Articles: cerebrovascular-disorders-diagnosis.
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Med. Clin. North Am. · Nov 2013
ReviewPatients with disease of brain, cerebral vasculature, and spine.
Several structural abnormalities involving the brain and surrounding structures have perioperative implications. This article reviews the preoperative assessment and preparation of patients with intracranial masses, vascular lesions, cerebrospinal fluid abnormalities, traumatic injuries, and dementia. Until definitive treatment of the underlying condition occurs, prevention of secondary injury to the patient's brain is the goal of medical management and final functional outcome.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewIntracranial endovascular balloon test occlusion: indications, methods, and predictive value.
Abrupt interruption of the internal carotid artery without a balloon test occlusion (BTO) carries a 26% risk of cerebral infarction. BTO is a test used to decrease this risk by evaluating the efficacy of the collateral circulation. Clinical tolerance of parent vessel occlusion can be assessed by a BTO with several variables, including the clinical examination, angiographic assessment, stump pressure, induced hypotension, perfusion scanning, transcranial Doppler ultrasonography, and neurophysiologic monitoring. This review discusses the indications, methods, predictive value, and complications of BTO.
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Vascular cognitive impairment (VCI) includes vascular dementia (VaD), vascular mild cognitive impairment (VaMCI) and mixed dementia. In clinical practice, VCI concerns patients referred for clinical stroke or cognitive complaint. To improve the characterization of VCI and to refine its diagnostic criteria, an international group has elaborated a new standardized evaluation battery of clinical, cognitive, behavioral and neuroradiological data which now constitutes the reference battery. ⋯ The first studies showed that about a third of patients with VaD due to small vessel disease or with poststroke dementia have amyloid PET imaging suggestive of AD. These new techniques will examine the interaction between vascular lesions and promotion of amyloid deposition. Although results of these on-going studies will be available in few years, these data indicate that efforts should be done in clinical practice to reduce underdiagnosis of VCI; VCI should be examined using a specific protocol which will be fully normalized soon for French-speaking patients; the sub-optimal sensitivity of screening tests prompts to use a structured interview to grade Rankin scale and to perform systematically a comprehensive assessment in stroke patients at risk of VCI; poststroke dementia occurring after 3 months poststroke may be preventable by treatment of modifiable vascular risk factors and secondary prevention of stroke recurrence according to recent recommendations.
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Ann Fr Anesth Reanim · Oct 2013
Observational Study[Usefulness of Bispectral Index (BIS) monitoring for early detection of cerebral hypoperfusions.]
The goal of the study was to assess whether clinically significant cerebral hypoperfusion in awake patients would be associated with some alterations in the values of the bispectral index (BIS) monitoring. ⋯ In awake patients, the observed values of the BIS monitoring seem to be associated with clinically relevant cerebral hypoperfusion.