Stroke; a journal of cerebral circulation
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Comparative Study
Differences in medical and surgical therapy for stroke prevention between leading experts in North America and Western Europe.
Large multicenter trials have evaluated the benefit of different medical and surgical therapies to prevent stroke. However, the application of trial results to clinical practice remains uncertain for some areas of stroke prevention and has been discussed passionately among international experts. As part of a worldwide survey, the purpose of this analysis was to provide an informative and comparative view of the current practice of leading experts in North America (NA) and Western Europe (WE), where most of the large prevention trials have been performed. ⋯ This analysis shows significant differences in several areas of stroke prevention practices between leading experts from NA and WE. These differences may be explained partly by divergent results of trials from the two continents, but in some areas of controversy currently available trial data are not sufficient to form an international consensus to guide daily clinical practice.
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Patients resuscitated from cardiac arrest have a high early mortality rate. Prognostic evaluation based on clinical observations is uncertain and would benefit from the use of biochemical markers of hypoxic brain damage. The astroglial protein S-100 is an established biochemical marker of central nervous system injury. The purpose of the present study was to validate the use of serum determinations of S-100 with regard to outcome after cardiac arrest. ⋯ The present study shows that hypoxic brain damage after cardiac arrest can be estimated by measurement of serum S-100 concentrations. The method can be used in early prognostic evaluation of short-term outcome after cardiac arrest.
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Transcranial doppler ultrasound (TCD) is used after subarachnoid hemorrhage to detect cerebral vasospasm and is often treated with induced hypertension. Cerebral autoregulation, however, may be disturbed in this population, raising the possibility that TCD velocities may be elevated by induced hypertension. To study this possibility, we performed continuous TCD monitoring of the middle cerebral artery during the induction and withdrawal of induced hypertension in patients after subarachnoid hemorrhage. ⋯ In patients with disturbed autoregulation after subarachnoid hemorrhage, induced hypertension can alter cerebral blood flow velocities. The level of autoregulation needs to be considered when interpreting TCD velocities in patients after subarachnoid hemorrhage.
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We sought to analyze the etiology and underlying vascular risk factors of transient ischemic attacks (TIAs) and minor ischemic strokes (MISs). ⋯ An etiologic classification of TIAs and MISs is feasible. The two most frequent pathogenetic mechanisms in our study were small-artery disease and cardioembolism. The prevalence of large-artery atherosclerosis was low.
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Case Reports Comparative Study
Pilot study of functional MRI to assess cerebral activation of motor function after poststroke hemiparesis.
Studies of cerebral activation of motor function after ischemic stroke may enhance our understanding of the underlying mechanisms of motor functional recovery, including the role of the noninfarcted hemisphere. ⋯ Synkinesia alone cannot explain the extent of ipsilateral activation in primary sensorimotor cortex. The explanation offered for our findings is that preexisting uncrossed motor neural pathways may be accessed or recruited to compensate for damage to the crossed motor pathways after ischemic stroke.