Enrique Leira, MD, MS

Specialty: Stroke
Acting Director, Comprehensive Stroke Center
Associate Professor of Neurology
Associate Professor of Epidemiology
Associate Professor of Neurosurgery

Contact Information

Primary Office: 2147 RCP
Iowa City, IA 52242


MD, Universidad de Santiago de Compostela
MS, Epidemiology, University of Iowa

Resident, Neurology, St. Louis University
Fellow, Cerebrovascular Diseases, University of Iowa College of Medicine

Research Summary

Enrique Leira MD MS specializes in Cerebrovascular Diseases and Epidemiology. His research focus is acute stroke management, including evidence-based strategies to improve and accelerate stroke treatment in rural areas. There is an unacceptable disparity in acute stroke practices between urban tertiary centers and those 25% patients living in rural areas. The gap will be further increased as rural patients continue to be excluded from time-dependent stroke trials due to distance/time from research centers. His research interests include novel strategies to enable participation of patients living in rural areas in acute trials testing stroke therapies, such as randomization before arrival to the University while they are being transported in a helicopter ambulance. Dr. Leira is also interested in designing novel forms of integrated physiological monitoring for stroke patients in order to modernize the current practice of performing gross "neurochecks" by nurses. The goal is to improve the beneficial effect of dedicated stroke units by detecting neurological deterioration in an objective, real time manner, without having to wake up the patient every few hours. He is a member of the Operator Performance laboratory in the College of Engineering. http://www.ccad.uiowa.edu/opl/. He also has an interest in aviation neurology, neurological emergencies in flight and developing real-time telecommunication solutions for the helicopter ambulances that transport stroke patients from small rural hospitals to large tertiary care centers.


Leira, E. C. (2017). Cervical artery dissections. In L. R. Caplan , et al (Eds.) Primer on cerebrovascular diseases. (Second edition) Elsevier ; Academic Press.

Leira, E., Phipps, M., Jasne, A. & Kleindorfer, D. (2017). Time to treat stroke patients in rural locations as an underserved minority. Neurology, 88(5), 422–423. DOI: 10.1212/WNL.0000000000003560.

Leira, E. C., Stilley, J. D., Schnell, T., Audebert, H. J. & Adams, H. P. (2016). Helicopter transportation in the era of thrombectomy: The next frontier for acute stroke treatment and research. European Stroke Journal, 1(3), 171-179. DOI: 10.1177/2396987316658994.

Leira, E. C., Levine, S. R. (2016). Vascular disorders of the spinal cord. In MedLink Neurology. (2016 update) San Diego: Arbor Publishing.

Zafar, A., Leira, E. C. (2016). Post-discharge complications of stroke. In Ischemic stroke therapeutics: a comprehensive guide. pp. 69-76. Cham: Springer.

Leira, E. C. (2016). Unusual causes of stroke. In M. V. Johnston , H. P. Adams, Jr. , A. Fatemi (Eds.) Neurobiology of disease. (second edition) Oxford ; New York: Oxford University Press.

Edwards, C., Leira, E. C. & Gonzalez-Alegre, P. (2015). Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology, 84(10), e69-72. PMID: 25754807.

Leira, E., Zaheer, A., Schnell, T., Torner, J., Olalde, H., Pieper, A., Ortega-Gutierrez, S., Nagaraja, N., Marks, N. & Adams, H. (2015). Effect of helicopter transport on neurological outcomes in a mouse model of embolic stroke with reperfusion: AIR-MICE pilot study. International Journal of Stroke, 10(A100), 119–124. DOI: 10.1111/ijs.12619.

Rodriguez, C. J., Allison, M., Daviglus, M. L., Isasi, C. R., Keller, C., Leira, E. C., Palaniappan, L., Piña, I. L., Ramirez, S. M., Rodriguez, B. & Sims, M. (2014). Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation, 130(7), 593-625. PMID: 25098323.

Leira, E., Coffey, C., Jorge, R., Morton, S., Froehler, M., Davis, P. & Adams, Jr., H. (2013). The NIHSS supplementary motor scale: A valid tool for multidisciplinary recovery trials. Cerebrovascular Diseases, 36(1), 69–73. DOI: 10.1159/000351514.

Leira, E., Kaskie, B., Froehler, M. T. & Adams, H. P. (2013). The Growing Shortage of Vascular Neurologists in The Era of Health Reform: Planning is Brain!. Stroke; a journal of cerebral circulation, 44(3), 822-7. PMID: 23386675.

Borte, B., Leira, E. (2013). Management of postdischarge complications. In Stroke Management and Recovery. pp. 167–177. Future Medicine Ltd..

Leira, E., Ludwig, B. R., Gurol, M. E., Torner, J. C. & Adams, H. P. (2012). The types of neurological deficits might not justify withholding treatment in patients with low total National Institutes of Health Stroke Scale scores. Stroke; a journal of cerebral circulation, 43(3), 782-6. PMID: 22308246.

Leira, E., Fairchild, G., Segre, A. M., Rushton, G., Froehler, M. T. & Polgreen, P. M. (2012). Primary stroke centers should be located using maximal coverage models for optimal access. Stroke; a journal of cerebral circulation, 43(9), 2417-22. PMID: 22811453.

Leira, E., Kaldjian, L. C., Ludwig, B. R., Torner, J. C., Olalde, H. M., Hacke, W. & Adams, H. P. (2012). Lack of international consensus on ethical aspects of acute stroke trials. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 21(3), 200-4. PMID: 20719537.

Mikami, K., Jorge, R. E., Adams, H. P., Davis, P. H., Leira, E., Jang, M. & Robinson, R. G. (2011). Effect of antidepressants on the course of disability following stroke. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 19(12), 1007-15. PMID: 21358384.

Leira, E. C., et al, (2011). Guidelines for treatment of spasticity with botuminum toxin. Elsevier.

Day, J. S., Policeni, B. A., Smoker, W. R., Dobre, M. C., Zhang, Y., Leira, E., Davis, P. H., Chen, S., Olalde, H. & Adams, H. P. (2011). Previous statin use is not associated with an increased prevalence or degree of gradient-echo lesions in patients with acute ischemic stroke or transient ischemic attack. Stroke; a journal of cerebral circulation, 42(2), 354-8. PMID: 21164134.

Cruz-Flores, S., Rabinstein, A., Biller, J., Elkind, M. S., Griffith, P., Gorelick, P. B., Howard, G., Leira, E., Morgenstern, L. B., Ovbiagele, B., Peterson, E., Rosamond, W., Trimble, B. & Valderrama, A. L. (2011). Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation, 42(7), 2091-116. PMID: 21617147.

Leira, E. C., et al, (2010). Principles of clinical research principles in neurology [in Spanish?]. SEN Sociedad Espanola Neurologia.

Kim, J., Leira, E., Callison, R. C., Ludwig, B., Moritani, T., Magnotta, V. A. & Madsen, M. T. (2010). Toward fully automated processing of dynamic susceptibility contrast perfusion MRI for acute ischemic cerebral stroke. Computer methods and programs in biomedicine, 98(2), 204-13. PMID: 20060614.

Leira, E. C., Ahmed, A. (2009). Development of an emergency department response to acute stroke ("Code Stroke"). (1), pp. 35-40. Current neurology and neuroscience reports. PMID: 19080751.

Leira, E. C., Ahmed, A., Lamb, D. L., Olalde, H. M., Callison, R. C., Torner, J. C. & Adams, H. P. (2009). Extending acute trials to remote populations: a pilot study during interhospital helicopter transfer. Stroke; a journal of cerebral circulation, 40(3), 895-901. PMID: 19131655.

Leira, E. C., Granner, M. A., Torner, J. C., Callison, R. C. & Adams, H. P. (2008). Education Research: The challenge of incorporating formal research methodology training in a neurology residency. Neurology, 70(20), e79-84. PMID: 18474837.

Leira, E. C., Adams, H. P., Rosenthal, G. E. & Torner, J. C. (2008). Baseline NIH stroke scale responses estimate the probability of each particular stroke subtype. Cerebrovascular diseases (Basel, Switzerland), 26(6), 573-7. PMID: 18946211.

Leira, E. C., Hess, D. C., Torner, J. C. & Adams, H. P. (2008). Rural-urban differences in acute stroke management practices: a modifiable disparity. Archives of neurology, 65(7), 887-91. PMID: 18625855.

Adams, H. P., Leira, E. C., Torner, J. C., Barnathan, E., Padgett, L., Effron, M. B. & Hacke, W. (2008). Treating patients with 'wake-up' stroke: the experience of the AbESTT-II trial. Stroke; a journal of cerebral circulation, 39(12), 3277-82. PMID: 18772451.

Callison, R. C., Leira, E. C. (2008). Strategies to improve acute stroke care of patients in rural and other geographically dispersed areas. (6), pp. 450-4. Current treatment options in neurology. PMID: 18990313.

Leira, E. C., Davis, P. H., Martin, C. O., Torner, J. C., Yoo, B., Weeks, J. B., Hindman, B. J. & Todd, M. M. (2007). Improving prediction of outcome in "good grade" subarachnoid hemorrhage. Neurosurgery, 61(3), 470-3; discussion 473-4. PMID: 17881957.

Leira, E. C., Pary, J. K., Davis, P. H., Grimsman, K. J. & Adams, H. P. (2007). Slow progressive acceptance of intravenous thrombolysis for patients with stroke by rural primary care physicians. Archives of neurology, 64(4), 518-21. PMID: 17420312.

Swenson, A. J., Leira, E. C. (2007). Paroxysmal sneezing at the onset of lateral medullary syndrome: cause or consequence?. European journal of neurology : the official journal of the European Federation of Neurological Societies, 14(4), 461-3. PMID: 17388999.

Leira, E. C., Lamb, D. L., Nugent, A. S., Ahmed, A., Grimsman, K. J., Clarke, W. R. & Adams, H. P. (2006). Feasibility of acute clinical trials during aerial interhospital transfer. Stroke; a journal of cerebral circulation, 37(10), 2504-7. PMID: 16946166.

Leira, E. C., Adams, Jr., H. P. (2006). Acute stroke. In H. F. Conn , R. E. Rakel , E. T. Bope (Eds.) Conn's Current Therapy. (58th edition, 2006), pp. 1088-1981. Philadelphia, PA: Saunders Elsevier.

Cruz-Flores, S., Diamond, A. L. & Leira, E. C. (2005). Cerebral air embolism secondary to intra-aortic balloon pump rupture. Neurocritical care, 2(1), 49-50. PMID: 16174969.

Leira, E., Cruz-Flores, S., Acharya, A. B. & Pan, Y. (2005). Treatment with tissue plasminogen activator is not associated with increased use of neurosurgery. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 14(6), 278-80. PMID: 17904037.

Leira, E. C., Cruz-Flores, S., Wyrwich, K. W., Northam, G. J., Acharya, A. B., Pan, Y., Holzemer, E. M. & Womack, S. B. (2005). Improving pilot response to in-flight strokes: a randomized controlled trial. Cerebrovascular diseases (Basel, Switzerland), 19(5), 317-22. PMID: 15775711.

Leira, E. C., Acharya, A. B., Cruz-Flores, S., Albaker, O. J., Rao, V. K. & Abdulrauf, S. I. (2005). Blood pressure surge precedes intracerebral hemorrhage. Neurocritical care, 2(1), 43-5. PMID: 16174967.

Leira, E. C., Adams, Jr., H. P. (Eds.) (2005). New therapies in acute stroke. Stroke, Clinical Update [National Stroke Association].

Leira, E. C., Condoor, S. S., Germani, M. P. & Vogler, G. A. (2005). A novel, simple pressure safety valve for lumbar puncture. Neurocritical care, 3(1), 68-70. PMID: 16159101.

Leira, E. C., Adams, H. P. (2004). Etiologies and Mechanisms of Ischemia. In Blue Books of Practical Neurology. (C), pp. 55–66. Elsevier. DOI: 10.1016/S1877-3419(09)70078-9.

Leira, E. C., Al-Baker, O. J. & Abdulrauf, S. I. (2004). Diagnosis and management of vascular sisease of the spinal cord. In H. P. Adams, Jr. (Eds.) Handbook of cerebrovascular diseases. (2nd edition, revised and expanded), pp. 637-652. New York: M. Dekker.

Leira, E. C., Abramns, Jr., H. P. (2004). Cerebrovascular disease. In R. Palmer , et. al. (Eds.) Current geriatric diagnosis and treatment. pp. 147-155. New York: McGraw-Hill.

Leira, E. C., Bertrand, M. E., Hogan, R. E., Cruz-Flores, S., Wyrwich, K. W., Albaker, O. J. & Holzemer, E. M. (2004). Continuous or emergent EEG: can bedside caregivers recognize epileptiform discharges?. Intensive care medicine, 30(2), 207-12. PMID: 14615839.

Cruz-Flores, S., de Assis Aquino Gondim F & Leira, E. C. (2004). Brainstem involvement in hypertensive encephalopathy: clinical and radiological findings. Neurology, 62(8), 1417-9. PMID: 15111687.

Leira, E. C., Chang, K. C., Davis, P. H., Clarke, W. R., Woolson, R. F., Hansen, M. D. & Adams, H. P. (2004). Can we predict early recurrence in acute stroke?. Cerebrovascular diseases (Basel, Switzerland), 18(2), 139-44. PMID: 15218280.

Leira, E. C. (2003). Hyperacute localization. In A. Bicknese (Eds.) Neuroanatomy in the Acute Setting 1KP 009 [syllabus]. American Academy of Neurology.

Leira, E. (2003). Treatment of acute stroke. Revista de neurologia, 36(1), 86-92. PMID: 12577221.

Johnston, S. C., Leira, E. C., Hansen, M. D. & Adams, H. P. (2003). Early recovery after cerebral ischemia risk of subsequent neurological deterioration. Annals of neurology, 54(4), 439-44. PMID: 14520654.

Gondim, F. A., Leira, E. C. & Bertrand, M. E. (2003). Video electroencephalogram monitoring during paroxysmal upside down reversal of vision. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 23(2), 180. PMID: 12782933.

Leira, E. C. (2002). Hyperacute localization. In A. Bicknese (Eds.) Practical Neuroanatomy 6PC.003 [syllabus]. American Academy of Neurology.

Kaiboriboon, K., Oliveira, G. R. & Leira, E. C. (2002). Apraxia of eyelid opening secondary to a dominant hemispheric infarction. Journal of neurology, 249(3), 341-2. PMID: 11993536.

Leira, E. C., Cruz-Flores, S., Leacock, R. O. & Abdulrauf, S. I. (2001). Sumatriptan can alleviate headaches due to carotid artery dissection. Headache, 41(6), 590-1. PMID: 11437896.

Selhorst, J. B., Kulkantrakorn, K., Corbett, J. J., Leira, E. C. & Chung, S. M. (2000). Retinol-binding protein in idiopathic intracranial hypertension (IIH). Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 20(4), 250-2. PMID: 11130751.

Leira, E. C., Adams, Jr., H. P. (2000). Which patients are inappropriate for surgery and what is the "best" medical management of non-surgical patients?. In C. M. Loftus , T. F. Kresowik (Eds.) Carotid artery surgery. pp. 113-120. New York: Thieme.

Leira, E. C., Love, B. B. & Adams, Jr., H. P. (1999). Stroke in young adults. In L. B. Goldstein , A. Shuaib (Eds.) Management of Acute Stroke. pp. 173-192. New York: Dekker.

Adams, H. P., Bendixen, B. H., Leira, E., Chang, K. C., Davis, P. H., Woolson, R. F., Clarke, W. R. & Hansen, M. D. (1999). Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology, 53(1), 122-5. PMID: 10408547.

Leira, E. C., Adams, H. P. (1999). Management of acute ischemic stroke. Clinics in geriatric medicine, 15(4), 701-20. PMID: 10499931.

Adams, H. P., Davis, P. H., Leira, E. C., Chang, K. C., Bendixen, B. H., Clarke, W. R., Woolson, R. F. & Hansen, M. D. (1999). Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology, 53(1), 126-31. PMID: 10408548.

Leira, E. C., Adams Jr., H. P. (1998). Emergent treatment of the patient with acute ischemic stroke. (Vols. 5). pp. 56-66. Journal of Clinical Outcomes Management.

Adams, H. P., Leira, E. C. (1998). Treatment of acute ischemic stroke. Drugs of today (Barcelona, Spain : 1998), 34(7), 655-60. PMID: 14988765.

Leira, E. C., Bendixen, B. H., Kardon, R. H. & Adams, H. P. (1998). Brief, transient Horner's syndrome can be the hallmark of a carotid artery dissection. Neurology, 50(1), 289-90. PMID: 9443497.

Adams, H. P., Leira, E. C. (1997). Brain attack. Acute therapeutic intervention. Antithrombotic and antiplatelet-aggregating drugs. (2), pp. 207-17. Neurosurgery clinics of North America. PMID: 9113702.

Leira, E. C., Ajax, T. & Adams, H. P. (1997). Limb-shaking carotid transient ischemic attacks successfully treated with modification of the antihypertensive regimen. Archives of neurology, 54(7), 904-5. PMID: 9236580.

Torner, J. C., Davis, P. & Leira, E. (1997). Epidemiology of stroke in requiring intensive care. New horizons (Baltimore, Md.), 5(4), 422-32. PMID: 9433994.