia and brainstem lesions. Neurology, 80(7), e73-6.
• Nael, K., Meshksar, A., Liebeskind, D. S., Coull, B. M., Krupinski, E. A., & Villablanca, J. P. (2013). Quantitative analysis of hypoperfusion in acute stroke: arterial spin labeling versus dynamic susceptibility contrast. Stroke, 44(11), 3090-6.
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  This study compares the concordance between arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) for the identification of regional hypoperfusion and diffusion-perfusion mismatch tissue classification using a quantitative method.
• Woo, D., Rosand, J., Kidwell, C., McCauley, J. L., Osborne, J., Brown, M. W., West, S. E., Rademacher, E. W., Waddy, S., Roberts, J. N., Koch, S., Gonzales, N. R., Sung, G., Kittner, S. J., Birnbaum, L., Frankel, M., Testai, F. D., Hall, C. E., Elkind, M. S., , Flaherty, M., et al. (2013). The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study protocol. Stroke, 44(10), e120-5.
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  Epidemiological studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, age at presentation, and outcomes among non-Hispanic white, black, and Hispanic populations. We report here the design and methods for this large, prospective, multi-center case-control study of ICH.
• Taylor-Piliae, R. E., & Coull, B. M. (2012). Community-based Yang-style Tai Chi is safe and feasible in chronic stroke: a pilot study. Clinical rehabilitation, 26(2), 121-31.
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  Examine the safety and feasibility of a 12-week Tai Chi intervention among stroke survivors.
• Taylor-Piliae, R. E., Latt, L. D., Hepworth, J. T., & Coull, B. M. (2012). Predictors of gait velocity among community-dwelling stroke survivors. Gait & posture, 35(3), 395-9.
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  Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance or paretic leg strength affecting their walking ability. Other reported underlying factors affecting gait velocity include functional disability, balance, cognitive impairment, or the distance they are required to walk.
• Coleman, W. P., Woodbury-Harris, K. M., & Coull, B. M. (2009). Phase I/II--design and analysis. Frontiers of neurology and neuroscience, 25, 52-54.
• Coull, B. M., & Johnston, S. C. (2009). Statins: not just for the young or the faint of heart. Neurology, 72(8), 684-5.
• Franz, D., & Coull, B. M. (2009). Clinical research training opportunities and elements. Frontiers of neurology and neuroscience, 25, 203-205.
• Bruno, A., Kent, T. A., Coull, B. M., Shankar, R. R., Saha, C., Becker, K. J., Kissela, B. M., & Williams, L. S. (2008). Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial. Stroke, 39(2), 384-9.
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  Hyperglycemia may worsen brain injury during acute cerebral infarction. We tested the feasibility and tolerability of aggressive hyperglycemia correction with intravenous insulin compared with usual care during acute cerebral infarction.
• Ritter, L., Funk, J., Schenkel, L., Tipton, A., Downey, K., Wilson, J., Coull, B., & McDonagh, P. (2008). Inflammatory and hemodynamic changes in the cerebral microcirculation of aged rats after global cerebral ischemia and reperfusion. Microcirculation (New York, N.Y. : 1994), 15(4), 297-310.
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  Effects of aging on inflammation and blood flow in the brain are unclear. Young (three to six months) and aged (19-22 months) male Brown Norway Fisher rats were used to compare (i) leukocyte function in nonischemic conditions and (ii) leukocyte function and hemodynamic changes after ischemia-reperfusion (I-R). In nonischemic studies, polymorphonuclear (PMN) CD11b expression and reactive oxygen species (ROS) production were measured with flow cytometry and PMN chemotaxis was measured with a Boyden chamber (+/-fMLP). In I-R studies, ischemia was induced by bilateral carotid artery occlusion and hypotension (20 minutes). During early reperfusion (30 minutes), leukocyte adhesion and rolling and blood-shear rates were measured using fluorescence microscopy. During late reperfusion (48 hours), mortality, neurological function, and leukocyte infiltration were measured. Stimulated PMN chemotaxis was increased in nonischemic aged rats (p < 0.05). In early reperfusion, there was a significant increase in leukocyte rolling and adhesion in the cerebral microcirculation and a significant decrease in shear rate in aged rats, compared to the young (p < 0.05). During late reperfusion, neurologic function was worse in aged vs. young rats (p < 0.05). These findings suggest that increased intravascular PMN adhesion and vascular dysfunction may contribute to poor neurologic outcome after cerebral I-R in the aged brain.
• Fridriksson, J., Holland, A. L., Coull, B. M., Plante, E., Trouard, T. P., & Beeson, P. (2002). Aphasia severity: Association with cerebral perfusion and diffusion. Aphasiology, 16(9), 859-871.
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  BACKGROUND: Previous studies of the relationship between perfusion, diffusion, and stroke suggest that the extent of cerebral hypoperfusion may be a better indicator of neurological status than lesion size in the early phases of recovery. It is not clear how these factors are related to aphasia severity. AIMS: The purpose of this study was to investigate the relationship between cerebral perfusion, diffusion, and aphasia severity in stroke. METHODS #ENTITYSTARTX00026; PROCEDURE: Nine participants were examined within 24 hours of stroke onset and six were re-examined at 1 month post stroke. The examination included administration of an aphasia test, a face recognition task, and a neuroimaging session including T2-, perfusion-, and diffusion-weighted MRI. OUTCOMES #ENTITYSTARTX00026; RESULTS: Participants with a variety of aphasia types and severity were included in the study. Visual inspection suggested larger perfusion abnormality than the actual lesion in eight of nine subjects at day 1. The correlation between aphasia severity and hypoperfusion was significant at day 1 and at 1 month post stroke. However, this was not the case for the relationship between aphasia severity and lesion size where the correlation was not statistically significant at day 1 or at 1 month post stroke. CONCLUSIONS: These results suggest that cerebral hypoperfusion is a more accurate indicator of aphasia severity in early stroke than lesion volume.

Presentations

• Nael, K., Bauer, A., & Kidwell, S. M. (2015, Fall). Risk of Thrombolysis-induced Hemorrhagic Transformation in Patients with Acute Ischemic Stroke: A Predictive Model Using Combined MR Perfusion Biomarkers. International Stroke Conference.

Poster Presentations

• Coull, B. M., Kidwell, S. M., Norato, G., Dixon, S., & Osborne, J. (2015, Spring). An Analysis of Cerebral Amyloid Angiopathy by the Boston Criteria in the Ethnic/Racial Variation of Intracerebral Hemorrhage (ERICH) Cohort. European Stroke Organisation. Glasgow, Scotland: European Stroke Organisation.