Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2003
Clinical TrialAcetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke.
The risk of intracerebral hemorrhage in systemic thrombolysis for acute ischemic stroke after acetylsalicylic acid (ASA) pretreatment or with subsequent heparin is controversially discussed. ⋯ ASA pretreatment does not increase the risk of symptomatic bleeding after systemic thrombolysis with rt-PA, even if thrombolysis is followed by anticoagulation.
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Cerebrovascular diseases · Jan 2003
Practice Guideline GuidelineEuropean Stroke Initiative Recommendations for Stroke Management-update 2003.
This article represents the update of 'European Stroke Initiative Recommendations for Stroke Management', first published in this Journal in 2000. The recommendations are endorsed by the 3 European societies which are represented in the European Stroke Initiative: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.
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Cerebrovascular diseases · Jan 2003
ReviewLong-term outcome after ischaemic stroke/transient ischaemic attack.
During the first 30 days after a stroke, the case fatality is about 25% and the major cause of death is the index stroke and its sequelae. The most consistent predictor of 30-day mortality after stroke is stroke severity. Other predictors include increasing age, a history of previous stroke, cardiac failure, and a high blood glucose concentration and white blood cell count. ⋯ The most powerful predictor of early recurrent stroke (within 30 days after stroke) is an atherosclerotic ischaemic stroke caused by large-artery atherosclerosis with >50% stenosis, whereas the strongest predictor of stroke recurrence over 5 years is diabetes. Other predictors of recurrent stroke include increasing age, previous TIA, atrial fibrillation, high alcohol consumption, haemorrhagic index stroke, and hypertension at discharge. The clinical implication of these findings is that strategies for optimizing long-term outcome after TIA and stroke should be directed toward reducing the high risk of recurrent stroke and coronary events by removing/recanalizing the symptomatic atherosclerotic plaque, controlling the underlying causal vascular risk factors, and administering long-term, effective antiplatelet therapy.
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Cerebrovascular diseases · Jan 2003
Cerebral magnetic resonance imaging within 6 hours of stroke onset: inter- and intra-observer reproducibility.
Magnetic resonance imaging (MRI) provides valuable pathophysiological information during the very first hours of cerebral ischemia. However, the reliability of prime-time MRI in the setting of emergency care remains unknown. ⋯ The visual assessment of T2* gradient echo, TOF, diffusion and perfusion sequences at the acute stage of stroke is reproducible between and within observers. The visual assessment is as good as the volumetric assessment to detect a mismatch of >20%.
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Cerebrovascular diseases · Jan 2003
Clinical TrialThe role of blood pressure in lacunar strokes preceded by TIAs.
Lacunar strokes (LS) are often preceded by repetitive transitory ischaemic attacks (TIAs) known as 'capsular warning syndrome'. The treatment of these symptoms remains controversial. Anticoagulants are often used in this situation, most of the time, however, with no or little benefit. ⋯ One patient received noradrenalin, which allowed stabilisation of the blood pressure values and complete resolution of the neurological symptoms. This observation suggests that in lacunar strokes preceded by TIAs monitoring and, if necessary, pharmacological increase of BP may prevent some patients from developing a definite stroke. Thus the 'capsular warning syndrome' could reflect a haemodynamic failure rather than repeated thrombo-embolism within the lumen of a single perforating arteriole.