Neurocritical care
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To determine the rate of subacute recanalization and reocclusion and its effect on clinical outcomes among patients with ischemic stroke treated with endovascular treatment. Subacute recanalization and reocclusion occurring hours after completion of the intravenous or intra-arterial thrombolysis for acute ischemic stroke has been reported in anecdotal cases. ⋯ We found that new or additional recanalization occurs in one-fourth of the patients within 24 h of endovascular treatment and is not associated with any adverse consequences. Subacute reocclusion occurs infrequently after endovascular treatment.
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Case Reports
Cerebral air embolism resulting in fatal stroke in an airplane passenger with a pulmonary bronchogenic cyst.
Cerebral air embolism is a rare cause of stroke, but may occur in patients undergoing invasive cardiac and pulmonary procedures, as well as in divers suffering pulmonary barotrauma from rapid ascent. Cerebral air embolism during air travel, however, is particularly rare. ⋯ This case suggests the importance of considering cerebral air embolism in patients with stroke associated with air travel; restricting air travel in patients with intrapulmonary cysts may be prudent.
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The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time interval during which this study needs to be completed. ⋯ We propose that only CT scans obtained within 24 h of a subarachnoid bleeding event should be used to estimate the risk of vasospasm.
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Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a serious complication resulting in delayed neurological deficit, increased morbidity, mortality, longer hospital stays, and rehabilitation time. It afflicts approximately 35 per 100,000 Americans per year, and there is currently no effective therapy. We present in vitro data suggesting that increasing intrinsic nitric oxide relaxation pathways in vascular smooth muscle via dopaminergic agonism ameliorates cerebral vasospasm after SAH. ⋯ Cerebral vasospasm is significantly reversed in a functional measure of vasospasm in vitro by dopamine, via a D(2)R-mediated pathway. The increase in NOS protein seen in both the endothelium and vascular smooth muscle in response to CSF(V) is enhanced by dopamine, also in a D(2)R-dependent mechanism.
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Stroke is the third most common cause of death in the Western World and is a condition seen by Neurologists, General Physicians and Primary Care Physicians. Neurogenic pulmonary edema can complicate the management of large strokes and cerebral hemorrhage. While the principles of management of this type of pulmonary edema are similar to the more common cardiogenic pulmonary edema, placing a patient in the prone position may be a helpful maneuver facilitating recovery. ⋯ This technique of prone positioning for ventilation is of importance to physicians who manage stroke and its complications.