Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Multicenter StudyRates and predictors of risk of stroke and its subtypes in diabetes: a prospective observational study.
Small vessel disease is reported to be a more common cause of ischaemic stroke in people with diabetes than in others. However, population based studies have shown no difference between those with and those without diabetes in the subtypes of stroke. We determined the rates and predictors of risk of stroke and its subtypes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial. ⋯ Older people with a history of stroke were at highest risk of stroke, but the prognosis and prognostic factors of subtypes were heterogeneous. The results will help clinicians quantify the absolute risk of stroke and its subtypes for typical diabetes patients.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Review Meta AnalysisCerebral microbleeds and the risk of intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: systematic review and meta-analysis.
Intracerebral haemorrhage (ICH) remains the most devastating yet unpredictable complication of intravenous thrombolysis for acute ischaemic stroke. We performed a systematic review and meta-analysis, to assess whether the presence of cerebral microbleeds (CMBs) on prethrombolysis MRI scans is associated with an increased risk of ICH. ⋯ The available evidence does not demonstrate a statistically significant increased risk of symptomatic ICH after thrombolysis for ischaemic stroke in patients with CMBs. However, in view of the methodological limitations of the studies included, the clinical relevance of any potential hazard associated with CMBs remains uncertain. Further studies are warranted to evaluate whether the risk of ICH might outweigh the benefit of thrombolysis, especially in patients with multiple lobar CMBs suggestive of cerebral amyloid angiopathy.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
ReviewStent usage in the treatment of intracranial aneurysms: past, present and future.
As endovascular approaches to intracranial aneurysm (IA) treatment continue to evolve, the use of intracranial stents has advanced from an infrequent adjunct to potential curative monotherapy. Early results of endovascular therapy for IAs have clearly underscored large aneurysm size, low coil packing density and wide aneurysm neck as factors limiting successful long term obliteration. ⋯ As evidence of their utility as flow diversion devices and as catalysts for aneurysm neck remodeling surfaced, their potential as standalone therapy was realised and is currently under close scrutiny. Here we review the evolution of stents in the treatment of IAs, from balloon expandable stents, to self-expanding stents, to the exciting advances in monotherapeutic flow diverting stents, amalgamating occlusion rates and reviewing complication rates.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications.
To investigate the premorbid use of secondary prevention medications in patients with recurrent vascular events. ⋯ Our findings underline the fact that the underuse of secondary preventive therapies is common in patients with recurrent vascular events, especially those with previous cerebral ischaemia. This underuse could be targeted to reduce recurrent vascular events.
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J. Neurol. Neurosurg. Psychiatr. · Mar 2013
Early neurological deterioration after subarachnoid haemorrhage: risk factors and impact on outcome.
Early neurological deterioration occurs frequently after subarachnoid haemorrhage (SAH). The impact on hospital course and outcome remains poorly defined. ⋯ Early worsening after SAH occurs in 35% of patients, is predicted by clot burden and is associated with mortality and poor functional outcome at 1 year.