Cerebrovascular diseases
-
Cerebrovascular diseases · Jan 2009
ReviewTelestroke networking offers multiple benefits beyond thrombolysis.
Patients with acute ischemic stroke (AIS) require immediate attention and stroke expertise, which is rarely offered by community hospitals. Telestroke networks were originally established for delivering thrombolysis to inhabitants of underserved regions where stroke expertise was not available 24/7. Rapidly expanding experience addresses the fact that thrombolysis, when given using telestroke consultation, is as safe and effective as when it is given in a stroke center. ⋯ Further benefits may be: to facilitate staff recruitment to spoke hospitals, to deliver expertise to developing countries, participation of spoke hospitals to acute stroke treatment trials and stroke prevention trials, and environmental effects. The magnitude of these benefits will become more obvious in the near future because this exciting field is progressing fast. The Finnish experience suggests that telestroke is a versatile tool for improving acute stroke care of inhabitants in underserved regions and it should be made more widely available.
-
Prior epidemiological work has shown higher mortality in ischemic stroke patients admitted on weekends, which has been termed the 'weekend effect'. Our aim was to assess stroke patient outcomes in order to determine the significance of the 'weekend effect' at 2 comprehensive stroke centers. ⋯ Our results suggest that comprehensive stroke centers (CSC) may ameliorate the 'weekend effect' in stroke patients. These results may be due to 24/7 availability of stroke specialists, advanced neuroimaging, or ongoing training and surveillance of specialized nursing care available at CSC. While encouraging, these results require confirmation in prospective studies.
-
Cerebrovascular diseases · Jan 2009
Multicenter StudyEuropean Stroke Facilities Survey: the German and Austrian perspective.
The aim of this nested analysis was to identify the major components of stroke centers and other facilities actually available for acute stroke patients in hospitals of Germany and Austria. ⋯ This survey shows that the minimum level of care is met in Germany and Austria in 63% of hospitals treating stroke patients, whereas the European average is 48.6%. However, the lack of stroke center coverage should encourage health policy decision makers to further improve the infrastructure for acute stroke care in order to make stroke centers available to every stroke victim.
-
Cerebrovascular diseases · Jan 2009
ReviewPoststroke emotional and behavior impairment: a narrative review.
Emotional and behavioral disturbances are a frequent complication in stroke survivors. They are underdiagnosed, have a high impact on quality of life and are often a precipitant of institutionalization. ⋯ In this article, we update some of the most common or relevant poststroke emotional and behavioral disturbances, including poststroke mania and poststroke depression, poststroke anxiety disorders, posttraumatic stress disorder, personality changes with focus on apathy and disturbances of emotional expression control. Significant advances in the management of poststroke emotional and behavioral disturbances will need the use of comparable instruments and methods and multicenter collaboration.
-
Cerebrovascular diseases · Jan 2009
ReviewDiagnosis of intracerebral hemorrhage with transcranial ultrasound.
In acute stroke, different sonographic methods can be used to assess structural and hemodynamic compromise. Structural abnormalities of brain parenchyma such as primary intracerebral hemorrhage (ICH) and epiphenomena such as midline shift can be detected by native transcranial B-mode ultrasound. ⋯ According to recent data, ultrasound perfusion imaging provides additional information for the diagnosis of ICH and may differentiate ischemic from hemorrhagic stroke. This review summarizes the impact of these different transcranial ultrasound methods on diagnosis and monitoring of ICH.