Brain and nerve = Shinkei kenkyū no shinpo
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Transient ischemic attack (TIA) is a medical emergency, which has been newly termed as "acute cerebrovascular syndrome" (ACVS). TIA is often ignored or unrecognized by patients or their families since its symptoms are naturally subsided without any treatment. TIA is also usually underestimated or nonprioritized by physicians because it is regarded merely as a minor stroke. ⋯ A large international, multicenter cooperative, observational study (TIA Registry. Org.) on 5,000 patients with TIA or minor stroke within 7 days of onset is being initiated. Now, we should say "Time is TIA".
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The US Food and Drug Administration (FDA) approved the use of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) in 1996, on the basis of the results of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study. IV rt-PA therapy at a dose of 0.9 mg/kg has been approved internationally for the treatment of hyperacute ischemic stroke. After a dose comparison study using duteplase and a multicenter study using a single dose of alteplase (Japan Alteplase Clinical Trial: J-ACT), the administration of IV rt-PA therapy at a dose of 0.6 mg/kg was approved in Japan in 2005. ⋯ A combination of reperfusion therapies, IV rt-PA and sonothrombolysis, neuroprotective agents or antiplatelet agents may be effective. However, currently available data do not provide conclusive evidence for the safety or efficacy of these combination therapies. Patients having ICA occlusion may require alternatives including a higher dose of alteplase, combined IV/IA thrombolysis, or possibly mechanical thrombectomy by using a thrombus-removal device.
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Endovascular therapy for cerebral aneurysms has been possible since the advent of Guglielmi detachable coils. The International Subarachnoid Aneurysm Trial (ISAT) showed that the 1-year outcome of endovascular coiling for ruptured aneurysms was significantly better than that of neurosurgical clipping. After the ISAT study, remarkably high numbers of aneurysms have been treated using coils across the world. ⋯ Bioactive coils allow the healing of aneurysm by promoting tissue reaction. However, it is difficult to cure very large and giant aneurysms even with the new coils. Hence flow-diverting stents and Onyx are being clinically tested for the treatment of such cases.