Neurocritical care
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Case Reports
Successful intravenous thrombolysis in ischemic stroke caused by infective endocarditis.
Infective endocarditis can lead to serious neurological complications including ischemic stroke and intracranial hemorrhage. Treatment with intravenous thrombolysis within 3 h of symptom onset has become the standard of care in acute ischemic stroke, but the safety and efficacy of this intervention in patients with infective endocarditis is unknown. ⋯ Favorable response to thrombolysis may occur in patients with stroke due to infectious endocarditis. The safety of this therapy remains to be established.
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Case Reports
Feasibility of IA thrombolysis for acute ischemic stroke among anticoagulated patients.
Limited information exists regarding thrombolysis among anticoagulated acute stroke patients. We present data from three consecutive patients, on active warfarin therapy, treated with intra-arterial reteplase. ⋯ Low dose, intra-arterial reteplase following acute reversal of elevated INR is feasible and may offer a potential treatment for patients suffering with acute ischemic stroke while receiving active warfarin treatment.
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Hypertonic saline (HS) solutions are increasingly being utilized as osmotherapeutic agents for the treatment of cerebral edema associated with brain injury from diverse etiologies. ⋯ These data demonstrate that (1) T(2)-weighted MRI imaging correlates with tissue water content in the ischemic core but not in the peri-infarct regions, and (2) attenuation of ischemia-evoked cerebral edema involves the modulation of AQP4 channels in the brain.
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Case Reports
Management of recurrent cerebral arterial occlusion in a patient with cardiac decompensation.
We describe a woman with congestive heart failure who presented with acute cardiac decompensation followed by ischemic stroke. The management of the patient posed unique challenges for thrombolytic treatment (due to existing coagulopathy) and subsequent optimization of hemodynamic status. Issues related to rethrombosis and use of platelet glycoprotein IIB/IIIA inhibitors are also discussed.