Stroke; a journal of cerebral circulation
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Case Reports
Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient.
Confirmation of clinical brain death with transcranial Doppler (TCD) has been described. With the introduction of mechanical assist devices, it is important to know how these devices influence TCD measurements. ⋯ Application of TCD in a patient with an IABP could lead to false interpretation of results if the TCD mean velocities are not registered with the IABP on standby or if the net flow velocities are not calculated.
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The needs of and appropriate service provision for patients dying from stroke have received little attention. The quality of care in the last year of life received by a population-based sample of stroke patients is described here, focusing on symptom control, communication with health professionals, and hospital care. ⋯ Improvements in symptom control and psychosocial support for patients who die from stroke are needed, as is better communication between health professionals and patients and their families. Education of doctors and nurses working with stroke patients in the principles of palliative care may help ensure that all dying stroke patients receive high-quality care.
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Hypertensive hypervolemic therapy has been shown to reverse delayed ischemic deficits after aneurysmal subarachnoid hemorrhage. Concern has been raised about systemic complications of therapy, including pulmonary edema and myocardial ischemia, especially when high doses of vasopressors are used. Patients in whom delayed ischemic deficits were treated with hypervolemia and phenylephrine were prospectively evaluated for signs of systemic toxicity. ⋯ Hypertensive hypervolemic therapy with the use of high-dose phenylephrine can be administered with acceptable systemic toxicity, even in patients with previous cardiac disease, provided that close monitoring is performed. To minimize risk, aggressive treatment should probably be reserved for patients with signs of delayed ischemia rather than administered prophylactically.
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We used near-infrared spectroscopy (NIRS) to monitor the cerebral oxygenation changes during CO2 reactivity tests. ⋯ NIRS signal changes in HbO2, Hb, and total hemoglobin concentration are very sensitive to alterations in EtCO2, which are largely independent of extracranial tissue perfusion. NIRS may be developed as an alternative method for testing cerebrovascular reactivity and may be of particular clinical importance when the ultrasound window is poor.
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It is well known that significant changes in cerebral hemodynamics may occur during the treatment of cerebral arteriovenous malformations with the complication of intracerebral hemorrhage and parenchymal edema. We used transcranial color-coded duplex sonography to study alterations in blood flow velocities during staged embolization. ⋯ The technical advantage of transcranial color-coded duplex sonography compared with transcranial Doppler sonography is that it allows the exact identification of different feeding arteries in arteriovenous malformations. Repeated measurements during stepwise embolization with corrected insonation angle are easily achieved, and noninvasive quantification of hemodynamic changes is possible. The method may be helpful in the planning of the different steps of embolization.