Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2010
Review Comparative StudyRisk of aneurysm rupture at intracranial arterial bifurcations.
Aneurysms on the posterior circulation, most commonly located at the basilar top, have a higher risk of rupture than aneurysms on the anterior circulation. If hemodynamic shear stress, which has its maximum impact at the distal carina of bifurcations, explains the higher rupture rate of basilar top aneurysms, aneurysms at the top of the carotid artery should have similar rupture rates given their geometrical similarities. ⋯ Aneurysms are less frequently located on the carotid than on the basilar artery bifurcation. The proportion of ruptured carotid aneurysms is smaller than that of unruptured carotid aneurysms, suggesting a lower rupture risk for aneurysms at the carotid artery bifurcation. The anatomical geometry of the bifurcations and concomitant hemodynamic stress are considered an unlikely explanation for the higher risk of posterior circulation aneurysms.
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Cerebrovascular diseases · Jan 2010
Association of platelet and leukocyte counts with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.
A proinflammatory prothrombotic state may increase the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). We studied the relationship of levels of leukocytes, platelets, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with the development of DCI and with clinical outcome in patients with aneurysmal SAH. ⋯ Counts of platelets and leukocytes disproportionally increase during the occurrence of DCI after aneurysmal SAH. Drugs with anti-thrombotic or anti-inflammatory properties should be studied for prevention and treatment of DCI.
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Cerebrovascular diseases · Jan 2010
Randomized Controlled Trial Comparative StudyVery early rehabilitation or intensive telemetry after stroke: a pilot randomised trial.
Stroke patients are more likely to make a good recovery if they receive care in a well-organised stroke unit. However, there are uncertainties about how best to provide such care. We studied 2 key aspects of early stroke unit care: early active mobilisation (EM) and automated monitoring (AM) for physiological complications such as hypoxia. ⋯ We have demonstrated the feasibility of implementing EM and AM for physiological complications in a randomised controlled trial. Larger trials are warranted to determine whether these interventions have clinical benefits.
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The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. ⋯ To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
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Cerebrovascular diseases · Jan 2010
EEG power spectrum to predict prognosis after hemicraniectomy for space-occupying middle cerebral artery infarction.
Early prediction of outcome after decompressive surgery for space-occupying middle cerebral artery (MCA) infarction is needed to guide further therapy. Here we applied spectral EEG analysis to determine the prognosis early after hemicraniectomy, while the patient is still treated in the intensive care unit. ⋯ Spectral analysis in the subacute phase following hemicraniectomy may represent a parameter to predict early regain of consciousness and thus the capability and potential for further rehabilitation and favorable outcome.