Stroke; a journal of cerebral circulation
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We aimed to prospectively determine whether the incidence of obstructive sleep apnea in patients with recent stroke was significantly different from that of a sex- and age-matched control group with no major medical problems. ⋯ Patients with stroke have an increased incidence of obstructive sleep apnea compared with normal sex- and age-matched control subjects. Hypoxia and hemodynamic responses to obstructive sleep apnea may have predisposed these patients to stroke.
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Comparative Study
Assessment of the posterior communicating artery by transcranial color-coded duplex sonography.
The aim of this study was to investigate flow velocity and flow direction in the posterior communicating artery (PcomA) by means of transcranial color-coded duplex sonography (TCCD) and to compare the results with angiographic findings. ⋯ TCCD appears to be a valuable method to determine flow velocity and flow direction not only in the large intracranial vessels but also in the smaller communicating arteries. In the future this method could be useful for the planning of ICA balloon occlusions and in deciding whether to perform extracranial/intracranial bypass surgery. It could furthermore show intracranial collaterals in patients with cerebrovascular disease and help to estimate the risk of watershed infarctions in patients with asymptomatic high-grade ICA stenosis and in patients undergoing carotid endarterectomy.
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Comparative Study
Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter.
The mechanisms underlying brain injury from intracerebral hemorrhage (ICH) are complex and poorly understood. To comprehensively examine pathophysiological and pathochemical alterations after ICH and to examine the effects of hematoma removal on these processes, we developed a physiologically controlled, reproducible, large-animal model of ICH in pigs (weight, 6 to 8 kg). ⋯ Experimental lobar ICH in pigs models a prominent pathological feature of human ICH, ie, early perihematomal edema. Our findings suggest that serum proteins, originating from the hematoma, accumulate in adjacent white matter and result in rapid and prolonged edema after ICH. This interstitial edema likely corresponds to the low densities on CT scans and the hyperintensities on T2-weighted MR images that surround intracerebral hematomas acutely after human ICH.
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Multicenter Study
Agreement on disease-specific criteria for do-not-resuscitate orders in acute stroke. Members of the Canadian and Western New York Stroke Consortiums.
The do-not-resuscitate (DNR) order is a mechanism of withholding cardiopulmonary resuscitation (CPR). The lack of DNR guidelines specific for acute stroke may result in many stroke patients receiving unnecessary and futile resuscitation and ventilator-assisted breathing. ⋯ Disease-specific criteria for DNR orders were developed to supplement general DNR policies for patients with hemispheric brain infarction and intracerebral hemorrhage during the first 2 weeks of stroke. A significant agreement was reached by a panel of physicians that patients with acute stroke should not be resuscitated if these disease-specific criteria are met.
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Comparative Study
Diabetes mellitus as a risk factor for death from stroke. Prospective study of the middle-aged Finnish population.
High blood pressure is the most important risk factor for stroke. It is also known that diabetic patients are at increased risk of both hypertension and stroke. The aim of this study was to assess the independent effect of diabetes as a risk factor for stroke. Results from the previous studies of this question have been somewhat inconclusive. ⋯ Diabetic subjects have a very high risk of death from stroke, particularly women. Our data also suggest that the duration of diabetes is an important factor contributing to the risk of stroke.