Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Feb 2014
Case ReportsCentral alveolar hypoventilation (Ondine's curse) caused by megadolichobasilar artery.
Central alveolar hypoventilation (CAH) syndrome is a clinical condition that is characterized by the loss of automatic breathing, particularly during sleep. Most forms in adults are caused by brainstem ischemia, mass, infection, demyelinating disease, or anoxic-ischemic damage. We present a case of a fatal symptomatic acquired CAH syndrome caused by megadolichobasilar artery. ⋯ During an unobserved episode, the patient was found unresponsive, with chemical signs of prolonged hypoventilation not explainable by cardiopulmonary disease. A diaphragmatic pacemaker, assisted ventilation, and repeated resuscitation were refused by the patient, who died some days later. CAH is a rare complication that can occur in patients with megadolichobasilar artery.
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J Stroke Cerebrovasc Dis · Feb 2014
Case ReportsPostoperative brain stroke after shoulder arthroscopy in the lateral decubitus position.
The beach chair position is used frequently for shoulder arthroscopy surgery. However, the beach chair position has been reported to be linked to postoperative cerebral stroke. ⋯ The patient experienced a brief period of intraoperative hypotension. Physicians should be aware of this potential complication that could be irrelevant to the position used.
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J Stroke Cerebrovasc Dis · Feb 2014
Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder.
Receiving information that one has a dissected cervical artery, which can cause a stroke at any time, is obviously traumatic, but details about the psychiatric and psychosocial sequelae are not known. We investigated the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in patients with spontaneous cervical artery dissection (CD) and the impact of PTSD on their psychosocial functioning. ⋯ PTSD seems to occur frequently in patients with CD and is associated with reduced mental HRQoL. Because the presence of a maladaptive coping style is correlated with PTSD, teaching patients better coping skills might be helpful.
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J Stroke Cerebrovasc Dis · Feb 2014
Initial experience with upfront arterial and perfusion imaging among ischemic stroke patients presenting within the 4.5-hour time window.
Although perfusion imaging is being evaluated as a tool to select acute ischemic stroke patients who are most likely to benefit from reperfusion therapies beyond the standard time windows, there are limited data on the utility of perfusion imaging within the intravenous (IV) thrombolytic time window. ⋯ An upfront CTA/CTP protocol aided stroke team decision-making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door to needle time ≤60 minutes returned to similar rates as the pre-CTA/CTP protocol.
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J Stroke Cerebrovasc Dis · Feb 2014
Multicenter StudyQuality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study.
Data concerning quality of acute stroke care and outcome are scarce in developing countries. ⋯ Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.