Stroke; a journal of cerebral circulation
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Clinical Trial Controlled Clinical Trial
Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia.
The purpose of this study was to examine the effects of diabetes mellitus and its severity on the cerebral vasodilatory response to hypercapnia. ⋯ Insulin-dependent diabetic patients have an impaired vasodilatory response to hypercapnia compared with that of the control group, and the present findings suggest that their degree of impairment is related to the severity of diabetes mellitus.
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The goal of this study was to document the long-term outcome of ischemic stroke patients in a population with predominant intracranial atherosclerosis and risk factors for a recurrent event. ⋯ Patients with intracranial atherosclerosis, especially coexisting extracranial carotid disease, are at higher risk of suffering death or further vascular event. Our findings provide important data for planning future randomized clinical trials for this high-risk group of stroke patients.
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We previously showed that mild hypothermia protects against experimental stroke, even when cooling was delayed by 2 hours. Protection may be due in part to inhibiting inflammation. To clarify, we examined leukocyte infiltration, microglial activation, and adhesion molecule expression in models of stroke and pure brain inflammation. ⋯ Mild hypothermia decreases inflammatory responses in both brain inflammation and stroke, implicating a direct anti-inflammatory effect of cooling. This suggests that hypothermia can attenuate factors contributing to delayed ischemic injury.
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Comparative Study Clinical Trial
Cerebral autoregulation in carotid artery occlusive disease assessed from spontaneous blood pressure fluctuations by the correlation coefficient index.
Estimation of dynamic cerebral autoregulation from spontaneous fluctuations of arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) is an attractive monitoring option for cerebral hemodynamic impairment. We evaluated the correlation coefficient index method in patients with severe obstructive carotid disease and compared it with transfer function analysis (frequency domain approach to cerebral autoregulation) and CO2 vasomotor reactivity. ⋯ The potential of the correlation coefficient indexes Dx and Mx in detecting hemodynamic impairment in patients with carotid stenosis is comparable to that of transfer function analysis and CO2 reactivity testing. In future, a combination of various hemodynamic tests might help to identify patients at risk for ischemic events.