Stroke; a journal of cerebral circulation
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Comparative Study
Identifying thresholds for penumbra and irreversible tissue damage.
Diffusion-weighted MRI (DWI) in combination with perfusion-weighted MRI (PWI) has become a widely accepted modality for the selection of patients amenable for acute therapy, if a mismatch between these procedures suggests viable penumbral tissue. However, DWI as well as PWI yields semiquantitative measures limiting the definitions of irreversible damage and of potentially viable penumbral tissue. These limitations of PWI/DWI may be better understood if findings in individual patients are compared with the results from measurements of blood flow, oxygen metabolism, and benzodiazepine receptor binding obtained with positron emission tomography (PET). ⋯ DWI correlates with FMZ results and, with a few exceptions, yields a good estimate of acute tissue damage and final infarct volume. PWI measures seem to be less reliable; the TTP prolongation of >4 seconds assessed only 83% of the volume of hypoperfusion <20 mL/100 g per minute. The mismatch volume imprecisely depicts increased oxygen extraction fraction, and, despite its clinical role for selection of patients for eventual therapy, it does not to seem to be a reliable correlate of penumbra.
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Early vasospasm (EVSP), defined here as arterial narrowing seen on diagnostic angiography within the first 48 hours of aneurysmal rupture, is a rarely reported and poorly defined phenomenon in patients with subarachnoid hemorrhage (SAH). The purpose of this study was to characterize EVSP in a large database of such patients. ⋯ EVSP was seen in 10% of SAH patients and was predictive of cerebral infarction and neurological worsening as well as unfavorable outcome at 3 months. EVSP was not associated with late vasospasm. EVSP may be as important as delayed vasospasm in predicting complications and long-term morbidity in SAH patients.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Preliminary report of the effects of complement suppression with pexelizumab on neurocognitive decline after coronary artery bypass graft surgery.
Pharmacological modulation of complement activation recently has been postulated as a therapeutic target in the treatment of neurological injury. We hypothesized that pexelizumab, a humanized scFv monoclonal antibody directed against the C5 complement component, would limit deficits in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. ⋯ Pexelizumab administration for 24 hours perioperatively had no effect on global measures of cognition but may reduce dysfunction in the visuo-spatial domain.
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Bleeding risks from combined antiplatelet-warfarin therapy have not been well-described in clinical practice. We examined antiplatelet therapy among warfarin users and the impact on major bleeding rates. ⋯ Although concerns about increased bleeding risk with combined warfarin-antiplatelet therapy are not unfounded, the risk of bleeding is moderately increased. The decision to use concurrent antiplatelet therapy appears to be tempered by cardiac and bleeding risk factors.
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Therapeutic hypothermia shows promise as a treatment for acute stroke. Surface cooling techniques are being developed but, although noninvasive, they typically achieve slower cooling rates than endovascular methods. We assessed the hypothesis that the addition of intravenous MgSO4 to an antishivering pharmacological regimen increases the cooling rate when using a surface cooling technique. ⋯ Administration of intravenous MgSO(4) increases the cooling rate and comfort when using a surface cooling technique.