Stroke; a journal of cerebral circulation
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Knowledge of the long-term excess mortality in pediatric aneurysm patients is lacking. The aim of this study was to assess the long-term excess mortality of 102 pediatric patients with cerebral aneurysm treated at the department of neurosurgery at Helsinki University Central Hospital between 1937 and 2009. ⋯ There is long-term excess mortality in pediatric patients with aneurysm even decades after successful treatment of a ruptured aneurysm, especially among boys. The excess mortality is mainly aneurysm-related.
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Improving stroke management, guideline adherence, and outcome is a global priority. Our aim was to examine trends in nationwide use of reperfusion therapy, stroke in-hospital management, and outcome. ⋯ Based on a nationwide stroke registry, use of reperfusion therapy, vascular imaging, and statins is steadily increasing, whereas in-hospital mortality is decreasing.
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A recent study suggested that in patients with acute headache suspicious of nontraumatic subarachnoid hemorrhage (SAH), cerebrospinal fluid (CSF) analysis is not needed to rule out SAH if head CT performed ≤6 hours after ictus is negative. Before implementation in daily practice, these results need replication. Therefore, we investigated test characteristics of head CT in patients with a clinical suspicion of SAH. ⋯ In patients presenting with acute headache and a normal head CT ≤6 hours after ictus, as interpreted by experienced neuroradiologists, there is no added value of CSF analysis. In patients with an atypical presentation without headache and in patients presenting >6 hours after ictus, CSF analysis is still indicated.
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Little is known about adoption or success of telestroke networks outside of published or federally funded programs. Under contract to the Health Resource Services Administration, we conducted an environmental scan of telestroke programs in the United States. ⋯ Telestroke is a widespread and growing practice model. Important barriers to expansion amenable to change relate to organizational, technical, and educational domains and external economic and regulatory forces.
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Localized head and neck cooling might be suited to induce therapeutic hypothermia in acute brain injury such as stroke. Safety issues of head and neck cooling are undetermined and may include cardiovascular autonomic side effects that were identified in this study. ⋯ Head and neck cooling prominently reduced tympanic temperature and thus might also induce intracerebral hypothermia; however, it did not significantly lower body core temperature. Profound skin temperature decrease induced sympathetically mediated peripheral vasoconstriction and prominent BP increases that are not offset by simultaneous parasympathetic heart rate slowing. Prominent peripheral vasoconstriction and BP increase must be considered as possibly harmful during head and neck cooling.