Stroke; a journal of cerebral circulation
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Review Comparative Study
Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey.
Scientific communication in medicine can be effective only if reports are based on unequivocal criteria for clinical conditions or specific diagnoses. ⋯ Reports about subarachnoid hemorrhage require closer scrutiny before publication to ascertain whether the conclusions about specific outcome events are based on unequivocal criteria.
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Treatments for acute ischemic stroke have evolved as knowledge about the pathophysiology of ischemic brain injury has advanced. Treatment strategies under development are aimed at offering neuroprotection acutely after focal cerebral ischemic injury, but delayed initiation of therapy may reduce efficacy. Pretreatment before ischemia begins could offer distinct advantages in patient groups at high risk for ischemic stroke. ⋯ The possibility of ameliorating the consequences of an acute ischemic stroke by pretreating high-risk patients with appropriate neuroprotective agents needs to be explored. Several types of high-risk population for prophylactic neuroprotection can be envisioned and then studied in clinical trials.
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Aspects of the mechanisms of hemostasis are reviewed with particular emphasis on the assembly of enzyme complexes on the membranes of cells. The way this membrane fixation of reactions accelerates coagulation, inhibition, and fibrinolytic systems is discussed. The complex nature of the hemostatic system and the multiple complications of its abnormalities present a difficult problem for the neurologist and neurosurgeon managing the patient with intracerebral hemorrhage. This is a situation in which close consultation and collaboration among the neurological and hematologic specialists are imperative to achieve the most favorable outcome for the patient with this life-threatening situation.
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The identification of gaseous emboli using Doppler ultrasound was described as early as the 1960s. Recently it has been demonstrated that this method can also detect solid emboli such as thrombi and platelet aggregates. This may make this technology useful in a large number of patients with, or at risk of, embolic stroke. ⋯ Detection of solid emboli using Doppler techniques offers an exciting new diagnostic tool. It has been demonstrated that the technique can detect solid emboli. The prognostic significance of such emboli remains to be determined. It is hoped that the technique will allow detection of patients at high risk of embolic stroke in whom appropriate prophylactic treatment can then be instituted.