Stroke; a journal of cerebral circulation
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Comparative Study
The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost. A community-based study.
Treatment of stroke patients in specialized stroke units has become more frequent, yet the effect of this treatment has not been determined. ⋯ Treatment of unselected acute stroke patients on a stroke care unit saved lives, reduced the length of hospital stay, reduced the frequency of discharge to a nursing home, and potentially reduced cost.
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Randomized Controlled Trial Clinical Trial
A randomized, double-blind, placebo-controlled pilot trial of intravenous magnesium sulfate in acute stroke.
Magnesium ions act as endogenous vasodilators of the cerebral circulation and act pharmacologically as noncompetitive antagonists of the N-methyl-D-aspartate receptor by virtue of their role as endogenous voltage-sensitive blockers of the ion channel. The preclinical efficacy of magnesium has been demonstrated in standard models of stroke. ⋯ Magnesium sulfate is well tolerated after acute stroke and has no deleterious hemodynamic effects at this dose. Further trials are required to determine efficacy.
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Case Reports
Venous transcranial Doppler ultrasound monitoring in acute dural sinus thrombosis. Report of two cases.
We sought to establish the efficacy of the Doppler technique in the evaluation of the intracranial venous system and to assess its usefulness in the monitoring of venous collateral pathways in superior sagittal sinus thrombosis. ⋯ Venous transcranial Doppler ultrasonography provides a reliable, noninvasive, and rapid technique for intracranial venous examination. It was performed without difficulty in young health volunteers, and it can be applied as a monitoring tool in the evaluation of collateral venous flow in superior sagittal sinus thrombosis.
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The purpose of this prospective study was to establish (1) whether patients with neurological symptoms scheduled for carotid endarterectomy had an increased incidence of electroencephalographic (EEG) abnormalities during awake baseline recordings, (2) whether these symptoms and EEG abnormalities predicted ischemic EEG pattern changes at carotid artery cross-clamp, and (3) whether there was an association between age, presence of EEG baseline abnormalities, and ischemic pattern changes at carotid artery cross-clamp. ⋯ Despite the strong association between a history of cerebral ischemic symptoms and preoperative EEG abnormalities in patients undergoing carotid endarterectomy, patients who have suffered strokes or transient ischemic events are at no greater risk of having EEG evidence of cerebral ischemia during carotid artery cross-clamp than patients without symptoms and with normal baseline EEGs. We conclude that preoperative EEG abnormalities in symptomatic patients are not due to age or to insufficiency of regional cerebral blood flow.
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There is no comprehensive and reliable model available in small animals that is suitable for the study of subarachnoid hemorrhage (SAH). Most of the existing models either require extensive surgery to achieve SAH or neglect the importance of an injury to the vessel and the impact of suddenly raised intracranial pressure (ICP). The presented model is designed to overcome these shortcomings. ⋯ We present an inexpensive and reliable model of SAH in the rat that allows the early course of biochemical, physiological, and pathological changes to be studied.