Neurological research
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Neurological research · May 2012
ReviewNeuroprotection targeting ischemic penumbra and beyond for the treatment of ischemic stroke.
Neuroprotection to attenuate or block the ischemic cascade and salvage neuronal damage has been extensively explored for the treatment of ischemic stroke. In the last two decades, neuroprotective strategy has been evolving from targeting a signal pathway in neurons to protecting all neurovascular components and improving cell-cell and cell-extracellular matrix interaction that ultimately benefits the brain recovery after ischemic stroke. The progression from potentially reversible to irreversible injury in the ischemic penumbra has provided the opportunity to develop therapies to attenuate the ischemic stroke damage. ⋯ In addition, increasing evidence has indicated ischemic stroke could induce long-lasing cellular and hemodynamic changes beyond the ischemic territory. It is unclear whether and how the global responses induced by the ischemic cascade contribute to the progression of cognitive impairment after ischemic stroke. The prolonged pathophysiological cascades induced by ischemic stroke beyond the ischemic penumbra might provide novel therapeutic opportunities for the neuroprotective intervention, which could prevent or slow down the progression of vascular dementia after ischemic stroke.
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Neurological research · Mar 2012
ReviewFrom bench-to-bedside in catastrophic cerebrovascular disease: development of drugs targeting the endothelin axis in subarachnoid hemorrhage-related vasospasm.
Survivors of aneurysmal subarachnoid hemorrhage (SAH) may suffer functional dependence, cognitive impairment, and mood disorders. Cerebral vasospasm and delayed cerebral ischemia are associated with poor outcome in SAH and have been the subjects of intense investigation for decades. ⋯ The results of these trials emphasize the disconnect between attenuation of cerebral vasospasm and improvement in functional outcome. The purpose of this review article is to evaluate the utilization of animal models for the development of drugs targeting the endothelin pathway in SAH and, given the recent endothelin receptor antagonist clinical trial results and lessons from the ischemic neuroprotection field, reflect on an alternative approach to in vivo preclinical drug testing in SAH.
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Neurological research · Apr 2011
ReviewNational Institutes of Health Chiari Research Conference: state of the research and new directions.
To establish the current Chiari knowledge base and develop recommendations for future research. ⋯ Implementation of the recommendations developed at the conference would not only further expand the current understanding of the condition, but would likely have a significant, positive impact on patient experiences and outcomes.
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Neurological research · Jul 2010
ReviewDiagnosis and management of Rosai-Dorfman disease involving the central nervous system.
Rosai-Dorfman disease is a benign non-neoplastic proliferative disorder of histiocytes originally described in the cervical lymph nodes. Extranodal sites were later recognized, and by 1990, they were shown to represent over 40% of cases; however, central nervous system involvement is still considered rare. We review the literature, which shows a steady increase in reports of Rosai-Dorfman disease involving the brain and/or spine. ⋯ Rosai-Dorfman disease involving the central nervous system appears to be more common than previously thought and may well assume a more prominent place in the differential diagnoses of dural-based lesions. Expert awareness of the characteristic histopathology and immunohistochemistry of the disease is required for accurate diagnosis.
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Neurological research · Jul 2009
Review Case ReportsPeri-operative measures for treatment and prevention of cerebral vasospasm following subarachnoid hemorrhage.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high early mortality rates. Cerebral vasospasm remains the major source of morbidity after aSAH. Angiographic evidence of vasospasm is apparent in 70% of patients, while clinical manifestation of vasospasm is present in one third of patients. Early or existing vasospasm at the time of presentation poses an additional challenge in the management of the patient, and forms the basis for this review. ⋯ The utilization of a multimodality approach to treat patients with aneurysmal subarachnoid hemorrhage presenting with existing vasospasm can result in good outcome.