European neurology
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Elevated intracranial pressure (ICP) as a result of intracerebral hemorrhage (ICH) and perihematomal edema often leads to tissue shift, which can be identified in cross-sectional imaging and presents a known predictor of functional outcome. Pulsatility indices (PIs) of the intracranial arteries as measured by transcranial Doppler sonography (TCD) may serve as surrogate parameters for ICP. This study aims to investigate whether PI correlates with ICP and midline shift and serves as a reliable predictor of functional outcome in patients with ICH. ⋯ Early PI monitoring by TCD correlated with ICP and may be used to predict the outcome after 6 months.
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We aimed to investigate the clinical courses and common nystagmus of isolated vertigo patients with vertebrobasilar stroke. ⋯ In the early stage of vertebrobasilar stroke, an accurate diagnosis was difficult in the Emergency Department even though a radiologic study was performed, but various VNG abnormalities and delayed neurologic signs could help to diagnose whether the origin is central or not.
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We propose an analog restless legs syndrome (RLS) rating scale (ARLS) to assess RLS severity. ARLS has three components: overall perceived severity of symptoms, the severity of urge to move and the degree to which symptoms improve with movement, each scored from 0 to 100. ARLS is relatively convenient, easy to administer in clinics and can be rapidly assessed. ⋯ For both low and high IRLS scores, the urge to move measured with ARLS saturated, suggesting a non-linear, multifactorial relationship between the perception of RLS severity and the urge to move. In conclusion, individual components of the ARLS correlated well with total IRLS score. We emphasize that the ARLS is a simple RLS rating tool that can be used in clinical settings.
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The Solitaire stent has been suggested as a promising device to perform intracranial thrombectomy in large vessels. We report our experience. ⋯ In this case series, thrombectomy using Solitaire stent in stroke related to large vessel occlusion appears to be feasible, safe and potentially effective. Randomized controlled trials are needed to demonstrate the superiority of thrombectomy alone or in combination with intravenous tPA over intravenous tPA alone in ischemic stroke patients with large intracranial arterial occlusion.
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Randomized Controlled Trial
Decompressive surgery for malignant middle cerebral artery infarcts: the results of randomized trials can be reproduced in daily practice.
In clinical randomized controlled trials (RCTs), decompressive surgery (DS) for malignant middle cerebral artery (MMCA) infarcts leads to a 50% absolute risk reduction in mortality, and improves the 1-year functional outcome. The reproducibility of these results in routine practice has never been evaluated. The purpose of this study was to test the hypothesis that the results of DS for MMCA in practice are similar to those observed in the surgical group of RCTs. ⋯ This observational study showed that DS for MMCA in a center without previous experience provides similar results as those obtained in the surgical arm of RCTs.