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Sample records for anterior circulation strokes

  1. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    International Nuclear Information System (INIS)

    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome

  2. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Power, Sarah, E-mail: drsarahpower@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); McEvoy, Sinead H., E-mail: sineadmcevoy@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Cunningham, Jane, E-mail: janecunningham0708@gmail.com [Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Ti, Joanna P., E-mail: joannapearlyti@gmail.com [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Looby, Seamus, E-mail: seamuslooby@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); O' Hare, Alan, E-mail: alanohare@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Williams, David, E-mail: davidwilliams@rcsi.ie [Department of Geriatrics and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI) and Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Brennan, Paul, E-mail: paulbrennan@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Thornton, John, E-mail: johnthornton@beaumont.ie [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland)

    2015-07-15

    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome.

  3. Thrombolysis in anterior versus posterior circulation strokes: timing of recanalization, ischemic tolerance, and other differences.

    Science.gov (United States)

    Pagola, Jorge; Ribo, Marc; Alvarez-Sabin, José; Rubiera, Marta; Santamarina, Estevo; Maisterra, Olga; Delgado-Mederos, Raquel; Ortega, Gemma; Quintana, Manuel; Molina, Carlos A

    2011-04-01

    Previous studies have suggested a greater ischemic tolerance in posterior circulation as compared to anterior cerebral circulation. We aimed to investigate whether a differential response exists between anterior and posterior circulation strokes. Two hundred and four middle cerebral artery (MCA) patients and 28 basilar artery occlusion (BAO) patients treated with intravenous recombinant tissue plasminogen activator were included. Transcranial Doppler assessed recanalization at different time points. Patients were divided in three groups: total time of ischemia (TTI)24 hours. We calculated the percentage of recovery (admission National Institutes of Health Stroke Scale [NIHSS]- discharge NIHSS/admission NIHSS)×100. Mean time to treatment was longer in BAO patients (P=.031). Early recanalization was more frequent among MCA occlusions (41% vs 29%; P=.039); the rate of persisting occlusion at 24 hours was similar (P=.933). Clinical recovery according to TTI was similar in each group: 24 hours: BAO -44%/MCA 11% (P=.23). For each hour of ischemia MCA patients worsened 1.78% (P=.035) and BAO 1.76% (P=.421). MCA occlusions compared to BAO were independently associated with hemorrhagic transformation (OR: 8.2; P=.043). Our data do not support the theory of increased ischemic tolerance in posterior circulation. Despite longer time-to-treatment, BAO were more resistant to hemorrhagic transformations. PMID:20040010

  4. Comparing perfusion CT evaluation algorithms for predicting outcome after endovascular treatment in anterior circulation ischaemic stroke

    International Nuclear Information System (INIS)

    Aim: To analyse perfusion CT (PCT) evaluation algorithms for their predictive value for outcome after endovascular therapy (ET) in acute ischaemic stroke. Materials and methods: Twenty-six patients were prospectively enrolled to undergo endovascular therapy for moderate to severe [National Institute of Health Stroke Scale (NIHSS) score of ≥5] anterior circulation stroke ≤6 h of onset. PCT datasets were evaluated according to three algorithms: visual mismatch estimate (VME), Alberta Stroke Programme Early CT Score (ASPECTS) perfusion, and quantitative perfusion ratios (QPRs: RCBF, RCBV) of cerebral blood flow (CBF) and volume (CBV). Results were correlated with outcome measures [NIHSS score at discharge, NIHSS score change until discharge (ΔNIHSSA/D), mRS at 90 days (mRS90d)] and compared with a matched control group. Results: Recanalization was achieved in 73%, median NIHSS score decreased from 14 to 5 at discharge. The treatment and control group did not differ by VME and ASPECTS perfusion, nor did VME correlate with any of the three outcome measures. ASPECTS perfusion was not predictive of any outcome measure in the ET group. RCBF and RCBV were associated with ΔNIHSSA/D in controls and, inversely, the ET group, but not with mRS90d. Receiver operating characteristic (ROC) analysis of RCBF (and RCBV) showed a positive predictive and negative predictive value of 87% (78%) and 74% (73%), respectively, for discriminating major neurological improvement (ΔNIHSSA/D <7 versus ≥7). Conclusions: Implementation of QPRs for CBF and CBV are superior to clinically used VME and ASPECTS perfusion evaluation methods for predicting early outcome after ET for anterior circulation stroke. - Highlights: • Quantitative Perfusion ratios (qPR) can be derived from Perfusion CT data sets. • qPR have a high predictive value for discriminating major neurological improvement. • qPR are superior compared to ASPECTS perfusion for predicting early outcome

  5. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

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    Seeters, Tom van; Schaaf, Irene C. van der; Dankbaar, Jan Willem; Horsch, Alexander D.; Niesten, Joris M.; Luitse, Merel J.A.; Mali, Willem P.T.M.; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Vos, Jan Albert [St. Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Schonewille, Wouter J. [St. Antonius Hospital, Department of Neurology, Nieuwegein (Netherlands); Walderveen, Marianne A.A. van [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Wermer, Marieke J.H. [Leiden University Medical Center, Department of Neurology, Leiden (Netherlands); Duijm, Lucien E.M. [Catharina Hospital, Department of Radiology, Eindhoven (Netherlands); Keizer, Koos [Catharina Hospital, Department of Neurology, Eindhoven (Netherlands); Bot, Joseph C.J. [VU University Medical Center, Department of Radiology, Amsterdam (Netherlands); Visser, Marieke C. [VU University Medical Center, Department of Neurology, Amsterdam (Netherlands); Lugt, Aad van der [Erasmus MC University Medical Center, Department of Radiology, Rotterdam (Netherlands); Dippel, Diederik W.J. [Erasmus MC University Medical Center, Department of Neurology, Rotterdam (Netherlands); Kesselring, F.O.H.W. [Rijnstate Hospital, Department of Radiology, Arnhem (Netherlands); Hofmeijer, Jeannette [Rijnstate Hospital, Department of Neurology, Arnhem (Netherlands); Lycklama a Nijeholt, Geert J. [Medical Center Haaglanden, Department of Radiology, The Hague (Netherlands); Boiten, Jelis [Medical Center Haaglanden, Department of Neurology, The Hague (Netherlands); Rooij, Willem Jan van [St. Elisabeth Hospital, Department of Radiology, Tilburg (Netherlands); Kort, Paul L.M. de [St. Elisabeth Hospital, Department of Neurology, Tilburg (Netherlands); Roos, Yvo B.W.E.M. [Academic Medical Center, Department of Neurology, Amsterdam (Netherlands); Meijer, Frederick J.A. [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands); Pleiter, C.C. [St. Franciscus Hospital, Department of Radiology, Rotterdam (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: Dutch acute stroke study (DUST) investigators

    2016-04-15

    We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R{sup 2} was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R{sup 2} = 0.58) was superior to patient characteristics and non-contrast CT alone (R{sup 2} = 0.44) and to addition of CTA alone (R{sup 2} = 0.55) or CTP alone (R{sup 2} = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

  6. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

    International Nuclear Information System (INIS)

    We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. (orig.)

  7. Blink Reflex as a Complementary Test to MRI in Early Detection of Brainstem Infarctions: Comparison of Blink Reflex Abnormalities in Anterior Versus Posterior Circulation Strokes

    Directory of Open Access Journals (Sweden)

    K Basiri

    2004-08-01

    Full Text Available Background: Early detection of vertebro-basilar insufficiency is of paramount importance. Brain MRI was the only method of diagnosis for many years, but in addition to high cost and delay in report, it may not detect all brain stem lesions. In this study Blink reflex (BR was evaluated as a complementary test to MRI. Methods: Fifty-four patients were studied [27 anterior circulation stroke patients (ACSP and 27 posterior circulation stroke patients (PCSP]. MRI was performed within the first week after the onset of stroke. Nineteen age and sex matched healthy people enrolled as controls. BR was performed within the first 24 hours of the onset. Frequency of abnormal blink reflex in ACSP and PCSP was compared with MRI findings. Then abnormal responses in two groups were compared by chi-square test. Results: In both ACSP and PCSP, two patients had normal BR responses, and in 25 patients R1 or R2 components of blink responses were absent or prolonged (92.5%. R1was absent or delayed in 16 PCSP, but it was abnormal in only two ACSP (P < 0.001. Abnormal R2 responses were detected in 22 PCSP and 24 ACSP. Conclusion: BR abnormalities had high correlation with MRI findings in PCSP (92.5% BR can be performed within the first 24 hours of onset of stroke, and its results is available immediately. This test is easy to perform and comfortable for the patient, has low cost, and is available every where. Therefore we introduced BR as a complementary (but not replacing test to MRI in early detection of brainstem infarctions. Comparison of BR responses in ACSP and PCSP showed that abnormalities of R1 responses had high accuracy in differentiation between anterior and posterior circulation strokes. We concluded that BR responses not only can detect brainstem infarctions rapidly and readily in its early stages, but also can differentiate ACSP from PCSP with high accuracy. Keywords: Blink Reflex, Anterior Circulation Stroke, Posterior Circulation Stroke Patients

  8. Computer modelling of anterior circulation stroke: Proof of concept in Cerebrovascular Occlusion

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    THANH G PHAN

    2014-09-01

    Full Text Available Background: Current literature emphasizes the role of the Circle of Willis (CoW in salvaging ischemic brain tissue but not that of leptomeningeal anastomoses (LA. We developed a computational model of the cerebral circulation to 1 evaluate the roles of the CoW and LA in restoring flow to the superficial compartment of the middle cerebral artery territory and 2 estimate the size of the LA required to maintain flow above the critical ischemic threshold (>30% of baseline under simulated occlusion. Methods: Cerebral vasculature was modelled as a network of junctions connected by cylindrical pipes. The experiments included occlusion of successive distal branches of the intracranial arteries while the diameters of LA were varied. Results: The model showed that the region of reduced flow became progressively smaller as the site of occlusion was moved from the large proximal to the smaller distal arteries. There was no improvement in flow in the MCA territory when the diameters of the inter-territorial LA were varied from 0.0625 mm to 0.5 mm while keeping the intra-territorial LA constant. By contrast, the diameter of the inter-territorial LA needed to be greater than 1.0 mm in order to provide adequate (>30% flow to selected arteries in the occluded MCA territory. Conclusions: The CoW and inter-territorial LA together play important supportive roles in intracranial artery occlusion. Computational modelling provides the ability to experimentally investigate the effect of arterial occlusion on CoW and LA function.

  9. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    International Nuclear Information System (INIS)

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  10. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

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    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  11. Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery

    Science.gov (United States)

    Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-01-01

    We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke. PMID:27446523

  12. Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery.

    Science.gov (United States)

    Imahori, Taichiro; Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-07-01

    We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke. PMID:27446523

  13. Endovascular Mechanical Recanalisation After Intravenous Thrombolysis in Acute Anterior Circulation Stroke: The Impact of a New Temporary Stent

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    Fesl, Gunther, E-mail: gunther.fesl@med.uni-muenchen.de; Patzig, Maximilian; Holtmannspoetter, Markus [University of Munich, Department of Neuroradiology (Germany); Mayer, Thomas E. [University of Jena, Department of Neuroradiology (Germany); Pfefferkorn, Thomas; Opherk, Christian [University of Munich, Department of Neurology (Germany); Brueckmann, Hartmut [University of Munich, Department of Neuroradiology (Germany); Wiesmann, Martin [University Hospital, Department of Diagnostic and Interventional Neuroradiology (Germany)

    2012-12-15

    Purpose: Treatment of acute stroke by endovascular mechanical recanalisation (EMR) has shown promising results and continues to be further refined. We evaluated the impact of a temporary stent compared with our results using other mechanical devices. Materials and Methods: We analysed clinical and radiological data of all patients who were treated by EMR after intravenous thrombolysis for acute carotid T- and middle-cerebral artery (M1) occlusions at our centre between 2007 and 2011. A comparison was performed between those patients in whom solely the stent-retriever was applied (group S) and those treated with other devices (group C). Results: We identified 14 patients for group S and 16 patients for group C. Mean age, National Institute of Health Stroke Scale score, and time to treatment were 67.1 years and 16.5 and 4.0 h for group S and 61.1 years and 17.6 and 4.5 h for group C, respectively. Successful recanalisation (thrombolysis in cerebral infarction scores {>=}IIb) was achieved in 93% of patients in group S and 56% of patients in group C (P < 0.05). Mean recanalisation times for M1 occlusions were 23 min (group S) and 29 min (group C) and for carotid-T occlusions were 39 min (group S) and 50 min (group C), and 45% of the patients in group S and 33% in group C had a favourable outcome (Modified Rankin Scale score {<=}2). Conclusion: The findings suggest an improvement in recanalisation success by the application of a temporary stent compared with previously used devices. These results are to be confirmed by larger studies.

  14. Endovascular Mechanical Recanalisation After Intravenous Thrombolysis in Acute Anterior Circulation Stroke: The Impact of a New Temporary Stent

    International Nuclear Information System (INIS)

    Purpose: Treatment of acute stroke by endovascular mechanical recanalisation (EMR) has shown promising results and continues to be further refined. We evaluated the impact of a temporary stent compared with our results using other mechanical devices. Materials and Methods: We analysed clinical and radiological data of all patients who were treated by EMR after intravenous thrombolysis for acute carotid T– and middle-cerebral artery (M1) occlusions at our centre between 2007 and 2011. A comparison was performed between those patients in whom solely the stent-retriever was applied (group S) and those treated with other devices (group C). Results: We identified 14 patients for group S and 16 patients for group C. Mean age, National Institute of Health Stroke Scale score, and time to treatment were 67.1 years and 16.5 and 4.0 h for group S and 61.1 years and 17.6 and 4.5 h for group C, respectively. Successful recanalisation (thrombolysis in cerebral infarction scores ≥IIb) was achieved in 93% of patients in group S and 56% of patients in group C (P < 0.05). Mean recanalisation times for M1 occlusions were 23 min (group S) and 29 min (group C) and for carotid-T occlusions were 39 min (group S) and 50 min (group C), and 45% of the patients in group S and 33% in group C had a favourable outcome (Modified Rankin Scale score ≤2). Conclusion: The findings suggest an improvement in recanalisation success by the application of a temporary stent compared with previously used devices. These results are to be confirmed by larger studies.

  15. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis and Current Management

    Directory of Open Access Journals (Sweden)

    Amre eNouh

    2014-04-01

    Full Text Available Posterior circulation (PC strokes represent approximately 20% of all ischemic strokes. In contrast to the anterior circulation (AC several differences in presenting symptoms, clinical evaluation, diagnostic testing and management strategy exist which may present a challenge to the treating physician. This review will discuss the anatomical, etiological and clinical classification of PC strokes, identify diagnostic pitfalls and overview current therapeutic regimens.

  16. Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

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    Felipe Torres Pacheco

    2015-05-01

    Full Text Available Objective The potential of computed tomography angiography (CTA was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours. Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2% based on both clinical grounds and imaging follow-up (stroke group, with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86% while artery-to-artery embolization was the most common stroke mechanism (52%. Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

  17. Anticoagulation after anterior myocardial infarction and the risk of stroke.

    Directory of Open Access Journals (Sweden)

    Jacob A Udell

    Full Text Available BACKGROUND: Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulation therapy for the prevention of stroke after anterior MI. METHODS AND FINDINGS: We performed a population-based cohort analysis of 10,383 patients who survived hospitalization for an acute MI in Ontario, Canada from April 1, 1999 to March 31, 2001. The primary outcome was four-year ischemic stroke rates compared between anterior and non-anterior MI patients. Risk factors for stroke were assessed by multivariate Cox proportional-hazards analysis. Warfarin use was determined at discharge and followed for 90 days among a subset of patients aged 66 and older (n = 1483. Among the 10,383 patients studied, 2,942 patients survived hospitalization for an anterior MI and 20% were discharged on anticoagulation therapy. Within 4 years, 169 patients (5.7% were admitted with an ischemic stroke, half of which occurred within 1-year post-MI. There was no significant difference in stroke rate between anterior and non-anterior MI patients. The use of warfarin up to 90 days was not associated with stroke protection after anterior MI (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.37-1.26. The use of angiotensin-converting-enzyme inhibitors (HR, 0.65; 95% CI, 0.44-0.95 and beta-blockers (HR, 0.60; 95% CI, 0.41-0.87 were associated with a significant decrease in stroke risk. There was no significant difference in bleeding-related hospitalizations in patients who used warfarin for up to 90 days post-MI. CONCLUSION: Many practitioners still consider a large anterior-wall MI as high risk for potential LV thrombus formation and stroke. Among a cohort of elderly patients who survived an anterior

  18. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  19. Predictor′s analysis of anterior circulation cerebral infarction after the endovascular treatment of anterior communicating artery aneurysms

    Directory of Open Access Journals (Sweden)

    Liqian Sun

    2014-01-01

    Full Text Available Background: Despite increasing acceptance of endovascular coiling for treating anterior communicating artery (ACoA aneurysms, anterior circulation cerebral infarction (ACI after embolization remains a limitation. With higher incidence, higher morbidity and higher mortality, it is one of the main factors influencing the ACoA aneurysms prognosis. Determining the risk factors leading to ACI after embolization will have clinical significance. Through retrospective case analysis, this study investigated the risk factors related to ACI after embolization in order to provide information to serve the clinical practice. Materials and Methods: A retrospective review was performed of patients who had undergone coiling of ACoA aneurysms from 2008 to 2012. All patients had ruptured prior to the completion of embolization. Cases with acute stroke symptoms without alternative diagnoses after embolization were diagnosed as ACI. A total of 32 risk factors such as age, sex, hypertension, diabetes mellitus, modified Fisher grade, Hunt-Hess grade, ventricular hemorrhage, etc. were analyzed using univariate and logistic regression analysis. Results: Univariate analysis showed that negative fluid volume balance (P = 0.041 <0.05 and modified Fisher grade (P = 0.049 <0.05 reached statistical significance, suggesting that they might be risk factors for ACI after embolization. Multiple logistic regression analysis showed that modified Fisher grade was significantly associated with ACI after embolization, suggesting that it was an independent risk factor (odds ratios (OR: 4.968, 95% confidence intervals (CI: 1.013-24.360, P = 0.048. Conclusion: Modified Fisher grade is an independent risk factor for ACI after embolization.

  20. Whole brain CT perfusion in acute anterior circulation ischemia: coverage size matters

    International Nuclear Information System (INIS)

    Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice. In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level. Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10 % as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4 % for the 8-cm, 7 % for the 4-cm, and 13 % for the 3-cm coverage size. This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage. (orig.)

  1. Whole brain CT perfusion in acute anterior circulation ischemia: coverage size matters

    Energy Technology Data Exchange (ETDEWEB)

    Emmer, B.J. [Erasmus Medical Centre, Department of Radiology, Postbus 2040, Rotterdam (Netherlands); Rijkee, M.; Walderveen, M.A.A. van [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Niesten, J.M.; Velthuis, B.K. [University Medical Centre Utrecht, Department of Radiology, Utrecht (Netherlands); Wermer, M.J.H. [Leiden University Medical Centre, Department of Neurology, Leiden (Netherlands)

    2014-12-15

    Our aim was to compare infarct core volume on whole brain CT perfusion (CTP) with several limited coverage sizes (i.e., 3, 4, 6, and 8 cm), as currently used in routine clinical practice. In total, 40 acute ischemic stroke patients with non-contrast CT (NCCT) and CTP imaging of anterior circulation ischemia were included. Imaging was performed using a 320-multislice CT. Average volumes of infarct core of all simulated partial coverage sizes were calculated. Infarct core volume of each partial brain coverage was compared with infarct core volume of whole brain coverage and expressed using a percentage. To determine the optimal starting position for each simulated CTP coverage, the percentage of infarct coverage was calculated for every possible starting position of the simulated partial coverage in relation to Alberta Stroke Program Early CT Score in Acute Stroke Triage (ASPECTS 1) level. Whole brain CTP coverage further increased the percentage of infarct core volume depicted by 10 % as compared to the 8-cm coverage when the bottom slice was positioned at the ASPECTS 1 level. Optimization of the position of the region of interest (ROI) in 3 cm, 4 cm, and 8 cm improved the percentage of infarct depicted by 4 % for the 8-cm, 7 % for the 4-cm, and 13 % for the 3-cm coverage size. This study shows that whole brain CTP is the optimal coverage for CTP with a substantial improvement in accuracy in quantifying infarct core size. In addition, our results suggest that the optimal position of the ROI in limited coverage depends on the size of the coverage. (orig.)

  2. Early surgery of ruptured anterior circulation aneurysm based on multislice helical computerised tomography angiography.

    Science.gov (United States)

    Hui, Ma; Dong, Wang Xiao; Ciceri, E; Marras, C; Tao, Sun; Chun, Xia He; Zheng, Li Zong; Fang, Li Guo

    2007-12-01

    The purpose of this study is to evaluate the utility of three-dimensional computed tomographic angiography (3D-CTA) as the primary diagnostic investigation in patients with spontaneous subarachnoid haemorrhage (SAH) from anterior circulation aneurysms, and to correlate the results with digital subtraction angiography (DSA) and intraoperative findings. From May 2005 to May 2007 a total of 38 consecutive patients admitted for SAH, suspicious for ruptured anterior circulation cerebral aneurysm, underwent 3D-CTA. Inclusion criteria were a SAH confirmed by a non-contrast head computed tomographic scan or by lumbar puncture. Exclusion criteria were: previous DSA, severe contrast medium allergy and severe renal failure. All patients underwent early surgical clipping of the aneurysm. The mean time between SAH onset and surgery was 43.6 h (range, 14-74 h). The 3D-CTA was performed in all cases; and in 13 out of 38 patients (34%) represented the only preoperative exam. In all patients that underwent surgery with the sole 3D-CTA, the images collected allowed a good visualisation of the morphology of aneurysms and of the anatomical relationship with the vascular structures. 3D-CTA allows accurate diagnosis with an excellent visualisation of ruptured aneurysms of the anterior circulation. Our results suggest that, in selected cases, ruptured anterior circulation aneurysms could be successfully treated on the basis of 3D-CTA alone. PMID:18175079

  3. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms.

    Science.gov (United States)

    Figueiredo, Eberval Gadelha; Welling, Leonardo C; Preul, Mark C; Sakaya, Gabriel Reis; Neville, Iuri; Spetzler, Robert F; Teixeira, Manoel Jacobsen

    2016-05-01

    The pterional approach was described in the 1970s and has become the most utilized cranial approach with many variations described, including the minipterional technique. Although described recently as an alternative to the pterional approach for anterior circulation aneurysms, to our knowledge a large series of cases using the minipterional approach in both ruptured and unruptured aneurysms has not been described. We present our clinical experience with the minipterional craniotomy in more than 100 ruptured and unruptured anterior circulation aneurysms. The results of 86 consecutive patients with 102 ruptured non-giant, anterior circulation aneurysms treated with early surgery utilizing the minipterional craniotomy were analyzed. Postoperative angiography was carried out in all cases. Outcome results were classified as excellent in 67 (77.9%), and good in seven (8.1%), while 16 (13.9%) patients died. The minipterional technique provides adequate surgical exposure and excellent outcomes for both ruptured and unruptured anterior circulation aneurysm clipping. It constitutes a safe and effective alternative to the pterional approach, with equivalent or potentially better aesthetic and functional outcomes. PMID:26924181

  4. Transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study

    Science.gov (United States)

    Paul, Nicola LM; Simoni, Michela; Rothwell, Peter M

    2013-01-01

    Summary Background Transient isolated brainstem symptoms (eg, isolated vertigo, dysarthria, diplopia) are not consistently classified as transient ischaemic attacks (TIAs) and data for prognosis are limited. If some of these transient neurological attacks (TNAs) are due to vertebrobasilar ischaemia, then they should be common during the days and weeks preceding posterior circulation strokes. We aimed to assess the frequency of TNAs before vertebrobasilar ischaemic stroke. Methods We studied all potential ischaemic events during the 90 days preceding an ischaemic stroke in patients ascertained within a prospective, population-based incidence study in Oxfordshire, UK (Oxford Vascular Study; 2002–2010) and compared rates of TNA preceding vertebrobasilar stroke versus carotid stroke. We classified the brainstem symptoms isolated vertigo, vertigo with non-focal symptoms, isolated double vision, transient generalised weakness, and binocular visual disturbance as TNAs in the vertebrobasilar territory; atypical amaurosis fugax and limb-shaking as TNAs in the carotid territory; and isolated slurred speech, migraine variants, transient confusion, and hemisensory tingling symptoms as TNAs in uncertain territory. Findings Of the 1141 patients with ischaemic stroke, vascular territory was categorisable in 1034 (91%) cases, with 275 vertebrobasilar strokes and 759 carotid strokes. Isolated brainstem TNAs were more frequent before a vertebrobasilar stroke (45 of 275 events) than before a carotid stroke (10 of 759; OR 14·7, 95% CI 7·3–29·5, p<0·0001), particularly during the preceding 2 days (22 of 252 before a vertebrobasilar stroke vs two of 751 before a carotid stroke, OR 35·8, 8·4–153·5, p<0·0001). Of all 59 TNAs preceding (median 4 days, IQR 1–30) vertebrobasilar stroke, only five (8%) fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) criteria for TIA. The other 54 cases were isolated vertigo (n=23), non-NINDS binocular visual

  5. Circulating Endothelial Progenitor Cells and the Risk of Vascular Events after Ischemic Stroke

    Science.gov (United States)

    Martí-Fàbregas, Joan; Delgado-Mederos, Raquel; Crespo, Javier; Peña, Esther; Marín, Rebeca; Jiménez-Xarrié, Elena; Fernández-Arcos, Ana; Pérez-Pérez, Jesús; Martínez-Domeño, Alejandro; Camps-Renom, Pol; Prats-Sánchez, Luís; Casoni, Francesca; Badimon, Lina

    2015-01-01

    Background and Purpose We evaluated the hypothesis that the number of circulating EPC could be associated with the risk of stroke recurrence (SR) or vascular events (VE) after an ischemic stroke. Methods We studied prospectively consecutive patients with cerebral infarction within the first 48 hours after the onset. We recorded demographic factors, vascular risk factors, previous Rankin scale (RS) score, and etiology. We analyzed EPC counts by flow cytometry in blood collected at day 7 and defined EPC as CD34+/CD133+/KDR+ cells. Mean follow-up was 29.3 ± 16 months. We evaluated SR as well as VE. Patients were classified as to the presence or absence of EPC in the circulation (either EPC+ or EPC-). Bivariate analyses, Kaplan-Meier survival curves and Cox regression models were used. Results We included 121 patients (mean age 70.1±12.6 years; 65% were men). The percentage of EPC+ patients was 47.1%. SR occurred in 12 (9.9%) and VE in 18 (14.9%) patients. SR was associated significantly with a worse prior RS score, previous stroke and etiology, but not with EPC count. VE were associated significantly with EPC-, worse prior RS score, previous stroke, high age, peripheral artery disease and etiology. Cox regression model showed that EPC- (HR 7.07, p=0.003), age (HR 1.08, p=0.004) and a worse prior RS score (HR 5.8, p=0.004) were associated significantly with an increased risk of VE. Conclusions The absence of circulating EPC is not associated with the risk of stroke recurrence, but is associated with an increased risk of future vascular events. PMID:25874380

  6. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Science.gov (United States)

    Iwasawa, Eri; Ichijo, Masahiko; Ishibashi, Satoru; Yokota, Takanori

    2016-01-01

    In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress, which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1, which is a known shear-stress mechanosensing protein. PMID:27127459

  7. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Eri Iwasawa

    2016-01-01

    Full Text Available In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress, which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1, which is a known shear-stress mechanosensing protein.

  8. Acute development of collateral circulation and therapeutic prospects in ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Eri Iwasawa; Masahiko Ichijo; Satoru Ishibashi; Takanori Yokota

    2016-01-01

    In acute ischemic stroke, collateral circulation plays an important role in maintaining blood lfow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate with-out hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by lfuid shear stress, which occurs be-tween the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate recep-tor 1, which is a known shear-stress mechanosensing protein.

  9. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  10. Bilateral Anterior Opercular Syndrome With Partial Kluver-Bucy Syndrome in a Stroke Patient: A Case Report.

    Science.gov (United States)

    Cho, Ah-Ra; Lim, Young-Ho; Chung, Sae-Hoon; Choi, Eun-Hi; Lim, Jong Youb

    2016-06-01

    Bilateral anterior opercular syndrome and partial Kluver-Bucy syndrome are associated with bilateral middle cerebral artery lesions. The combination of these two syndromes has only been reported in a child with limbic encephalitis. In this case, a 44-year-old woman with bilateral middle cerebral artery infarction, which occurred 2 years prior, could walk independently. However, she showed automatic-voluntary dissociation and anarthria with preserved writing skills. She also presented hypersexuality, hypermetamorphosis, and memory disturbances. Here, we report a case of an adult stroke patient who suffered from bilateral anterior opercular syndrome accompanied by partial Kluver-Bucy syndrome. PMID:27446793

  11. Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    Shou-sen WANG

    2012-05-01

    Full Text Available Objective  To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods  A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results  VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions  The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.

  12. Stroke

    Science.gov (United States)

    ... to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is ... rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment ...

  13. Intracranial carotid calcification on cranial computed tomography: visual scoring methods, semiautomated scores, and volume measurements in patients with stroke

    OpenAIRE

    Subedi, Deepak; Zishan, U.M.; Chappell, Francesca; Gregoriades, M.L.; Sudlow, Catherine; Sellar, Robin; Wardlaw, Joanna

    2015-01-01

    Background and Purpose—Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods—We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cr...

  14. Impaired executive functioning after left anterior insular stroke: a case report.

    Science.gov (United States)

    Markostamou, Ioanna; Rudolf, Jobst; Tsiptsios, Iakovos; Kosmidis, Mary H

    2015-01-01

    Given the insular's anatomic complexity and functional interconnectivity, acute lesions may result in varied clinical presentations, including autonomic, somatosensory, perceptual, motor, affective, and cognitive deficits. Although functional neuroimaging studies have demonstrated its role in executive functions, no clinical manifestations have been reported to date. We present the case of a woman with an acute left anterior insular infarction leading to executive (i.e., word and design fluency, mental flexibility, sustained attention, inhibitory control), but not language, visuoperceptual, or memory impairment. This case confirms the left anterior insula's involvement in executive functioning and suggests that an infarction may result in executive impairment. PMID:25537237

  15. Associations of Circulating Growth Differentiation Factor-15 and ST2 Concentrations With Subclinical Vascular Brain Injury and Incident Stroke

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Preis, Sarah R; Beiser, Alexa;

    2015-01-01

    Framingham Offspring cohort. METHODS: We followed 3374 stroke- and dementia-free individuals (mean age, 59.0±9.7 years; 53% women) attending the Framingham Offspring sixth examination cycle 11.8±3.0 years for incident stroke. A subsample of 2463 individuals underwent brain magnetic resonance imaging and...... remained significantly associated with stroke/transient ischemic attack, hazard ratio for Q4 versus Q1 of 1.76, 95% confidence interval of 1.06 to 2.92, and P=0.03. CONCLUSIONS: Circulating GDF-15 and sST2 are associated with subclinical brain injury and cognitive impairment. Higher sST2 concentrations are...

  16. Stroke

    Science.gov (United States)

    ... include: Change in alertness (including sleepiness, unconsciousness, and coma) Changes in hearing or taste Changes that affect ... or prevent more strokes Nutrients and fluids Physical therapy, occupational therapy, speech therapy, and swallowing therapy will ...

  17. Stroke

    International Nuclear Information System (INIS)

    The advent of computed tomography (CT) in the early 1970s greatly facilitated the diagnosis and management of stroke and added significantly to our understanding of the pathophysiologic brain alterations it causes in humans. With CT it is now possible for the first time to noninvasively and reliably diagnose and distinguish between stroke resulting from cerebral infraction and that resulting from cerebral hemorrhage. In addition, other brain lesions that at times may clinically present as stroke-like syndromes, such as primary or metastatic brain tumor, brain abscess, or subdural hematoma, can usually be clearly differentiated by the CT examination. In most instances it is no longer necessary to perform cerebral angiography to exclude a possible surgical lesion in patients in whom the clinical diagnosis of stroke may have been in doubt

  18. Supplementary Motor Complex and Disturbed Motor Control – a Retrospective Clinical and Lesion Analysis of Patients after Anterior Cerebral Artery Stroke

    OpenAIRE

    Brugger, Florian; Galovic, Marian; Weder, Bruno J.; Kägi, Georg

    2015-01-01

    Background Both the supplementary motor complex (SMC), consisting of the supplementary motor area (SMA) proper, the pre-SMA, and the supplementary eye field, and the rostral cingulate cortex are supplied by the anterior cerebral artery (ACA) and are involved in higher motor control. The Bereitschaftspotential (BP) originates from the SMC and reflects cognitive preparation processes before volitional movements. ACA strokes may lead to impaired motor control in the absence of limb weakness a...

  19. Demethylation of Circulating Estrogen Receptor Alpha Gene in Cerebral Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Hsiu-Fen Lin

    Full Text Available Estrogen is involved in neuron plasticity and can promote neuronal survival in stroke. Its actions are mostly exerted via estrogen receptor alpha (ERα. Previous animal studies have shown that ERα is upregulated by DNA demethylation following ischemic injury. This study investigated the methylation levels in the ERα promoter in the peripheral blood of ischemic stroke patients.The study included 201 ischemic stroke patients, and 217 age- and sex-comparable healthy controls. The quantitative methylation level in the 14 CpG sites of the ERα promoter was measured by pyrosequencing in each participant. Multivariate regression model was used to adjust for stroke traditional risk factors. Stroke subtypes and sex-specific analysis were also conducted.The results demonstrated that the stroke cases had a lower ERα methylation level than controls in all 14 CpG sites, and site 13 and site 14 had significant adjusted p-values of 0.035 and 0.026, respectively. Stroke subtypes analysis showed that large-artery atherosclerosis and cardio-embolic subtypes had significantly lower methylation levels than the healthy controls at CpG site 5, site 9, site 12, site 13 and site 14 with adjusted p = 0.039, 0.009, 0.025, 0.046 and 0.027 respectively. However, the methylation level for the patients with small vessel subtype was not significant. We combined the methylation data from the above five sites for further sex-specific analysis. The results showed that the significant association only existed in women (adjusted p = 0.011, but not in men (adjusted p = 0.300.Female stroke cases have lower ERα methylation levels than those in the controls, especially in large-artery and cardio-embolic stroke subtypes. The study implies that women suffering from ischemic stroke of specific subtype may undergo different protective mechanisms to reduce the brain injury.

  20. Computed tomography perfusion imaging may predict cognitive impairment in patients with first-time anterior circulation transient ischemic attack.

    Science.gov (United States)

    Wang, Jun; Li, Yunming; Zheng, Bo; Wang, Jian; Wang, Zhiqiang; Duan, Dan; Li, Yuxia; Wang, Qingsong

    2016-04-01

    To determine whether computed tomography perfusion imaging (CTPI)-derived parameters are associated with vascular cognitive impairment (VCI) in patients with transient ischemic attack (TIA). Patients with first-time anterior circulation TIA (diagnosed within 24 h of onset) and normal cognition, treated between August 2009 and August 2014 at the Department of Neurology of Chengdu Military General Hospital, China, were analyzed retrospectively. Patients underwent whole-brain CTPI within 1 week of TIA to detect cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) in the ischemic region. Based on cognitive function assessment 4 weeks after TIA, using the Montreal cognitive assessment (MoCA) and mini mental state examination, the patients were divided into control and VCI groups. CTPI parameters and other clinical data were compared between groups, and Spearman's correlation analysis used to identify associations between cognitive scores and CTPI parameters in the VCI group. 50 patients (25 per group; aged 55-72 years) were included. Patient age, gender, smoking status, alcohol consumption, educational level, time from TIA onset to admission, time from TIA onset to CTPI, and prevalence of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and hyperhomocysteinemia did not differ between groups. Both groups showed TTP and MTT prolongation, CBF reduction, but no change in CBV in the ischemic region; these changes were significantly larger in the VCI group (P < 0.05). MTT correlated negatively with MoCA score (r = -0.51, P = 0.009). CTPI could facilitate early diagnosis of VCI in patients with anterior circulation TIA. PMID:26721459

  1. Evolving Treatments for Acute Ischemic Stroke.

    Science.gov (United States)

    Zerna, Charlotte; Hegedus, Janka; Hill, Michael D

    2016-04-29

    The purpose of this article is to review advances in stroke treatment in the hyperacute period. With recent evolutions of technology in the fields of imaging, thrombectomy devices, and emergency room workflow management, as well as improvement in statistical methods and study design, there have been ground breaking changes in the treatment of acute ischemic stroke. We describe how stroke presents as a clinical syndrome and how imaging as the most important biomarker will help differentiate between stroke subtypes and treatment eligibility. The evolution of hyperacute treatment has led to the current standard of care: intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation. All patients with acute ischemic stroke are in need of hyperacute secondary prevention because the risk of recurrence is highest closest to the index event. The dominant themes of modern stroke care are the use of neurovascular imaging and speed of diagnosis and treatment. PMID:27126651

  2. Aldosterone and the mineralocorticoid receptor in the cerebral circulation and stroke

    Directory of Open Access Journals (Sweden)

    Dinh Quynh N

    2012-10-01

    Full Text Available Abstract Ischemic stroke is a leading cause of morbidity and mortality worldwide. Elevated plasma aldosterone levels are an independent cardiovascular risk factor and are thought to contribute to hypertension, a major risk factor for stroke. Evidence from both experimental and human studies supports a role for aldosterone and/or the mineralocorticoid receptor (MR in contributing to detrimental effects in the cerebral vasculature and to the incidence and outcome of ischemic stroke. This article reviews the evidence, including the protective effects of MR antagonism. Specifically, the effects of aldosterone and/or MR activation on cerebral vascular structure and on immune cells will be reviewed. The existing evidence suggests that aldosterone and the MR contribute to cerebral vascular pathology and to the incidence and outcome of stroke. We suggest that further research into the signaling mechanisms underlying the effects of aldosterone and MR activation in the brain and its vasculature, especially with regard to cell-specific actions, will provide important insight into causes and potential treatments for cerebrovascular disease and stroke.

  3. Fetal Circulation

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Fetal Circulation Updated:Jul 8,2016 click to enlarge The ... fetal heart. These two bypass pathways in the fetal circulation make it possible for most fetuses to survive ...

  4. A study on regional cerebral circulation in stroke patients with aphasia

    International Nuclear Information System (INIS)

    To study the pathophysiology of aphasia due to cerebral stroke, regional cerebral blood flow (rCBF) was measured by the 133Xe clearance method and the volume of low density area (LDA) was estimated on the basis of computerized tomography in 43 thrombotic (24 aphasia and 19 non-aphasia), 30 hemorrhagic (16 aphasia and 14 non-aphasia) and 6 non-stroke cases. 1) In the healthy hemisphere, rCBF showed no significant difference between aphasia and non-aphasia in both thrombotic and hemorrhagic cases. In the affected hemisphere, thrombotic cases showed significantly decreased rCBF in aphasic cases as compared to non-aphasic, however, hemorrhagic cases revealed no difference. 2) LDA volume showed no significant difference between aphasia and non-aphasia in cerebral thrombosis, however, LDA volume in non-aphasia was smaller than that in aphasia in cerebral hemorrage. 3) Significant differences in the pathophysiology of aphasia due to cerebral stroke were recognized between cerebral thrombosis and cerebral hemorrhage. Such differences should be taken into consideration in the management and treatment of aphasia caused by cerebral stroke. (author)

  5. Airborne pollutants and lacunar stroke: a case cross-over analysis on stroke unit admissions.

    Science.gov (United States)

    Corea, Francesco; Silvestrelli, Giorgio; Baccarelli, Andrea; Giua, Alessandra; Previdi, Paolo; Siliprandi, Giorgio; Murgia, Nicola

    2012-06-14

    Particulate air pollution is known to be associated with cardiovascular disease. The relation of particulate air pollution with cerebrovascular disease (CVD) has not been extensively studied, particularly in relation to different subtypes of stroke. A time-series study was conducted to evaluate the association between daily air pollution and acute stroke unit hospitalizations in Mantua, Italy. We analyzed 781 CVD consecutive patients living in Mantua county admitted between 2006-08. Data on stroke types, demographic variables, risk factors were available from the Lombardia Stroke Registry. Daily mean value of particulate matter with a diameter <10 µm (PM(10)), carbon monoxide, nitric oxide, nitrogen dioxide, sulphur dioxide, benzene and ozone were used in the analysis. The association between CVD, ischemic strokes subtypes and pollutants was investigated with a case-crossover design, using conditional logistic regression analysis, adjusting for temperature, humidity, barometric pressure and holidays. Among the 781 subjects admitted 75.7% had ischemic stroke, 11.7% haemorrhagic stroke 12.6% transient ischemic attack. In men admission for stroke was associated with PM(10) [odds ratio (OR) 1.01, 95%; confidence interval (CI) 1.00-1.02; P<0.05]. According to the clinical classification, lacunar anterior circulation syndrome stroke type was related to PM(10) level registered on the day of admission for both genders (OR: 1.01, 95%; CI: 1.00-1.02; P<0.05) while for total anterior circulation syndrome stroke only in men (OR: 1.04, 95%; CI 1.01-1.07; P<0.05).In conclusion, our study confirms that air pollution peaks may contribute to increase the risk of hospitalization for stroke and particulate matter seems to be a significant risk factor, especially for lacunar stroke. PMID:23139849

  6. Airborne pollutants and lacunar stroke: a case cross-over analysis on stroke unit admissions

    Directory of Open Access Journals (Sweden)

    Francesco Corea

    2012-08-01

    Full Text Available Particulate air pollution is known to be associated with cardiovascular disease. The relation of particulate air pollution with cerebrovascular disease (CVD has not been extensively studied, particularly in relation to different subtypes of stroke. A time-series study was conducted to evaluate the association between daily air pollution and acute stroke unit hospitalizations in Mantua, Italy. We analyzed 781 CVD consecutive patients living in Mantua county admitted between 2006-08. Data on stroke types, demographic variables, risk factors were available from the Lombardia Stroke Registry. Daily mean value of particulate matter with a diameter <10 mm (PM10, carbon monoxide, nitric oxide, nitrogen dioxide, sulphur dioxide, benzene and ozone were used in the analysis. The association between CVD, ischemic strokes subtypes and pollutants was investigated with a case-crossover design, using conditional logistic regression analysis, adjusting for temperature, humidity, barometric pressure and holidays. Among the 781 subjects admitted 75.7% had ischemic stroke, 11.7% haemorrhagic stroke 12.6% transient ischemic attack. In men admission for stroke was associated with PM10 [odds ratio (OR 1.01, 95%; confidence interval (CI 1.00-1.02; P<0.05]. According to the clinical classification, lacunar anterior circulation syndrome stroke type was related to PM10 level registered on the day of admission for both genders (OR: 1.01, 95%; CI: 1.00-1.02; P<0.05 while for total anterior circulation syndrome stroke only in men (OR: 1.04, 95%; CI 1.01-1.07; P<0.05. In conclusion, our study confirms that air pollution peaks may contribute to increase the risk of hospitalization for stroke and particulate matter seems to be a significant risk factor, especially for lacunar stroke.

  7. Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report

    NARCIS (Netherlands)

    M.J.H.L. Mulder (Maxim J. H.); G.J. Lycklama à Nijeholt (Geert); W. Dinkelaar (Wouter); T.P.W. de Rooij (T. P W); A. Van Es (Acgm); B.F.W. van der Kallen (Bas); B.J. Emmer (Bart J.)

    2015-01-01

    textabstractWe describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomogr

  8. Diagnosis in stroke - an uptake

    International Nuclear Information System (INIS)

    In practical day-to-day terms, most patients have one of the common causes of stroke: ischemic stroke caused by the complications of atherothrombosis, intracranial small vessel disease, embolism from the heart, primary intracerebral hemorrhage caused by hypertension, or subarachnoid hemorrhage as a result of a ruptured saccular aneurysm. There are three issues to be considered in assessing the reliability of the clinical diagnosis of stroke: the diagnosis of stroke itself: is it a stroke or not; whether the stroke is caused by an infarct or a hemorrhage and particular in ischemic stroke the site and size of the lesion (anterior vs. posterior circulation, lacunar vs. cortical, etc.). No clinical scoring method can differentiate with absolute reliability ischemic stroke from primary intracerebral hemorrhage. To do this brain computed tomography or magnetic resonance imaging is required. For vascular diagnosis ultrasound and magnetic resonance angiography are ideal and complementary non-invasive techniques. Both have no risks and are reasonably sensitive. Catheterangiography is only reserved for patients with subarachnoid hemorrhage with a view to surgical or endovascular treatment or in exceptional cases to establish a more firm prognosis. The diagnosis of ischemic stroke caused by embolism from the heart can only be considered at all if there is an identifiable cardioembolic source which is the case in about 30 % of ischemic stroke, a higher proportion in recent studies using transoesophageal echocardiography. It is not clear that transoesophageal echocardiography provides much more information for clinical decision-making than transthoracic echocardiography, although it certainly provides more anatomical information in selected patients. This article summarizes the diagnostic armamentarium which is used for the diagnosis of stroke and gives an overview of clinically reliable and relevant measures. Refs. 23 (author)

  9. Spatial localization and distribution of the TMS-related 'hotspot' of the tibialis anterior muscle representation in the healthy and post-stroke motor cortex.

    Science.gov (United States)

    Sivaramakrishnan, Anjali; Tahara-Eckl, Lenore; Madhavan, Sangeetha

    2016-08-01

    Transcranial magnetic stimulation (TMS) is a type of noninvasive brain stimulation used to study corticomotor excitability of the intact and injured brain. Identification of muscle representations in the motor cortex is typically done using a procedure called 'hotspotting', which involves establishing the optimal location on the scalp that evokes a maximum TMS response with minimum stimulator intensity. The purpose of this study was to report the hotspot locations for the tibialis anterior (TA) muscle representation in the motor cortex of healthy and post stroke individuals. A retrospective data analyses from 42 stroke participants and 32 healthy participants was conducted for reporting TMS hotspot locations and their spatial patterns. Single pulse TMS, using a 110mm double cone coil, was used to identify the motor representation of the TA. The hotspot locations were represented as x and y-distances from the vertex for each participant. The mediolateral extent of the loci from the vertex (x-coordinate) and anteroposterior extent of the loci from the vertex (y-coordinate) was reported for each hemisphere: non-lesioned (XNLes, YNLes), lesioned (XLes, YLes) and healthy (XH, YH). We found that the mean hotspot loci for TA muscle from the vertex were approximately: 1.29cm lateral and 0.55cm posterior in the non-lesioned hemisphere, 1.25cm lateral and 0.5cm posterior in the lesioned hemisphere and 1.6cm lateral and 0.8cm posterior in the healthy brain. There was no significant difference in the x- and y-coordinates between the lesioned and non-lesioned hemispheres. However, the locations of the XNLes (p=0.01) and XLes (p=0.004) were significantly different from XH. The YNLes and YLes showed no significant differences from YH loci. Analyses of spatial clustering patterns using the Moran's I index showed a negative autocorrelation in stroke participants (NLes: Moran's I=-0.09, p<0.001; Les: Moran's I=-0.14, p=0.002), and a positive autocorrelation in healthy participants

  10. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.)

  11. Experimental microangiography for measuring cerebral blood circulation following local cold stroke

    International Nuclear Information System (INIS)

    In 54 female Wistar rats the exposed brain was right-parietally traumatised; cerebral perfusion of two anatomically different brain sections was angiographically imaged and densitometrically evaluated at various instants. The observation period ranged between 1 and 168 hours after the local cold stroke had been applied. Whereas in the telencephal section situated beyond the direct zone of lesion a maximum perfusion difference between the two hemispheres occurred already 1 hour after the animal had been traumatised, a maximum of perfusion difference was observed 6 hours after traumatisation in the diencephalic section situated directly across the site of the cold lesion. Within the first posttraumatic hours the total cerebral perfusion rapidly decreased. The minimum was reached 24 hours after traumatisation. Then it increased again and on the 7th posttraumatic day the perfusion level reached that of the control group. The tendencies of perfusion behaviour differing from one another, which were observed in both hemispheres, followed the course of the total perfusion. The decrease of perfusion occurring during the first hours after traumatisation is provoked by the compressive effect due to the expanding edema. This is principally indicated by the acute hyperperfusion during the first hours to be observed in the telencephalic section. The different velocities at which the hemispheres recover in the diencephalic section must be attributed to metabolic and hypoxic components. The incomplete recovery of perfusion in the injured hemisphere after 7 days may be due to the glial reaction. (orig./MG)

  12. Thrombectomy in posterior circulation stroke through persistent primitive trigeminal artery: A case report.

    Science.gov (United States)

    Mulder, Mjhl; Lycklama À Nijeholt, G J; Dinkelaar, W; de Rooij, Tpw; van Es, Acgm; van der Kallen, B F; Emmer, B J

    2015-12-01

    We describe a case of intra-arterial treatment (IAT) of acute posterior circulation occlusion in a patient with a persistent primitive trigeminal artery (PPTA). The patient presented with an acute left sided hemiparesis and loss of consciousness (Glasgow coma score of 5). Computed tomography angiography showed an acute occlusion of the right internal carotid artery (ICA), the PPTA, distal basilar artery (BA), right posterior cerebral artery (PCA), and right superior cerebellar artery (SCA). Stent-retriever assisted thrombectomy was not considered possible through the hypoplastic proximal BA. After passage of the proximal ICA occlusion, the right PCA and SCA were recanalized through the PPTA, with a single thrombectomy procedure. Ten days after intervention patient was discharged scoring optimal EMV with only a mild facial and left hand paresis remaining. PPTA is a persistent embryological carotid-basilar connection. Knowledge of existing (embryonic) variants in neurovascular anatomy is essential when planning and performing acute neurointerventional procedures. PMID:26464287

  13. Ischemic Stroke

    Science.gov (United States)

    ... can help you. Learn more What Is Stroke? Hemorrhagic Stroke Ischemic Stroke What is TIA? Stroke Facts Recognizing ... Stroke Survey Faces of Stroke What is stroke? Hemorrhagic stroke Ischemic stroke What is TIA? Stroke facts I ...

  14. Distribution territories and causative mechanisms of ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A.; Grive, E.; Alvarez-Sabin, J. [Unidad de Resonancia Magnetica, Hospital Vall d' Hebron, Barcelona (Spain)

    2005-03-01

    Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests. (orig.)

  15. Circulating CD133+CD34+ progenitor cells inversely correlate with soluble ICAM-1 in early ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Frank Joseph

    2011-08-01

    Full Text Available Abstract Background and Purpose Both endothelial progenitor cells (EPC and markers of neuroinflammation are candidate biomarkers for stroke severity and outcome prediction. A relationship between EPC and neuroinflammatory markers in early stroke is not fully elucidated. The objectives were to investigate correlations between EPC and neuroinflammation markers (adhesion molecules ICAM-1, VCAM-1, E-selectin, tumor necrosis factor (TNF-α, interleukin (IL-6, endothelin (ET-1, markers of tissue injury (matrix metalloproteinases (MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP-1 in early stroke patients. Methods We prospectively recruited symptomatic patients with ischemic cerebrovascular disease. We assessed stroke severity by using of acute (diffusion-weighted imaging (DWI and final lesion volumes (fluid attenuated inversion recovery (FLAIR. We measured serum soluble ICAM-1, VCAM-1, E-selectin, MMP-9, TIMP-1 and plasma TNF-α, IL-6, ET-1 by ELISA, and quantified EPC in mononuclear fraction of peripheral blood on days 1 and 3 in 17 patients (mean(SD age 62(14, with admission National Institutes of Health Stroke Scale (NIHSS 10(8 selected from 175 patients with imaging confirmed ischemic stroke. Non-parametric statistics, univariate and multivariate analysis were used. Results Only ICAM-1 inversely correlated with EPC subset CD133+CD34+ on day 1 (Spearman r = -0.6, p Conclusion Our study showed that high ICAM-1 is associated with low CD133+CD34+subset of EPC. Biomarkers of neuroinflammation may predict tissue injury and stroke severity in early ischemia.

  16. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke

    DEFF Research Database (Denmark)

    Saver, Jeffrey L; Goyal, Mayank; Bonafe, Alain;

    2015-01-01

    BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addit......BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever......, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy...

  17. Endovascular treatment of tandem occlusions of the anterior cerebral circulation with solitaire FR thrombectomy system. Initial experience

    International Nuclear Information System (INIS)

    Purpose: The optimal treatment in the acute phase of cervical internal carotid occlusion associated with intracranial obstruction is a matter of debate. In this study, we report our experience using the Solitaire FR revascularization device and synchronous intravenous fibrinolysis. The distal occlusion was treated with Solitaire FR before the proximal one in all cases, a technique not reported so far in the literature. Methods: We examined all cases of tandem occlusion treated in our institution between November 2009 and November 2010. The proximal occlusion was treated using manual thromboaspiration in order to achieve intracranial recanalization as rapid as possible. When necessary, stenting was performed after the reconstitution of the intracranial vessel. Morphological and clinical results were recorded in the immediate post-operative phase and at the three-month follow-up. Clinical success was defined as a mRS at 3 months ≤2. Results: Four male and six female patients were treated (mean age 66 years). The cervical carotid was recanalized in all cases and the intracranial vessel (TICI ≥ 2b) in eight. Adverse events were recorded in four patients of which three were asymptomatic. These included two cases of subarachnoid hemorrhage, one case of traumatic dissection, and one case of fatal intra-cerebral hemorrhage seven days following the procedure. At the three-month follow-up a mRS ≤ 2 was observed in four patients. Conclusions: The described approach for the treatment of tandem occlusions is promising with regard to both morphological and clinical assessments and thus may be considered a valid tool in acute stroke.

  18. Endovascular treatment of tandem occlusions of the anterior cerebral circulation with solitaire FR thrombectomy system. Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Maldonado, Igor Lima, E-mail: imaldonado@terra.com.br [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Vendrell, Jean Francois, E-mail: jfvendrell@yahoo.fr [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France); Bonafe, Alain, E-mail: bonafeh@aol.com [Montpellier University Hospital, Department of Neuroradiology, Montpellier (France)

    2012-11-15

    Purpose: The optimal treatment in the acute phase of cervical internal carotid occlusion associated with intracranial obstruction is a matter of debate. In this study, we report our experience using the Solitaire FR revascularization device and synchronous intravenous fibrinolysis. The distal occlusion was treated with Solitaire FR before the proximal one in all cases, a technique not reported so far in the literature. Methods: We examined all cases of tandem occlusion treated in our institution between November 2009 and November 2010. The proximal occlusion was treated using manual thromboaspiration in order to achieve intracranial recanalization as rapid as possible. When necessary, stenting was performed after the reconstitution of the intracranial vessel. Morphological and clinical results were recorded in the immediate post-operative phase and at the three-month follow-up. Clinical success was defined as a mRS at 3 months {<=}2. Results: Four male and six female patients were treated (mean age 66 years). The cervical carotid was recanalized in all cases and the intracranial vessel (TICI {>=} 2b) in eight. Adverse events were recorded in four patients of which three were asymptomatic. These included two cases of subarachnoid hemorrhage, one case of traumatic dissection, and one case of fatal intra-cerebral hemorrhage seven days following the procedure. At the three-month follow-up a mRS {<=} 2 was observed in four patients. Conclusions: The described approach for the treatment of tandem occlusions is promising with regard to both morphological and clinical assessments and thus may be considered a valid tool in acute stroke.

  19. Is it important to classify ischaemic stroke?

    LENUS (Irish Health Repository)

    Iqbal, M

    2012-02-01

    Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total\\/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.

  20. Elevated Troponin Level with Negative Outcome Was Found in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Buse Hasırcı

    2013-01-01

    Full Text Available Background. Troponin increment is a highly sensitive and specific marker of myocardial necrosis. The reason of high troponin levels in acute stroke is not clear. The aim of this study was to identify the relationships between cardiac troponin-I (cTnI level and stroke. Methods. This study recruited 868 patients who were admitted to Istanbul Medeniyet University due to acute ischemic stroke, and the diagnosis was confirmed by diffusion magnetic resonance imaging. The patients with the causes increasing troponin level were excluded from the study. A total of 239 patients were finally included in the study. Clinics were evaluated by the modified Rankin Scale (mRS and the National Institutes of Health Stroke Scale (NIHSS. Results. Serum level of troponin was higher in ischemic stroke patients with anterior circulation involvement in comparison to posterior involvement or hemorrhagic stroke (. Higher troponin levels related to increased stroke scale scores at discharge in ischemic stroke (. The level of cTnI was correlated with stroke scale scores at both admission and discharge in posterior stroke patients (. Conclusion. cTnI is a highly specific and sensitive marker of myocardial damage, and its elevation was associated with more severe neurological deficits in acute ischemic stroke.

  1. Stroke in central nervous system infections

    Directory of Open Access Journals (Sweden)

    Carod-Artal Francisco

    2008-01-01

    Full Text Available Background: Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. Objective: To review the main infectious diseases associated with stroke. Discussion: Prevalence of stroke in HIV patients is around 1%. Pathogenic mechanisms include HIV vasculopathy, vasculitis, cardioembolism, acquired hypercoagulability, and the effect of opportunistic infections. Treatment with protease inhibitors has been associated with premature atherosclerotic vascular disease. Emerging viral infections that are associated with stroke include viral hemorrhagic fevers, Japanese encephalitis, dengue, and West Nile virus. Vasculitis involving perforating vessels of the brain is a cerebrovascular complication of tuberculous meningitis. Small, medium, and large arteries of the anterior circulation can be involved. A progressive intracranial arteriopathy after Leptospira interrogans infection has been described, which involves the large intracranial arteries. Cerebrovascular complications of mycosis are associated with large vessel vasculitis, direct vessel damage by invasion or embolization, and subarachnoid hemorrhage due to mycotic aneurysm rupture. Pathological findings of cerebral malaria include diffuse cerebral edema, perivascular ring hemorrhages, white matter necrosis, parenchyma petechial hemorrhages, occlusion of brain vessels, and sequestration of infected erythrocytes in cortical and perforating arteries. Stroke can occur in subarachnoid neurocysticercosis and the lesions in such cases consist mostly of deep lacunar infarctions resulting from endarteritis of small penetrating arteries. Cardiac arrhythmias, congestive heart failure, apical aneurysm, and mural thrombus are the conditions that predispose patients with American trypanosomiasis to cardioembolism. Gnathostoma spinigerum infestation is a cause of hemorrhagic stroke in Asia. Conclusion: Infectious and

  2. Pediatric Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... communicate with your child’s doctor. Symptoms of a Stroke Stroke is an injury to part of the ...

  3. Stroke Treatments

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke Stroke Treatments A stroke occurs when a vessel in ... Busting Clots to Save Lives Hemorrhagic Stroke Treatment Stroke Prevention The good news is that 80 percent ...

  4. Effects of whole- and partial-body irradiation on circulating anterior pituitary hormones and testosterone and the relationship of these hormones to drug-metabolizing enzymes in the liver

    International Nuclear Information System (INIS)

    Doses within the range of 850 to 1500 rad given to the whole body, head, or lower-trunk region of male rats cause a marked depression in the rate of oxidative demethylation of drugs in the liver endoplasmic reticulum, 3 to 4 days after the irradiation. The V/sub max/ of the enzyme system is depressed and the K/sub m/ increased. Irradiation to the whole body, head, or lower trunk also causes a fall in the circulating levels of testosterone and luteinizing hormone (LH) and the concentrations of these hormones are markedly reduced 3 to 4 days after the irradiation. Injections of testosterone or anterior pituitary extract effectively restore the activity of the liver enzyme system after irradiation of the head or lower trunk. It is concluded that whole-body irradiation causes inhibition of drug-metabolizing enzymes in the liver by a complex series of interrelated effects on the testis, anterior pituitary, and possibly the hypothalamus

  5. Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand to sit in post-stroke vs healthy subjects

    OpenAIRE

    Augusta Silva; Andreia S. P. Sousa; Rita Pinheiro; Joana Ferraz; João Manuel R. S. Tavares; Rubim Santos; Filipa Sousa

    2013-01-01

    Introduction: Sit-to-stand (SitTS) and stand-to-sit (StandTS) are very important functional tasks that become compromised in stroke patients. As in other voluntary movements, they require an adequate postural control (PC) involving the generation of anticipatory postural adjustments (APAs). In order to give clues for more efficient and directed rehabilitation programs, a deeper knowledge about APAs during challenging and daily life movements is essential. Purpose: To analyze the activation ti...

  6. Cervicoplastia anterior Anterior cervicoplasty

    Directory of Open Access Journals (Sweden)

    Lucas Gomes Patrocínio

    2004-10-01

    Full Text Available Muitos pacientes buscam correção estética da frouxidão da pele do pescoço, depósito de gordura na região submentoneana ou bandas de platisma. Em grande parte dos casos a ação medial, via cervicoplastia anterior é necessária. OBJETIVO: Demonstrar a casuística e avaliar os resultados e complicações com a técnica de cervicoplastia anterior no Serviço de Otorrinolaringologia da Universidade Federal de Uberlândia. FORMA DE ESTUDO: Relato de série. PACIENTES E MÉTODOS: Quarenta e dois pacientes, entre 39 e 65 anos de idade, sendo 40 (95,2% do sexo feminino e 2 (4,8% do masculino, foram submetidos a cervicoplastia anterior. Retrospectivamente foram avaliados resultados e complicações. RESULTADOS: Destes, 34 apresentaram resultados satisfatórios, 4 apresentaram déficit estético notado somente pelo cirurgião, 3 apresentaram déficit estético notado somente pelo paciente e 1 apresentou déficit estético necessitando cirurgia revisional. Ao estudo fotográfico, todos os pacientes apresentaram melhora do perfil cervical, redução das bandas de platisma e da frouxidão da pele, estabilização da musculatura cervical e acentuação do ângulo cervicomental, em graus variados. Houve complicação em 2 casos (discreto serohematoma e cicatriz um pouco alargada. CONCLUSÃO: A cervicoplastia, associada ou não à tração lateral pela ritidoplastia, é uma técnica que produz resultados satisfatórios na grande maioria dos casos.Many patients look for aesthetic correction of the laxity of neck skin, submandibular fat deposit or platisma bands. In a large part of the cases, medial action, through anterior cervicoplasty is necessary. AIM: To demonstrate the casuistic and to evaluate the results and complications with anterior cervicoplasty technique in the Otorhinolaryngology Service of the Federal University of Uberlândia. STUDY DESIGN: Serie report. PATIENTS AND METHODS: Forty-two patients, between 39 and 65 years of age, being 40 (95

  7. Stroke in pregnancy.

    Science.gov (United States)

    Feske, Steven K

    2007-11-01

    Although pregnancy-associated stroke is uncommon, the risk of stroke is greatly increased above the low baseline rate in young patients during late pregnancy and, even more so, during the puerperium. Stroke is a major contributor to the serious morbidity and mortality of pregnancy. The physiological hormonally mediated changes in circulation, vascular tissue structure, and coagulability, and the pathological state of pre-eclampsia-eclampsia contribute to this increased risk of stroke. Pregnancy-associated strokes are roughly evenly divided among hemorrhagic strokes, mainly from rupture of aneurysms and arteriovenous malformations (AVMs); ischemic strokes, mainly from late pregnancy and postpartum cerebral venous thrombosis; and strokes associated with pre-eclampsia-eclampsia, with a contribution from cardioembolism, especially in populations at risk from a high rate of underlying rheumatic valvular heart disease. Awareness of the types of stroke to expect during pregnancy will facilitate early diagnosis. This article discusses the pathogenesis of pregnancy-associated stroke, its epidemiology, and some diagnostic and therapeutic issues unique to pregnancy. PMID:17940923

  8. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

  9. Stroke - discharge

    Science.gov (United States)

    ... stroke - discharge; Brain bleeding - discharge; Brain hemorrhage - discharge; Stroke - hemorrhagic - discharge; Hemorrhagic cerebrovascular disease - discharge; Cerebrovascular accident - discharge

  10. Stroke Neurologist's Perspective on the New Endovascular Trials.

    Science.gov (United States)

    Grotta, James C; Hacke, Werner

    2015-06-01

    Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits--Intra-Arterial (EXTEND IA), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment Trial (SWIFT PRIME), and Randomized Trial of Revascularization With the Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) studies. We review the main results of these studies and how they inform stroke patient management going forward. The main take home points for neurologists are (1) intra-arterial thrombectomy is a potently effective treatment and should be offered to patients who have documented occlusion in the distal internal carotid or the proximal middle cerebral artery, have a relatively normal noncontrast head computed tomographic scan, severe neurological deficit, and can have intra-arterial thrombectomy within 6 hours of last seen normal; (2) benefits are clear in patients receiving r-tPA before intra-arterial thrombectomy; r-tPA should not be withheld if the patient meets criteria, and benefit in patients who do not receive r-tPA or have r-tPA exclusions requires further study; and (3) these favorable results occur when intra-arterial thrombectomy is performed in an endovascular stroke center by a coordinated multidisciplinary team that extends from the prehospital stage to the endovascular suite, minimizes time to recanalization, uses stent-retriever devices, and avoids general

  11. Machine learning for outcome prediction of acute ischemic stroke post intra-arterial therapy.

    Directory of Open Access Journals (Sweden)

    Hamed Asadi

    Full Text Available INTRODUCTION: Stroke is a major cause of death and disability. Accurately predicting stroke outcome from a set of predictive variables may identify high-risk patients and guide treatment approaches, leading to decreased morbidity. Logistic regression models allow for the identification and validation of predictive variables. However, advanced machine learning algorithms offer an alternative, in particular, for large-scale multi-institutional data, with the advantage of easily incorporating newly available data to improve prediction performance. Our aim was to design and compare different machine learning methods, capable of predicting the outcome of endovascular intervention in acute anterior circulation ischaemic stroke. METHOD: We conducted a retrospective study of a prospectively collected database of acute ischaemic stroke treated by endovascular intervention. Using SPSS®, MATLAB®, and Rapidminer®, classical statistics as well as artificial neural network and support vector algorithms were applied to design a supervised machine capable of classifying these predictors into potential good and poor outcomes. These algorithms were trained, validated and tested using randomly divided data. RESULTS: We included 107 consecutive acute anterior circulation ischaemic stroke patients treated by endovascular technique. Sixty-six were male and the mean age of 65.3. All the available demographic, procedural and clinical factors were included into the models. The final confusion matrix of the neural network, demonstrated an overall congruency of ∼ 80% between the target and output classes, with favourable receiving operative characteristics. However, after optimisation, the support vector machine had a relatively better performance, with a root mean squared error of 2.064 (SD: ± 0.408. DISCUSSION: We showed promising accuracy of outcome prediction, using supervised machine learning algorithms, with potential for incorporation of larger multicenter

  12. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lose because of ... damage. Rehabilitation can help them relearn those skills. Stroke can cause five types of disabilities: Paralysis or ...

  13. Hemorrhagic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  14. Preventing stroke

    Science.gov (United States)

    Stroke - prevention; CVA - prevention; cerebral vascular accident - prevention; TIA - prevention, transient ischemic attack - prevention ... A stroke occurs when the blood supply is cut off to any part of the brain. A stroke is ...

  15. Mechanical thrombectomy for ischaemic stroke: the first UK case series.

    Directory of Open Access Journals (Sweden)

    Nasar Ahmad

    Full Text Available BACKGROUND AND PURPOSE: Endovascular treatments have the potential to accelerate reperfusion in acute ischaemic stroke with large vessel occlusion. In the UK only a few stroke centres offer this interventional option. The University Hospital of North Staffordshire (UHNS has treated the largest number of cases in the UK. Results of the first 106 endovascular treatments (EVT are presented here. METHODS: All patients treated with EVT (intra-arterial thrombolysis (IAT, mechanical thrombectomy (MT or both, or an attempt at intervention for acute stroke at UHNS, Stoke-on-Trent, UK, were entered into a prospective register. Baseline demographic and clinical data, the National Institutes for Health Stroke Scale (NIHSS, imaging results including Thrombolysis in Cerebral Infarction (TICI score, and complications were recorded. Mortality, and modified Rankin score (mRS were assessed at 90 days. RESULTS: From December 2009 to January 2013 106 patients (mean age 64 years, median baseline NIHSS 18 were treated with EVT (thrombectomy ± IAT 83%, IAT alone 13%, neither 4%. Seventy-eight per cent of occlusions were in the anterior circulation. Intravenous bridging thrombolysis was performed in 81%. Revascularization was successful (TICI 2b/3 in 84%. The median time from stroke onset to the end of the procedure was 6 h 03 min. A good outcome (mRS ≤ 2 at 90 days was achieved in 48% with a mortality of 15%. Fatal or nonfatal symptomatic intracranial haemorrhage (sICH within 10 days occurred in 9%. The median length of stay was 14 days (31% discharged home ≤ 7 days. CONCLUSIONS: EVT led to good clinical outcomes in almost 50% of patients with severe strokes.

  16. Ischemic Stroke

    OpenAIRE

    Eleni Dokoutsidou; Konstantina Antoniou

    2009-01-01

    Stroke is currently the third leading cause of death, ranking after heart disease and cancer and causes 10% of deaths, worldwide.Aim: The aim of the present study was to review the literature about the types of stroke and the risk factors for ischemic stroke.The methodoly that was followed included bibliography review from the both the research and the review literature of Greek and international data base which referred to ischemic stroke.Results: Stroke, according to its’ underlying etio...

  17. Stent-assisted mechanical recanalization for the treatment of acute ischemic stroke

    International Nuclear Information System (INIS)

    Objective: to evaluate the safety and efficacy of stent-assisted mechanical recanalization technique in treating acute ischemic stroke. Methods: Stent-assisted mechanical recanalization procedure was carried out in 12 patients with acute ischemic stroke. The lesions were located at the anterior circulation in 10 cases and at posterior circulation in 2 cases. The clinical data were retrospectively analyzed. The technical success rate, the vascular recanalization, the occurrence of symptomatic intracranial hemorrhage, the clinical improvement and mortality were observed and evaluated. Results: The stent was successfully deployed in 11 patients (92%). After the treatment, different degrees of vascular recanalization were obtained in all patients. The complete (TIMI 3), partial (TIMI 2) and minor (TIMI 1) recanalization rate was 58.3% (7/12), 25% (3/12) and 8.3% (1/12), respectively. Postoperative symptomatic intracranial hemorrhage occurred in one patient (8.3%). Stroke-related death occurred in one patient (8.3%) and eight patients had their modified Rankin Score ≤ 2. Conclusion: For the treatment of acute ischemic stroke, stent-assisted mechanical recanalization technique is clinically feasible and safe with high vascular recanalization rate although further studies with larger sample to clarify its clinical usefulness are still needed. (authors)

  18. [Cerebellar stroke].

    Science.gov (United States)

    Paradowski, Michał; Zimny, Anna; Paradowski, Bogusław

    2015-01-01

    Cerebellar stroke belongs to a group of rare diseases of vascular origin. Cerebellum, supplied by three pairs of arteries (AICA, PICA, SCA) with many anastomoses between them is less susceptible for a stroke, especially ischemic one. Diagnosis of the stroke in this region is harder due to lower sensibility of commonly used CT of the head in case of stroke suspicion. The authors highlight clinical symptoms distinguishing between vascular territories or topographical locations of the stroke, diagnostic procedures, classical and surgical treatment, the most common misdiagnoses are also mentioned. The authors suggest a diagnostic and therapeutic algorithm development, including rtPA treatment criteria for ischemic cerebellar stroke. PMID:26181157

  19. Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Eleni Dokoutsidou

    2009-05-01

    Full Text Available Stroke is currently the third leading cause of death, ranking after heart disease and cancer and causes 10% of deaths, worldwide.Aim: The aim of the present study was to review the literature about the types of stroke and the risk factors for ischemic stroke.The methodoly that was followed included bibliography review from the both the research and the review literature of Greek and international data base which referred to ischemic stroke.Results: Stroke, according to its’ underlying etiology, can be classified into two major categories, ischemic and hemorrhagic. 20% of stroke are of hemorrhagic type, whereas 80% are of ischemic type. Although, ischemic stroke is the most common type, its’ etiology differs. Ischemic stroke is categorized in thrombotic, embolic, lacunar, unknown etiology, transient and due to systematic low blood pressure. In the literature is cited that risk factors for stroke are classified in non-modifiable and modifiable. Non-modifiable risk factors are age, gender, ethnicity and heredity. The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation. Other modifiable risk factors include high blood cholesterol levels, diabetes mellitus, cigarette smoking (active and passive, carotid artery stenosis, heavy alcohol consumption, drug abuse, lack of physical activity, obesity and unhealthy diet.Conclusions: As it is supported by published evidence, ischemic stroke is of higher incidence compared to hemorrhagic stroke. Risk factor modification remains as the principal aspect of care for ischemic stroke prevention.

  20. Challenges in the Anesthetic and Intensive Care Management of Acute Ischemic Stroke.

    Science.gov (United States)

    Kirkman, Matthew A; Lambden, Simon; Smith, Martin

    2016-07-01

    Acute ischemic stroke (AIS) is a devastating condition with high morbidity and mortality. In the past 2 decades, the treatment of AIS has been revolutionized by the introduction of several interventions supported by class I evidence-care on a stroke unit, intravenous tissue plasminogen activator within 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. There is new class I evidence also demonstrating benefits of endovascular therapy on functional outcomes in those with anterior circulation stroke. In addition, the importance of the careful management of key systemic physiological variables, including oxygenation, blood pressure, temperature, and serum glucose, has been appreciated. In line with this, the role of anesthesiologists and intensivists in managing AIS has increased. This review highlights the main challenges in the endovascular and intensive care management of AIS that, in part, result from the paucity of research focused on these areas. It also provides guidelines for the management of AIS based upon current evidence, and identifies areas for further research. PMID:26368664

  1. Stroke: Overview

    Science.gov (United States)

    ... NICHD Research Information Clinical Trials Resources and Publications Stroke: Overview Skip sharing on social media links Share this: Page Content Stroke is a leading cause of disability and death ...

  2. Know Stroke

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section Know Stroke Past Issues / Summer 2007 Table of Contents For ... D. Director, National Institute of Neurological Disorders and Stroke Photo courtesy of NIH/NINDS Welcome to this ...

  3. Stroke Rehabilitation

    Science.gov (United States)

    ... relearn skills they lose because of the damage. Rehabilitation can help them relearn those skills. Stroke can ... Problems with thinking and memory Emotional disturbances Stroke rehabilitation involves many kinds of health professionals. The goal ...

  4. Preventing stroke

    Science.gov (United States)

    Stroke - prevention; CVA - prevention; cerebral vascular accident - prevention; TIA - prevention, transient ischemic attack - prevention ... live a longer, healthier life. This is called preventive care. An important way to help prevent stroke ...

  5. Anterior tarsaltunnelsyndrom

    DEFF Research Database (Denmark)

    Miliam, Palle B; Basse, Peter N

    2009-01-01

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum of the ankle. It may be rare because it is underrecognized clinically.We present a case regarding a 29-year-old man, drummer, who for one and a half year experienced clinical...

  6. Imaging, Intervention, and Workflow in Acute Ischemic Stroke: The Calgary Approach.

    Science.gov (United States)

    Zerna, C; Assis, Z; d'Esterre, C D; Menon, B K; Goyal, M

    2016-06-01

    Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention. PMID:26659339

  7. Recovery After Stroke: Recurrent Stroke

    Science.gov (United States)

    ... who have had transient ischemic attacks (TIAs) or mini- strokes. TIAs are brief episodes of stroke-like ... exerts on blood vessel walls as your heart pumps. The second, diastolic blood pressure, is the measurement ...

  8. Basics of acute stroke treatment; Grundzuege der akuten Schlaganfalltherapie

    Energy Technology Data Exchange (ETDEWEB)

    Haass, A. [Neurologische Universitaetsklinik Homburg/Saar (Germany)

    2005-05-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O{sub 2} delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [German] Jeder akute Schlaganfall ist ein Notfall und muss sofort in einer spezialisierten Klinik, am besten einer Stroke Unit, behandelt werden. Die Stroke-Unit-Behandlung senkt den Behinderungsgrad und die Letalitaet um 30% staerker als die

  9. Distribution and natural course of intracranial vessel wall lesions in patients with ischemic stroke or TIA at 7.0 tesla MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kolk, Anja G. van der; Luijten, Peter R.; Hendrikse, Jeroen [University Medical Center Utrecht, Department of Radiology, Postbox 85500, Utrecht (Netherlands); Zwanenburg, Jaco J.M. [University Medical Center Utrecht, Department of Radiology, Postbox 85500, Utrecht (Netherlands); University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Brundel, Manon; Biessels, Geert Jan [University Medical Center Utrecht, Department of Neurology, Utrecht (Netherlands); Visser, Fredy [University Medical Center Utrecht, Department of Radiology, Postbox 85500, Utrecht (Netherlands); Philips Healthcare, Best (Netherlands)

    2015-06-01

    Previous studies using intracranial vessel wall MRI techniques showed that over 50 % of patients with ischemic stroke or TIA had one or more intracranial vessel wall lesions. In the current study, we assessed the preferential location of these lesions within the intracranial arterial tree and their potential changes over time in these patient groups. Forty-nine patients with ischemic stroke (n = 25) or TIA (n = 24) of the anterior cerebral circulation underwent 7.0 T MRI, including a T{sub 1}-weighted magnetization-preparation inversion recovery turbo-spin-echo (MPIR-TSE) sequence within one week and approximately one month after symptom onset. Intracranial vessel wall lesions were scored for multiple locations within the arterial tree and differences between one-week and one-month images. At baseline, 132 intracranial vessel wall lesions were found in 41 patients (84 %), located primarily in the anterior cerebral circulation (74 %), with a preferential location in the distal internal carotid artery and M1 and M2 segments of the middle cerebral artery. During follow-up, presence or enhancement patterns changed in 14 lesions (17 %). A large burden of intracranial vessel wall lesions was found in both the anterior and posterior cerebral circulation. Most lesions were found to be relatively stable, possibly indicating a more generalized atherosclerotic process. (orig.)

  10. 部分前循环脑梗死与遗忘型轻度认知功能损害患者认知功能的对比研究%The study on cognitive functions of patients with partial anterior circulation infarct and amnesic mild cognitive impairment

    Institute of Scientific and Technical Information of China (English)

    张美燕; 杨琼; 于欣; 刘娜; 樊东升; 王华丽

    2011-01-01

    目的 比较部分前循环脑梗死(partial anterior circulation infact,PACI)和遗忘型轻度认知损害(amnesic mild cognitive impairment,aMCI)患者的认知损害的特点.方法 选择29例符合牛津社区卒中项目(Oxford Community Stroke Droject,OCSP)分型的PACI患者,35例符合Petersen 诊断标准的aMCI患者,以及60例健康老年人为对照组,采用认知功能筛选测验-C2.1(Cognitive Ability Screening Instrument-C2.1,CASI)评定认知功能.结果 PACI组(86.28±12.04)和aMCI组(89.86±6.03)的CASI总分均比正常对照组(95.57±3.44)低,差异具有统计学意义[F(2)=8.547,P<0.05],而PACI组与aMCI组间无统计学差异.在CASI分领域方面,与对照组相比,PACI组在心算力(P=0.000)和定向力(P=0.021)两方面均较差;与aMCI组比较,PACI组的心算力(P=0.000)较aMCI组差,而短时记忆(P=0.016)和思维流畅性(P=0.005)方面则较好.aMCI组与对照组相比,在短时记忆(P=0.000)、抽象与判断能力(P=0.013)和思维流畅性(P=0.001)方面均较差.结论 PACI患者存在认知损害,尤其在心算力和定向力方面,与aMCI患者相比,可能更好地保留了执行功能,推测缺血性脑卒中与神经退行性变引起的认知损害可能涉及不同认知领域.%Objective Cerebral ischemia mcreases the risk of vasc:ular cognitive impairment. The study aimed to compare the cognitive function of patients with partial anterior circulation infarct ( PACI ) and amnesic mild cognitive impairment ( aMCI ). Methods Twenty-nine patients meeting the classification criteria of PACI by Oxford Community Stroke Project ( OCSP ), 35 individuals with aMCI by Petersen criteria. and 60 healthy elderly controls were enrolled in this prospective study. Cognitive functions were assessed by Cognitive Ability Screening Instrument-C2. I ( CASI ) within l month after diagnosis. The scores of nine cognitive domains in CASI and the total score of CASI were used for comparisons. Age , education and gender were entered

  11. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeromel, Miran, E-mail: miran.jeromel@gmail.com; Milosevic, Z. V., E-mail: zoran.milosevic@guest.arnes.si; Kocijancic, I. J., E-mail: igor.kocijancic@gmail.com; Lovric, D., E-mail: dimitrijlavric@yahoo.com [University Medical Centre Ljubljana, Clinical Institute of Radiology, Department for Diagnostic and Interventional Neuroradiology (Slovenia); Svigelj, V., E-mail: viktor.svigelj@gmail.com; Zvan, B., E-mail: bojana.zvan@guest.arnes.si [University Medical Centre Ljubljana, Division Vascular and Intensive Neurology, Department of Neurology (Slovenia)

    2013-04-15

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 {+-} 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5-19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS {<=}2) 30 days after stroke. Overall, significant neurological improvement ({>=}4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of {>=}4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  12. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    International Nuclear Information System (INIS)

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 ± 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5–19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS ≤2) 30 days after stroke. Overall, significant neurological improvement (≥4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of ≥4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  13. Relationship between serum high-sensitivity C-reactive protein and modified TOAST classification as well as OCSP subtypes in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hua-jun CHANG

    2014-10-01

    Full Text Available This paper aims to investigate the relationship between serum high-sensitivity C-reactive protein (hs-CRP level and modified TOAST classification as well as OCSP subtypes in patients with acute ischemic stroke. Serum hs-CRP was measured in 240 patients with acute ischemic stroke and 120 normal controls. All patients were classified according to modified TOAST classification and OCSP criteria. Serum hs-CRP levels in acute ischemic stroke group were significantly higher than those in normal control group [(13.68 ± 6.92 mg/L vs (3.98 ± 0.76 mg/L; t = 6.922, P = 0.002]. Among modified TOAST subtypes, the highest serum hs-CRP level was in cardioembolism (CE group [(16.82 ± 6.16 mg/L], followed by arterothrombosis (AT group [(15.17 ± 5.68 mg/L], stroke of undetermined etiology (SUD group [(10.06 ± 3.89 mg/L] and small artery disease (SAD group [(9.86 ± 3.75 mg/L, P = 0.027]. Among OCSP subtypes, the highest serum hs-CRP level was in total anterior circulation infarct (TACI group [(17.02 ± 6.98 mg/L], followed by posterior circulation infarct (POCI group [(15.91 ± 7.12 mg/L], partial anterior circulation infarct (PACI group [(12.83 ± 4.95 mg/L] and lacunar infarct (LACI group [(10.61 ± 5.73 mg/L, P = 0.005]. Serum hs-CRP levels are various in different modified TOAST and OCSP subtypes, which may reflect etiological and pathophysiological diversity of acute ischemic stroke, guide clinical treatment and help to predict prognosis. doi: 10.3969/j.issn.1672-6731.2014.10.013

  14. Mechanical thrombectomy with snare in patients with acute ischemic stroke

    International Nuclear Information System (INIS)

    We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died). According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS. (orig.)

  15. The Brine Shrimp's Butterfly Stroke

    CERN Document Server

    Johnson, Brennan; Dasi, Lakshmi Prasad

    2011-01-01

    We investigate the fluid dynamics of brine shrimp larvae swimming in this gallery of fluid motion video. Time resolved particle image velocimetry was performed using nano-particles as seeding material to measure the time dependent velocity and vorticity fields. The Reynolds number of the flow was roughly 8 and the Womerseley number (ratio of periodic forcing to viscous forcing) was about 5. Vorticity dynamics reveals the formation of a vortex ring structure at the tip of each arm at the beginning of the power stroke. This two vortex system evolves dramatically with time as the stroke progresses. The outer circulation is noted to weaken while the inner circulation strengthens over the power stroke. The gaining strength of the inner vortex correlates with the acceleration and forward movement of the larvae.

  16. Intravenous flat-detector CT angiography in acute ischemic stroke management

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, Raphael; Pistocchi, Silvia; Bartolini, Bruno; Piotin, Michel [Fondation Rothschild Hospital, Department of Interventional Neuroradiology, Paris (France); Babic, Drazenko [Philips Healthcare, Best (Netherlands); Obadia, Michael [Fondation Rothschild Hospital, Department of Neurology, Paris (France); Alamowitch, Sonia [APHP Hopital Tenon, Universite Paris VI, Department of Neurology, Paris (France)

    2012-04-15

    In the settings of stroke, a non-invasive high-resolution imaging modality to visualize the arterial intracranial circulation in the interventional lab is a helpful mean to plan the endovascular recanalization procedure. We report our initial experience with intravenously enhanced flat-detector CT (IV FDCT) technology in the detection of obstructed intracranial arteries. Fourteen consecutive patients elected for endovascular stroke therapy underwent IV FDCT. The scans were intravenously enhanced and acquired in accordance with the previously calculated bolus arrival time. Images were processed on a commercially available workstation for reconstructions and 3D manipulation. Occlusion level and clot length, the quality of collateral vessels, and the patency of anterior and posterior communicating arteries were assessed. IV FDCT was performed successfully in all the cases and allowed for clot location and length visualization, assessment of communicating arteries patency, and evaluation of vessel collateral grade. Information obtained from this technique was considered useful for patients treated by endovascular approach. Retrospective review of the images by two independent readers was considered accurate and reproducible. IV FDCT technology provided accurate delineation of obstructed vessel segments in acute ischemic stroke disease. It gave a significant help in the interventional strategy. This new technology available in the operating room might provide a valuable tool in emerging endovascular stroke therapy. (orig.)

  17. Cardioembolic stroke: An update on etiology, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Leary Megan

    2008-01-01

    Full Text Available Stroke and ischemic heart diseases are among the most common causes of death and disability throughout the world. Even more worrisome is the suggestion that stroke rates may further increase in certain developing nations. The purpose of this article is to review the particular subtype of stroke known as cardioembolic stroke. A cardioembolic stroke occurs when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. The etiology, clinical manifestations, diagnosis and management of cardioembolic stroke are reviewed.

  18. Patent Foramen Ovale: Stroke and Device Closure.

    Science.gov (United States)

    Suradi, Hussam S; Hijazi, Ziyad M

    2016-05-01

    Patent foramen ovale (PFO) is a common finding in healthy adults and has long been implicated in cryptogenic stroke. The pathogenesis is hypothesized to be caused by microemboli gaining access into the systemic circulation via a PFO. Proposed treatment options include medical therapy and/or PFO closure. Despite numerous studies and several randomized trials, much debate persists regarding the efficacy of this approach in reducing the risk of recurrent stroke in cryptogenic stroke patients. This article reviews the association between PFO and cryptogenic stroke, as well as current evidence for PFO device closure. PMID:27150171

  19. Ischemic Stroke.

    Science.gov (United States)

    Capriotti, Teri; Murphy, Teresa

    2016-05-01

    Each year, more than 795,000 people in the United States suffer a stroke and by 2030, it is estimated that 4% of the U.S. population will have had a stroke. Home healthcare clinicians will be increasingly called upon to assist stroke survivors and their caregivers adjust to disability and assist the survivor during their reintegration into the community. Therapeutic modalities are changing with advanced technology. Great strides are being made in the treatment of acute stroke; particularly endovascular interventions. More patients are surviving the acute stroke event and therefore will need to learn how to live with various degrees of disability. It is important for home healthcare clinicians to understand the process from acute event to medical stabilization, and from rehabilitation to long-term adaptation. PMID:27145407

  20. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders; Henriksen, Marius

    2014-01-01

    BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...... walking speed and clinical indices of spasticity in patients with stroke. METHODS: Thirty-two patients (9 women) receiving rehabilitation after stroke (average, 50 days since stroke) who had impaired walking ability were recruited. Primary outcome was maximal walking speed measured by the 10-meter walk......, although a trend was observed indicating a lesser degree of spasticity. CONCLUSION: The results of this study indicate that kinesthetic taping of the anterior thigh and knee provides an immediate improvement in walking function in patients with stroke. Such a positive effect on motor function could be a...

  1. Penumbra Stroke System as an ''add-on'' for the treatment of large vessel occlusive disease following thrombolysis: first results

    International Nuclear Information System (INIS)

    The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. (orig.)

  2. Post stroke dementia and Post stroke depression

    OpenAIRE

    Trkanjec, Zlatko

    2012-01-01

    Stroke is the rapid loss of brain function due to disturbance in the blood supply to the brain causing predominantly motor and sensory symptoms. However, stroke can cause some other symptoms. Post stroke dementia and depression are probably the most important non-motor consequences of stroke. Post stroke dementia and depression are important and often overlooked symptoms following stroke. Treatment options for Post stroke dementia and depression are still limited, therefore diagnosis of Post ...

  3. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  4. After Stroke

    Science.gov (United States)

    ... much function as possible. Learn more about spasticity . Deep Venous Thrombosis – Deep venous thrombosis happens when a clot forms in ... from all RESCUE fact sheets. American Stroke Association Web: www.strokeassociation.org * Phone: 1-888-478-7653 ...

  5. Healthy Living after Stroke

    Science.gov (United States)

    ... After Stroke Weight Training After Stroke Tips for Improving Fine Motor Skills Functional Tone Management Arm Training Program Constraint-Induced Movement Therapy Emotional & Behavioral Challenges Self-Esteem after Stroke Post-Stroke Mood Disorders One-side ...

  6. Atherosclerosis and Stroke

    Science.gov (United States)

    ... After Stroke Weight Training After Stroke Tips for Improving Fine Motor Skills Functional Tone Management Arm Training Program Constraint-Induced Movement Therapy Emotional & Behavioral Challenges Self-Esteem after Stroke Post-Stroke Mood Disorders One-side ...

  7. Driving After a Stroke

    Science.gov (United States)

    ... After Stroke Weight Training After Stroke Tips for Improving Fine Motor Skills Functional Tone Management Arm Training Program Constraint-Induced Movement Therapy Emotional & Behavioral Challenges Self-Esteem after Stroke Post-Stroke Mood Disorders One-side ...

  8. Patent foramen ovale (PFO), stroke and pregnancy.

    Science.gov (United States)

    Chen, Lei; Deng, Wenjun; Palacios, Igor; Inglessis-Azuaje, Ignacio; McMullin, David; Zhou, Dong; Lo, Eng H; Buonanno, Ferdinando; Ning, MingMing

    2016-06-01

    Patent foramen ovale (PFO)-related stroke is increasingly recognized as an important etiology of ischemic embolic stroke-accounting for up to 50% of strokes previously considered 'cryptogenic' or with an unknown mechanism. As a 'back door to the brain,' PFO can allow venous clots to enter arterial circulation via interatrial right-to-left shunting, potentially resulting in ischemic stroke. We observe that clinically, PFO-related stroke affects women of childbearing age, and that pregnancy-owing to major changes in hemocoagulative, hormonal, and cardiovascular parameters-can enhance stroke risks. However, no systematic study has been performed and little is known regarding complications, pregnancy outcomes and treatment for PFO-related stroke during pregnancy. To identify and characterize the complications and clinical outcomes related to PFOs during pregnancy, we performed a literature review and analysis from all reported cases of pregnancy with PFO-related complications in the medical literature from 1970 to 2015. We find that during pregnancy and post-partum, PFO is associated with complications affecting multiple organs, including the brain, heart and lung. The three principal complications reported are stroke, pulmonary emboli and myocardial infarction. In contrast to other pregnancy-related stroke etiologies, which peak during later pregnancy and postpartum, PFO-related stroke peaks during early pregnancy (first and second trimester-60%), and most patients had good neurological outcome (77%). In patients with PFO with recurrent stroke during pregnancy, additional key factors include high-risk PFO morphology (atrial septal aneurysm), larger right-to-left shunt, multiple gestation and concurrent hypercoagulability. Compared to strokes of other etiologies during pregnancy, most PFO stroke patients experienced uneventful delivery (93%) of healthy babies with a good clinical outcome. We conclude with recommended clinical treatment strategies for pregnant patients

  9. Phacoemulsification in anterior megalophthalmos.

    Science.gov (United States)

    Lee, Graham A; Hann, Joshua V; Braga-Mele, Rosa

    2006-07-01

    This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes. PMID:16857490

  10. Anterior cerebral artery territory infarctions presenting with ascending tetraparesis.

    Science.gov (United States)

    Okamoto, Kensho; Hamada, Eri; Okuda, Bungo

    2004-01-01

    We describe a patient with ascending tetraparesis following stroke. The patient presented initially with spastic paraparesis which acutely evolved to tetraparesis with abulia. Magnetic resonance imaging revealed acute infarctions in the bilateral medial frontal regions but not in the brainstem or spinal cord. Multiple infarctions in the anterior cerebral artery territory appeared to originate from artery to artery embolism. The present case provides distinct clinical features of anterior cerebral artery syndrome which mimic myelopathy or brainstem lesions. PMID:17903956

  11. Endothelial progenitor cells in acute ischemic stroke

    Science.gov (United States)

    Martí-Fàbregas, Joan; Crespo, Javier; Delgado-Mederos, Raquel; Martínez-Ramírez, Sergi; Peña, Esther; Marín, Rebeca; Dinia, Lavinia; Jiménez-Xarrié, Elena; Fernández-Arcos, Ana; Pérez-Pérez, Jesús; Querol, Luis; Suárez-Calvet, Marc; Badimon, Lina

    2013-01-01

    Objectives The levels of circulating endothelial progenitor cells (EPCs) in ischemic stroke have not been studied extensively and reported results are inconsistent. We aimed to investigate the time course, the prognostic relevance, and the variables associated with EPC counts in patients with ischemic stroke at different time points. Material and methods We studied prospectively 146 consecutive patients with ischemic stroke within the first 48 h from the onset of symptoms (baseline). We evaluated demographic data, classical vascular risk factors, treatment with thrombolysis and statins, stroke etiology, National Institute of Health and Stroke Scale score and outcome (favorable when Rankin scale score 0–2). Blood samples were collected at baseline, at day 7 after stroke (n = 121) and at 3 months (n = 92). The EPC were measured by flow cytometry. Results We included 146 patients with a mean age of 70.8 ± 12.2 years. The circulating EPC levels were higher on day 7 than at baseline or at 3 months (P = 0.045). Pretreatment with statins (odds ratio [OR] 3.11, P = 0.008) and stroke etiology (P = 0.032) were predictive of EPC counts in the baseline sample. EPC counts were not associated with stroke severity or functional outcome in all the patients. However, using multivariate analyses, a better functional outcome was found in patients with higher EPC counts in large-artery atherosclerosis and small-vessel disease etiologic subtypes. Conclusions After acute ischemic stroke, circulating EPC counts peaked at day 7. Pretreatment with statins increased the levels of EPC. In patients with large-artery atherosclerosis and small-vessel disease subtypes, higher counts were related to better outcome at 3 months. PMID:24363968

  12. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke.......This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  13. Penumbra Stroke System as an ''add-on'' for the treatment of large vessel occlusive disease following thrombolysis: first results

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, Tobias; Engelhorn, Tobias; Richter, Gregor; Doerfler, Arnd [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany); Koehrmann, Martin; Nowe, Tim; Schellinger, Peter D.; Schwab, Stefan [University of Erlangen-Nuremberg, Department of Neurology, Erlangen (Germany)

    2009-09-15

    The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS {<=} 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. (orig.)

  14. The Use of Animal Models for Stroke Research: A Review

    OpenAIRE

    Juliana B Casals; Pieri, Naira CG; Feitosa, Matheus LT; Ercolin, Anna CM; Roballo, Kelly CS; Barreto, Rodrigo SN; Bressan, Fabiana F; Daniele S. Martins; Maria A. Miglino; Carlos E. Ambrósio

    2011-01-01

    Stroke has been identified as the second leading cause of death worldwide. Stroke is a focal neurologic deficit caused by a change in cerebral circulation. The use of animal models in recent years has improved our understanding of the physiopathology of this disease. Rats and mice are the most commonly used stroke models, but the demand for larger models, such as rabbits and even nonhuman primates, is increasing so as to better understand the disease and its treatment. Although the basic mech...

  15. ANTITHROMBOTIC THERAPY IN THE PREVENTION OF RECURRENT ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Andrey Vladimirovich Fonyakin

    2009-01-01

    Full Text Available The paper gives the current views of the role of antithrombotic therapy in the prevention of recurrent ischemic strokes and describes on-going trials of new antithrombotic agents. It is demonstrated that this treatment should be performed in all patients with ischemic disorders in the brain circulation. Long-term therapy with oral anticoagulants is reasonable in cardioembolic stroke caused by atrial fibrillation and a number of other disorders. Therapy with thrombocytic antiaggregants is more advisable in noncardioembolic stroke

  16. Patent Foramen Ovale and Stroke.

    Science.gov (United States)

    Sun, Yee-Ping; Homma, Shunichi

    2016-07-25

    A patent foramen ovale (PFO) is common and found in nearly 25% of healthy individuals. The majority of patients with PFO remain asymptomatic and they are not at increased risk for developing a stroke. The presence of PFO, however, has been found to be higher in patients with cryptogenic stroke, suggesting there may be a subset of patients with PFO who are indeed at risk for stroke. Paradoxical embolization of venous thrombi through the PFO, which then enter the arterial circulation, is hypothesized to account for this relationship. Although aerated-saline transesophageal echocardiography is the gold standard for diagnosis, aerated-saline transthoracic echocardiography and transcranial Doppler are often used as the initial diagnostic tests for detecting PFO. Patients with cryptogenic stroke and PFO are generally treated with antiplatelet therapy in the absence of another condition for which anticoagulation is necessary. Based on the findings of 3 large randomized clinical trials, current consensus guidelines do not recommend percutaneous closure, though this is an area of controversy. The following review discusses the relationship of PFO and cryptogenic stroke, focusing on the epidemiology, pathophysiological mechanisms, diagnostic tools, associated clinical/anatomic factors and treatment. (Circ J 2016; 80: 1665-1673). PMID:27334127

  17. Mixed Stroke

    Institute of Scientific and Technical Information of China (English)

    HuangRuxun(黄如训); Zeng Jinsheng(曾进胜)

    2000-01-01

    Purpose To summarize the chnical, autoptic and animal experimental dala of stroke, propose the concept of mixed stroke (MS) and demonstrate the enoiogy, pathogenesis, clinical mainfestations, prophylaxis and treatment of MS Background At present. stroke still is classified in the national and international academic fields as two main groups: hemorrhage and ischema In fact, thc cerebral vascular disease with hemorrhage forus and ischema focus at the same time is not rare moreover, this type of stroke has special etiology, pathogenesis and clinical manifestations. But it is always made a main dagnosis and neglected the other nature of coexistent focus on either clinical or pathological diagnosis according to traditional classification of stroke Data sources and methods Mort of pablished originsl articles about MS in our department and laboralory wcre reviewed. Resulta The clinical autoptic and animal experimental dats all prcved that hemorrhage and infarction could occur in the course of a stroke simultaneously or in suecession during a short time, which demonstrated the existence of MS It was found clinically that MS patients all had the hustory of hypcrtension and in the autoptic data the MS patients dying of stroke all had typical hypertensive changes in the heart and kidney. and had hypertensive arteriosclerosis in the cerebral arteriole and small artery. MS was cas lily thdueed in stroke-prone renovascular hypertensivc rats This kind of rats are free from genetic deficiency and arc not affected by senile factor, so their cerebral vascular foci are mainly induced by the single factor -hypertension. TThese indicate definitely that hypertensive cerebral vascular lesion is the basis inducing MS. The main lesions of hypertensive cerebral arteriole and small artery were hyalinosis and fibrinoid of the walls, and the formation of microaneurysms or hyperplasla of iniernal and external layers The math lcsions of hypertensive cerebral capillaries were increasing vascular

  18. Salivary neuron specific enolase: an indicator for neuronal damage in patients with ischemic stroke and stroke-prone patients

    OpenAIRE

    Al-Rawi, Natheer H.; Atiyah, Karim M.

    2009-01-01

    Background: The blood-brain barrier is compromised in patients with stroke. The release of neuro-biochemical protein markers, such as neuron specific enolase (NSE) into the circulation may allow the pathophysiology and prognosis of patients with cerebrovascular diseases to be evaluated further. The present study was designed to measure the marker of neuronal damage, NSE, in saliva and serum of patients with acute ischemic stroke and patients with stroke related diseases as a diagnostic and/or...

  19. Bilateral anterior choroidal artery infarction presenting with progressive somnolence.

    Science.gov (United States)

    van Son, Brechtje; Vandevenne, Jan; Viaene, Pieter

    2014-09-01

    A 55-year-old woman was admitted with a 3 days history of increasing lethargy with bradyphrenia and apathy. She progressively developed severe somnolence with marked abulia, right hemiparesis, right hemianopsia, and pseudobulbar palsy. Brain magnetic resonance imaging showed the rare image of bilateral acute anterior choroidal artery infarction. Pseudobulbar mutism and in rare cases abulia have been described in acute anterior choroidal artery infarction contralateral to an older lesion in mirror position. Although neurologic deterioration is not infrequent in anterior choroidal artery territory infarcts, the absence of focal neurologic signs on admission is rare and did not raise suspicion of acute stroke. PMID:25106836

  20. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  1. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. PMID:21571152

  2. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  3. Depression after Stroke

    Science.gov (United States)

    ... Library CARING FOR SOMEONE WITH EMOTIONAL & BEHAVIORAL NEEDS Depression After Stroke After a stroke, your loved one ... available! Almost half of all stroke survivors have depression. Depression is a normal response to the losses ...

  4. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Current Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents ... campaign for the U.S. Hispanic community. 1 Know Stroke A stroke occurs when the blood supply to ...

  5. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... This includes healthy eating, controlling illnesses such as diabetes and high blood pressure, and sometimes taking medicine ...

  6. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  7. Questions and Answers about Stroke

    Science.gov (United States)

    ... Find People About NINDS Questions and Answers About Stroke What is a stroke? A stroke occurs when blood flow to the ... need to function. What are the types of strokes? A stroke can occur in two ways. In ...

  8. Treatment of patients with mild acute ischemic stroke and associated large vessel occlusion.

    Science.gov (United States)

    Cerejo, Russell; Cheng-Ching, Esteban; Hui, Ferdinand; Hussain, M Shazam; Uchino, Ken; Bullen, Jennifer; Toth, Gabor

    2016-08-01

    Several recent studies have shown that patients presenting with mild acute ischemic stroke (mAIS) symptoms may have an unfavorable natural history. The presence of associated large vessel occlusion (LVO) may lead to even worse outcomes, but most mAIS patients are still excluded from acute stroke treatment (AST). A retrospective review of patients with acute ischemic stroke presenting to our institution between 2010 and 2014 was carried out. Inclusion criteria were mAIS (initial National Institutes of Health Stroke Scale [NIHSS] ⩽7) due to LVO, presenting within 6hours from onset. Demographics, treatments and short-term outcomes were analyzed. Favorable 30day outcome was defined as modified Rankin Scale (mRS) ⩽2. Out of 2636 patients, 62 patients (median age 63years, 33 (53.2%) males) met inclusion criteria. The anterior circulation was involved in 74.1%. Median admission NIHSS and pre-admission mRS were 4 and 0, respectively. Twenty-three patients (71.8%) received AST (intravenous tissue plasminogen activator: 14, intra-arterial therapy: 4, both: 5). Favorable outcomes were 4.5 times higher in treated (78.3%) versus untreated (53.8%) patients (odds ratio 4.5, 95% confidence interval 1.26-19.2; p=0.028). None of the treated patients had symptomatic intracranial hemorrhage. We demonstrate that a significant proportion of untreated mAIS patients with LVO have an unfavorable natural history. Our results suggest better outcomes in patients who receive early therapy rather than conservative management. The detection of LVO, even with mild clinical symptoms, may prompt rapid treatment considerations. PMID:27050916

  9. Know your tools - concordance of different methods for measuring brain volume change after ischemic stroke

    International Nuclear Information System (INIS)

    Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between different analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1 week of onset and at 1 and 3 months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions. (orig.)

  10. Know your tools - concordance of different methods for measuring brain volume change after ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yassi, Nawaf; Campbell, Bruce C.V.; Davis, Stephen M.; Bivard, Andrew [The University of Melbourne, Departments of Medicine and Neurology, Melbourne Brain Centre rate at The Royal Melbourne Hospital, Parkville, Victoria (Australia); Moffat, Bradford A.; Steward, Christopher; Desmond, Patricia M. [The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Parkville (Australia); Churilov, Leonid [The University of Melbourne, The Florey Institute of Neurosciences and Mental Health, Parkville (Australia); Parsons, Mark W. [University of Newcastle and Hunter Medical Research Institute, Priority Research Centre for Translational Neuroscience and Mental Health, Newcastle (Australia)

    2015-07-15

    Longitudinal brain volume changes have been investigated in a number of cerebral disorders as a surrogate marker of clinical outcome. In stroke, unique methodological challenges are posed by dynamic structural changes occurring after onset, particularly those relating to the infarct lesion. We aimed to evaluate agreement between different analysis methods for the measurement of post-stroke brain volume change, and to explore technical challenges inherent to these methods. Fifteen patients with anterior circulation stroke underwent magnetic resonance imaging within 1 week of onset and at 1 and 3 months. Whole-brain as well as grey- and white-matter volume were estimated separately using both an intensity-based and a surface watershed-based algorithm. In the case of the intensity-based algorithm, the analysis was also performed with and without exclusion of the infarct lesion. Due to the effects of peri-infarct edema at the baseline scan, longitudinal volume change was measured as percentage change between the 1 and 3-month scans. Intra-class and concordance correlation coefficients were used to assess agreement between the different analysis methods. Reduced major axis regression was used to inspect the nature of bias between measurements. Overall agreement between methods was modest with strong disagreement between some techniques. Measurements were variably impacted by procedures performed to account for infarct lesions. Improvements in volumetric methods and consensus between methodologies employed in different studies are necessary in order to increase the validity of conclusions derived from post-stroke cerebral volumetric studies. Readers should be aware of the potential impact of different methods on study conclusions. (orig.)

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... routinely get MRAs and CTAs or whether that's something that they're comfortable minimizing in an asymptomatic ... intracranial circulation. We would expect, Pierre, to see something here which is missing the anterior cerebral artery. ...

  12. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  13. Diffusion and perfusion correlates of the {sup 18}F-MISO PET lesion in acute stroke: pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Alawneh, Josef A.; Marrapu, S.T.; Jensen-Kondering, Ulf; Morris, Rhiannon S.; Jones, P.S. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Moustafa, Ramez R. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Ain Shams University, Department of Neurology, Cairo (Egypt); Aigbirhio, Franklin I.; Fryer, Tim D.; Carpenter, T.A. [University of Cambridge, Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, Cambridge (United Kingdom); Warburton, Elizabeth A. [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Stroke Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom); Baron, Jean-Claude [University of Cambridge, Stroke Research Group, Department of Clinical Neurosciences, Cambridge (United Kingdom); Universite Paris Descartes, INSERM U894, Centre Hospitalier Sainte-Anne, Paris (France)

    2014-04-15

    Mapping the ischaemic penumbra in acute stroke is of considerable clinical interest. For this purpose, mapping tissue hypoxia with {sup 18}F-misonidazole (FMISO) PET is attractive, and is straightforward compared to {sup 15}O PET. Given the current emphasis on penumbra imaging using diffusion/perfusion MR or CT perfusion, investigating the relationships between FMISO uptake and abnormalities with these modalities is important. According to a prospective design, three patients (age 54-81 years; admission NIH stroke scale scores 16-22) with an anterior circulation stroke and extensive penumbra on CT- or MR-based perfusion imaging successfully completed FMISO PET, diffusion-weighted imaging and MR angiography 6-26 h after stroke onset, and follow-up FLAIR to map the final infarction. All had persistent proximal occlusion and a poor outcome despite thrombolysis. Significant FMISO trapping was defined voxel-wise relative to ten age-matched controls and mapped onto coregistered maps of the penumbra and irreversibly damaged ischaemic core. FMISO trapping was present in all patients (volume range 18-119 ml) and overlapped mainly with the penumbra but also with the core in each patient. There was a significant (p ≤ 0.001) correlation in the expected direction between FMISO uptake and perfusion, with a sharp FMISO uptake bend around the expected penumbra threshold. FMISO uptake had the expected overlap with the penumbra and relationship with local perfusion. However, consistent with recent animal data, our study suggests FMISO trapping may not be specific to the penumbra. If confirmed in larger samples, this preliminary finding would have potential implications for the clinical application of FMISO PET in acute ischaemic stroke. (orig.)

  14. Diffusion and perfusion correlates of the 18F-MISO PET lesion in acute stroke: pilot study

    International Nuclear Information System (INIS)

    Mapping the ischaemic penumbra in acute stroke is of considerable clinical interest. For this purpose, mapping tissue hypoxia with 18F-misonidazole (FMISO) PET is attractive, and is straightforward compared to 15O PET. Given the current emphasis on penumbra imaging using diffusion/perfusion MR or CT perfusion, investigating the relationships between FMISO uptake and abnormalities with these modalities is important. According to a prospective design, three patients (age 54-81 years; admission NIH stroke scale scores 16-22) with an anterior circulation stroke and extensive penumbra on CT- or MR-based perfusion imaging successfully completed FMISO PET, diffusion-weighted imaging and MR angiography 6-26 h after stroke onset, and follow-up FLAIR to map the final infarction. All had persistent proximal occlusion and a poor outcome despite thrombolysis. Significant FMISO trapping was defined voxel-wise relative to ten age-matched controls and mapped onto coregistered maps of the penumbra and irreversibly damaged ischaemic core. FMISO trapping was present in all patients (volume range 18-119 ml) and overlapped mainly with the penumbra but also with the core in each patient. There was a significant (p ≤ 0.001) correlation in the expected direction between FMISO uptake and perfusion, with a sharp FMISO uptake bend around the expected penumbra threshold. FMISO uptake had the expected overlap with the penumbra and relationship with local perfusion. However, consistent with recent animal data, our study suggests FMISO trapping may not be specific to the penumbra. If confirmed in larger samples, this preliminary finding would have potential implications for the clinical application of FMISO PET in acute ischaemic stroke. (orig.)

  15. Lung Circulation.

    Science.gov (United States)

    Suresh, Karthik; Shimoda, Larissa A

    2016-01-01

    The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed. © 2016 American Physiological Society. Compr Physiol 6:897-943, 2016. PMID:27065170

  16. The Effect of Stroke on Pharyngeal Laterality During Swallowing

    OpenAIRE

    Yang, Seoyon; Choi, Kyoung Hyo; Son, Yu Ri

    2015-01-01

    Objective To investigate whether patterns of dysphagia and swallowing laterality differ according to the location of brain lesions in patients with stroke. Methods Patients with stroke >20 years of age were enrolled in this study. A videofluoroscopic swallowing study (VFSS) including the anterior-posterior view was used to assess swallowing. Patterns of swallowing were classified into three types according to the width of barium sulfate flow while passing the pharyngoesophageal segment: right...

  17. Bilateral anterior shoulder dislocation

    OpenAIRE

    Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

    2013-01-01

    Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side...

  18. “第一时间”改善脑血循环在非溶栓缺血性脑血管病仍然有重要的治疗意义%The key treatment principle of acute ischemic stroke still to improve collateral and micro circulation right the first time for non-thrombolysis patients

    Institute of Scientific and Technical Information of China (English)

    李震中

    2016-01-01

    理论上缺血性脑血管病治疗有多个靶点,但是在临床治疗实践中改善脑血循环是第一位的特异性治疗方法。然而,在中国只有1.6%的缺血性脑血管病患者能够得到“时间窗”内的静脉溶栓治疗。那么非溶栓缺血性脑血管病患者在“第一时间”是否还需要积极治疗?我们在临床治疗实践中体会到:在“第一时间”改善脑侧支血循环及微血循环,增加缺血区有效灌注仍然是最重要的治疗原则。%Despite the existence of numerous therapeutic targets for acute ischemic stroke in theory,improving the blood supply to the brain comes first in clinical practice.Thrombolysis constitutes the only approved therapy for acute ischemic stroke.However,only 1.6% of the patients with acute ischemic stroke received thrombolytic therapy within the time window in China.And the question raises:what else could we do for non-thrombolysis patients after acute cerebral infarction right the first time? In clinical practice,we found that the key to treat the patients with ischemic cerebrovascular disease is still to improve and recover cerebral perfusion,and the cerebral collateral circulation plays an important role right the first time.

  19. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H;

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  20. Stroke: secondary prevention

    OpenAIRE

    Lip, Gregory YH; Kalra, Lalit

    2010-01-01

    Prevention in this context is the long-term management of people with previous stroke or TIA, and of people at high risk of stroke for other reasons, such as atrial fibrillation. Risk factors for stroke include: previous stroke or TIA; increasing age; hypertension; diabetes; cigarette smoking; and emboli associated with atrial fibrillation, artificial heart valves, or MI.

  1. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  2. Sleep disorders and stroke

    OpenAIRE

    Wallace, Douglas M; Ramos, Alberto R.; Rundek, Tatjana

    2012-01-01

    The purpose of this review is to highlight existing literature on the epidemiology, pathophysiology, and treatments of stroke sleep disorders. Stroke sleep disorders are associated with many intermediary vascular risk factors leading to stroke, but they may also influence these risk factors through direct or indirect mechanisms. Sleep disturbances may be further exacerbated by stroke or caused by stroke. Unrecognized and untreated sleep disorders may influence rehabilitation efforts and poor ...

  3. Sleep and stroke

    OpenAIRE

    Dib, Salim; Ramos, Alberto R.; Wallace, Douglas M; Rundek, Tatjana

    2012-01-01

    Obstructive Sleep-Disordered Breathing (OSDB) is an under-recognized risk factor for stroke. OSDB is associatedwith traditional vascular risk factors such as hypertension, obesity, and diabetes, and can influence the risk for stroke through direct and indirect mechanisms. Untreated OSDB may also influence rehabilitation efforts and functional outcome following a stroke, as well as the risk for stroke recurrence. Stroke risk is greatly reduced if the OSDB is adequately treated. Conversely, ...

  4. A rare presentation of stroke in young age ( moyamoya disease

    Directory of Open Access Journals (Sweden)

    Amal F Radwan

    2013-01-01

    Full Text Available A 37-year-old hypertensive housewife presented with a sudden onset of left-sided hemiplegia, hemianaesthesia, dysarthria and urinary incontinence. The condition was preceded by recurrent attacks of motor neurological deficits over a 3-year duration. She reported a history of a fall from a height at the age of 10, which was followed by a hearing deficit and a history of two caesarean sections after eclampsia. The blood pressure was 170/100 mmHg. Laboratory investigations revealed hyperglycaemia (fasting glucose 306 mg/dl and normal kidney function tests. The computed tomography scans revealed old multiple bilateral cerebral infarcts with recent intracranial haemorrhage in the right parietal region. The inflammatory markers (ESR and CRP and immune profile (ANA, anti-ds DNA and ANCA were found to be normal. Cerebral angiography revealed a complete occlusion of the intracranial parts of both internal carotid arteries at their supraclinoid segments along with the proximal parts of the anterior cerebral artery and middle cerebral artery, with collaterals from the posterior circulation. Consequently, the diagnosis of moyamoya disease with the collaterals was confirmed. Antihypertensive medications and insulin were administered. Cerebral dehydration measures were undertaken with partial improvement. A superficial temporal artery-middle cerebral artery bypass operation was performed with some postoperative improvement. One month later, she suffered a new stroke with severe impairment of the level of consciousness; the computed tomography scans revealed a large recent cerebral infarct, her condition deteriorated rapidly and she died shortly thereafter.

  5. The validity and reliability of signs of early infarction on CT in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Dippel, D.W.J.; Du Ry van Beest Holle, M.; Kooten, F. van; Koudstaal, P.J. [Univ. Hospital Rotterdam (Netherlands). Dept. of Neurology

    2000-09-01

    It has been suggested that subtle signs of early cerebral infarction on CT are important indicators of outcome and of the effect of thrombolytic treatment in acute ischaemic stroke. We studied these signs prospectively, in 260 patients with an anterior circulation stroke from a European-Australian randomised trial of lubeluzole in acute ischaemic stroke. Interobserver reliability was assessed by means of the {chi} statistic. The validity of the early signs was assessed by comparing the assessments of the first CT with another CT at 1 week after the onset of stroke, and with stroke outcome at 12 weeks. Each initial CT study was assessed by two of a group of five reviewers, who were blinded to each other's assessments and to the findings on the follow-up CT. The images were assessed twice, once without clinical information and again after disclosure of the side (left or right hemisphere) of the lesion. All reviewers were experienced clinicians with a special interest and training in vascular neurology and CT. The median time between stroke onset and the first CT was 3.2 h; 59 % of the patients were imaged within 3 h and 77 % within 6 h. More than half of the patients (52 %) had a large middle cerebral artery territory (MCA) infarct on follow-up CT. Chance-adjusted interobserver agreement ({chi}) for any early infarct was 0.27 (95 % confidence interval (CI): 0.15 to 0.39). Agreement ({chi}) on the extent of a middle cerebral artery (MCA) infarct and on the indication for treatment with recombinant tissue plasminogen activator (rt-PA) was fair: 0.37 and 0.35, respectively. Patients with early signs of an infarct of more than 1/3 of the MCA territory were more likely to have a large MCA infarct on follow-up CT (odds ratio 5.7, 95 % confidence interval 2.8-11.5); the positive and negative predictive value of these signs was 81 % and 57 %, respectively. Chance-adjusted interobserver agreement on early, subtle signs of a large MCA territory infarct on CT by

  6. The validity and reliability of signs of early infarction on CT in acute ischaemic stroke

    International Nuclear Information System (INIS)

    It has been suggested that subtle signs of early cerebral infarction on CT are important indicators of outcome and of the effect of thrombolytic treatment in acute ischaemic stroke. We studied these signs prospectively, in 260 patients with an anterior circulation stroke from a European-Australian randomised trial of lubeluzole in acute ischaemic stroke. Interobserver reliability was assessed by means of the χ statistic. The validity of the early signs was assessed by comparing the assessments of the first CT with another CT at 1 week after the onset of stroke, and with stroke outcome at 12 weeks. Each initial CT study was assessed by two of a group of five reviewers, who were blinded to each other's assessments and to the findings on the follow-up CT. The images were assessed twice, once without clinical information and again after disclosure of the side (left or right hemisphere) of the lesion. All reviewers were experienced clinicians with a special interest and training in vascular neurology and CT. The median time between stroke onset and the first CT was 3.2 h; 59 % of the patients were imaged within 3 h and 77 % within 6 h. More than half of the patients (52 %) had a large middle cerebral artery territory (MCA) infarct on follow-up CT. Chance-adjusted interobserver agreement (χ) for any early infarct was 0.27 (95 % confidence interval (CI): 0.15 to 0.39). Agreement (χ) on the extent of a middle cerebral artery (MCA) infarct and on the indication for treatment with recombinant tissue plasminogen activator (rt-PA) was fair: 0.37 and 0.35, respectively. Patients with early signs of an infarct of more than 1/3 of the MCA territory were more likely to have a large MCA infarct on follow-up CT (odds ratio 5.7, 95 % confidence interval 2.8-11.5); the positive and negative predictive value of these signs was 81 % and 57 %, respectively. Chance-adjusted interobserver agreement on early, subtle signs of a large MCA territory infarct on CT by neurologists was thus no

  7. Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Kawiorski, Michal M.; Alonso de Lecinana, Maria [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Martinez-Sanchez, Patricia; Fuentes, Blanca; Sanz-Cuesta, Borja E.; Marin, Begona; Ruiz-Ares, Gerardo; Diez-Tejedor, Exuperio [Hospital Universitario La Paz, IdiPAZ, Universidad Autonoma de Madrid, Madrid (Spain); Garcia-Pastor, Andres; Diaz-Otero, Fernando [Hospital Universitario Gregorio Maranon, IiSGM, Universidad Complutense de Madrid, Madrid (Spain); Calleja, Patricia [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Lourido, Daniel; Vicente, Agustina; Fandino, Eduardo [Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala de Henares, Madrid (Spain); Sierra-Hidalgo, Fernando [Hospital Universitario 12 de Octubre, Universidad Autonoma de Madrid, Madrid (Spain); Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid (Spain)

    2016-05-15

    Reliable predictors of poor clinical outcome despite successful revascularization might help select patients with acute ischemic stroke for thrombectomy. We sought to determine whether baseline Alberta Stroke Program Early CT Score (ASPECTS) applied to CT angiography source images (CTA-SI) is useful in predicting futile recanalization. Data are from the FUN-TPA study registry (ClinicalTrials.gov; NCT02164357) including patients with acute ischemic stroke due to proximal arterial occlusion in anterior circulation, undergoing reperfusion therapies. Baseline non-contrast CT and CTA-SI-ASPECTS, time-lapse to image acquisition, occurrence, and timing of recanalization were recorded. Outcome measures were NIHSS at 24 h, symptomatic intracranial hemorrhage, modified Rankin scale score, and mortality at 90 days. Futile recanalization was defined when successful recanalization was associated with poor functional outcome (death or disability). Included were 110 patients, baseline NIHSS 17 (IQR 12; 20), treated with intravenous thrombolysis (IVT; 45 %), primary mechanical thrombectomy (MT; 16 %), or combined IVT + MT (39 %). Recanalization rate was 71 %, median delay of 287 min (225; 357). Recanalization was futile in 28 % of cases. In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SI-ASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %). CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies. (orig.)

  8. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    International Nuclear Information System (INIS)

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy

  9. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lescher, Stephanie, E-mail: stephanie.lescher@kgu.de; Czeppan, Katja; Porto, Luciana [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C. [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  10. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... Help a Friend Who Cuts? Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... anyway. But it may change my post-procedure management under -- if there are PO collaterals from posterior circulation to the MCA or from the anterior circulation to the middle cerebral artery, then it's a sign of a ...

  12. Stroke in childhood

    OpenAIRE

    Serap Teber; Gülhis Deda

    2011-01-01

    Stroke in childhood is one of the most common causes of death or severe impairment worldwide, with annual incidence estimated from 1,3 to 13 cases/100.000 population. The definition of stroke consists both of arterial ischemic stroke (AIS) and hemorrhagic stroke. The incidence of ischemic and hemorrhagic stroke in children is approximately the same, in contrast to adults, while the incidence is higher in boys than it is in girls. Risks factors for pediatric stroke differ from those for adults...

  13. Let's Talk about Hemorrhagic Stroke

    Science.gov (United States)

    ... Pressure Tools & Resources Stroke More Let's Talk About Hemorrhagic Stroke Updated:Dec 9,2015 About 13 percent of ... or near the brain. This is called a hemorrhagic stroke. When a hemorrhagic stroke happens, blood collects in ...

  14. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... After Stroke Weight Training After Stroke Tips for Improving Fine Motor Skills Functional Tone Management Arm Training Program Constraint-Induced Movement Therapy Emotional & Behavioral Challenges Self-Esteem after Stroke Post-Stroke Mood Disorders One-side ...

  15. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Raul G. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States); Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J. [Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States)

    2008-04-15

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score {<=}2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66{+-}17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17{+-}3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9{+-}3.9 h (anterior circulation) and 11.0{+-}7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and

  16. Anterior cervical plating

    Directory of Open Access Journals (Sweden)

    Gonugunta V

    2005-01-01

    Full Text Available Although anterior cervical instrumentation was initially used in cervical trauma, because of obvious benefits, indications for its use have been expanded over time to degenerative cases as well as tumor and infection of the cervical spine. Along with a threefold increase in incidence of cervical fusion surgery, implant designs have evolved over the last three decades. Observation of graft subsidence and phenomenon of stress shielding led to the development of the new generation dynamic anterior cervical plating systems. Anterior cervical plating does not conclusively improve clinical outcome of the patients, but certainly enhances the efficacy of autograft and allograft fusion and lessens the rate of pseudoarthrosis and kyphosis after multilevel discectomy and fusions. A review of biomechanics, surgical technique, indications, complications and results of various anterior cervical plating systems is presented here to enable clinicians to select the appropriate construct design.

  17. Anterior knee pain

    Science.gov (United States)

    Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee ... or playing soccer). You have flat feet. Anterior knee pain is more ... skiers, bicyclists, and soccer players who exercise often ...

  18. Anterior knee pain

    Science.gov (United States)

    ... or playing soccer). You have flat feet. Anterior knee pain is more common in: People who are overweight People who have had a dislocation, fracture, or other injury to the kneecap Runners, jumpers, ...

  19. Locomotion in Stroke Subjects: Interactions between Unaffected and Affected Sides

    Science.gov (United States)

    Kloter, Evelyne; Wirz, Markus; Dietz, Volker

    2011-01-01

    The aim of this study was to evaluate the sensorimotor interactions between unaffected and affected sides of post-stroke subjects during locomotion. In healthy subjects, stimulation of the tibial nerve during the mid-stance phase is followed by electromyography responses not only in the ipsilateral tibialis anterior, but also in the proximal arm…

  20. The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

    International Nuclear Information System (INIS)

    Recently two classification methods based on the location and the extent of thrombosis detected with CT angiography have been introduced: the Boston Acute Stroke Imaging Scale (BASIS) and the clot burden score (CBS). We studied the performance of BASIS and CBS in predicting good clinical outcome (mRS ≤2 at 90 days) in an acute (<3 h) stroke cohort treated with intravenous thrombolytic therapy. Eighty-three consecutive patients who underwent multimodal CT were analyzed. Binary logistic regression model was used to assess how BASIS, CBS, and cerebral blood volume (CBV) ASPECTS predict favorable clinical outcome. Diagnostic sensitivities and specificities were calculated and compared. Patients with low CBS and CBV ASPECTS scores and major strokes according to BASIS had significantly higher admission NIHSS scores, larger perfusion defects, and more often poor clinical outcome. In logistic regression analysis, CBV ASPECTS, CBS and BASIS were significantly associated with the clinical outcome. The performance of BASIS improved when patients with thrombosis of the M2 segment of the middle cerebral artery were classified as having minor stroke (M1-BASIS). In the anterior circulation, the sum of CBS and CBV ASPECTS (CBSV) proved to be the most robust predictor of favorable outcome. CBV ASPECTS and CBS had high sensitivity but moderate to poor specificity while BASIS was only moderately sensitive and specific. CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. (orig.)

  1. The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sillanpaa, Niko; Hakomaki, Jari; Lahteela, Arto; Dastidar, Prasun; Soimakallio, Seppo [Tampere University Hospital, Medical Imaging Center, Tampere (Finland); Saarinen, Jukka T.; Numminen, Heikki; Elovaara, Irina [Tampere University Hospital, Department of Neurology, Tampere (Finland); Rusanen, Harri [Oulu University Hospital, Department of Neurology, Oulu (Finland)

    2012-07-15

    Recently two classification methods based on the location and the extent of thrombosis detected with CT angiography have been introduced: the Boston Acute Stroke Imaging Scale (BASIS) and the clot burden score (CBS). We studied the performance of BASIS and CBS in predicting good clinical outcome (mRS {<=}2 at 90 days) in an acute (<3 h) stroke cohort treated with intravenous thrombolytic therapy. Eighty-three consecutive patients who underwent multimodal CT were analyzed. Binary logistic regression model was used to assess how BASIS, CBS, and cerebral blood volume (CBV) ASPECTS predict favorable clinical outcome. Diagnostic sensitivities and specificities were calculated and compared. Patients with low CBS and CBV ASPECTS scores and major strokes according to BASIS had significantly higher admission NIHSS scores, larger perfusion defects, and more often poor clinical outcome. In logistic regression analysis, CBV ASPECTS, CBS and BASIS were significantly associated with the clinical outcome. The performance of BASIS improved when patients with thrombosis of the M2 segment of the middle cerebral artery were classified as having minor stroke (M1-BASIS). In the anterior circulation, the sum of CBS and CBV ASPECTS (CBSV) proved to be the most robust predictor of favorable outcome. CBV ASPECTS and CBS had high sensitivity but moderate to poor specificity while BASIS was only moderately sensitive and specific. CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. (orig.)

  2. Significance of periventricular hyperintensity in T2 weighted MRI on memory dysfunction and depression after stroke

    International Nuclear Information System (INIS)

    We studied the effect of periventricular hyperintensity (PVH) in T2 weighted MRI on memory function and post-stroke depression in 159 patients with cerebrovacular disease. Memory function was assessed with Hasegawa's scale, and depressive state was estimated with Zung's self-rating depression scale. Patients showing diffusely distributed PVH had significantly low scores in memory function tests. Localized PVH around the anterior horns of the laterals ventricle was also associated with impaired memory function when the area of PVH was large. The incidence of post-stroke depression was high in patients with large PVH around the anterior horn in comparison with patients with PVH around the posterior horn. The severity of PVH around the posterior horn did not affect memory function and post-stroke depression. These findings suggest that memory dysfunction and post-stroke depression were accelerated by the diffusely or anteriorly distributed PVH. (author)

  3. Developing Precision Stroke Imaging

    Directory of Open Access Journals (Sweden)

    DavidSLiebeskind

    2014-03-01

    Full Text Available Stroke experts stand at the cusp of a unique opportunity to advance the care of patients with cerebrovascular disorders across the globe through improved imaging approaches. NIH initiatives including the Stroke Progress Review Group (SPRG promotion of imaging in stroke research and the newly established NINDS Stroke Trials network converge with the rapidly evolving concept of precision medicine. Precision stroke imaging portends the coming shift to individualized approaches to cerebrovascular disorders where big data may be leveraged to identify and manage stroke risk with specific treatments utilizing an improved neuroimaging infrastructure, data collection and analysis. We outline key aspects of the stroke imaging field where precision medicine may rapidly transform the care of stroke patients in the next few years.

  4. Stroke - risk factors

    Science.gov (United States)

    ... Risk of stroke goes up with age. Your gender. Men have a higher risk of getting heart disease than women, except in older adults. Your genes and race. If your parents had a stroke, you are at higher risk. ...

  5. Two Kinds of Stroke

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table ... minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ...

  6. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  7. Atrial Fibrillation and Stroke

    Science.gov (United States)

    ... Find People About NINDS NINDS Atrial Fibrillation and Stroke Information Page Table of Contents (click to jump ... done? Clinical Trials What is Atrial Fibrillation and Stroke? Atrial fibrillation (AF) describes the rapid, irregular beating ...

  8. Brain Basics: Preventing Stroke

    Science.gov (United States)

    ... free mailed brochure Cómo Prevenir un Accidente Cerebrovascular Brain Basics: Preventing Stroke Request free mailed brochure Table ... Americans are protecting their most important asset—their brain. Are you? Stroke ranks as the fourth leading ...

  9. Stroke: Hope through Research

    Science.gov (United States)

    ... hormone replacement therapy can reduce some of the effects of menopause and decrease stroke risk. Currently, the NINDS is sponsoring the Women's Estrogen for Stroke Trial (WEST), a randomized, placebo-controlled, double-blind trial, to determine whether estrogen ...

  10. Stroke Fact Sheet

    Science.gov (United States)

    ... tells you to. Return to top Does taking birth control pills increase my risk for stroke? Taking birth ... your vagina Return to top Does using the birth control patch increase my risk for stroke? The patch ...

  11. Hemorrhagic Stroke in Children

    OpenAIRE

    Jordan M.D., Lori C.; Hillis M.D., Argye E.

    2007-01-01

    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  12. Sleep and Stroke

    OpenAIRE

    M V Padma Srivastav

    2014-01-01

    Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB) are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients ...

  13. MRI of Stroke Recovery

    OpenAIRE

    Jiang, Quan; Zhang, Zheng Gang; Chopp, Michael

    2009-01-01

    MRI is a vital tool for the measurement of acute stroke and has been used to visualize changes in activation patterns during stroke recovery. There is emerging interest on using MRI to monitor the structural substrates of spontaneous recovery and neurorestorative treatment of stroke. In this review, we describe the use of MRI and its associated challenges to measure vascular and neuronal remodeling in response to spontaneous and therapy-induced stroke recovery. We demonstrate that MRI methodo...

  14. Comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MRI in patients with acute stroke.

    Directory of Open Access Journals (Sweden)

    Yen-Chu Huang

    Full Text Available BACKGROUND: The aim of this study was to evaluate whether arterial spin labeling (ASL perfusion magnetic resonance imaging (MRI can reliably quantify perfusion deficit as compared to dynamic susceptibility contrast (DSC perfusion MRI. METHODS: Thirty-nine patients with acute ischemic stroke in the anterior circulation territory were recruited. All underwent ASL and DSC MRI perfusion scans within 30 hours after stroke onset and 31 patients underwent follow-up MRI scans. ASL cerebral blood flow (CBF and DSC time to maximum (T(max maps were used to calculate the perfusion defects. The ASL CBF lesion volume was compared to the DSC Tmax lesion volume by Pearson's correlation coefficient and likewise the ASL CBF and DSC T(max lesion volumes were compared to the final infarct sizes respectively. A repeated measures analysis of variance and least significant difference post hoc test was used to compare the mean lesion volumes among ASL CBF, DSC T(max >4-6 s and final infarct. RESULTS: Mean patient age was 72.6 years. The average time from stroke onset to MRI was 13.9 hours. The ASL lesion volume showed significant correlation with the DSC lesion volume for T(max >4, 5 and 6 s (r = 0.81, 0.82 and 0.80; p5 s (29.2 ml, p6 s (21.8 ml, p5 or 6 s were close to mean final infarct size. CONCLUSION: Quantitative measurement of ASL perfusion is well correlated with DSC perfusion. However, ASL perfusion may overestimate the perfusion defects and therefore further refinement of the true penumbra threshold and improved ASL technique are necessary before applying ASL in therapeutic trials.

  15. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women and...

  16. PISA. The effect of paracetamol (acetaminophen and ibuprofen on body temperature in acute stroke: Protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

    Directory of Open Access Journals (Sweden)

    Kappelle Jaap

    2002-03-01

    Full Text Available Abstract Background During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may improve their functional outcome. Previously, we studied the effect of high dose (6 g daily and low dose (3 g daily paracetamol (acetaminophen in a randomised placebo-controlled trial of 75 patients with acute ischemic stroke. In the high-dose paracetamol group, mean body temperature at 12 and 24 hours after start of treatment was 0.4°C lower than in the placebo group. The effect of ibuprofen, another potent antipyretic drug, on body-core temperature in normothermic patients has not been studied. Aim The aim of the present trial is to study the effects of high-dose paracetamol and ibuprofen on body temperature in patients with acute ischaemic stroke, and to study the safety of these treatments. Design Seventy-five (3 × 25 patients with acute ischaemic stroke confined to the anterior circulation will be randomised to treatment with either: 400 mg ibuprofen, 1000 mg acetaminophen, or with placebo 6 times daily during 5 days. Body-temperatures will be measured with a rectal electronic thermometer at the start of treatment and after 24 hours. An infrared tympanic thermometer will be used to monitor body temperature at 2-hour intervals during the first 24 hours and at 12-hour intervals thereafter. The primary outcome measure will be rectal temperature at 24 hours after the start of treatment. The study results will be analysed on an intent-to-treat basis, but an on-treatment analysis will also be performed. No formal interim analysis will be carried out.

  17. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  18. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, patheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. PMID:26898578

  19. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  20. Congenital anterior urethral diverticulum.

    Science.gov (United States)

    Singh, Sanjeet Kumar; Ansari, Ms

    2014-09-01

    Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. PMID:26328174

  1. Serum cholinesterase activities distinguish between stroke patients and controls and predict 12-month mortality

    DEFF Research Database (Denmark)

    Ben Assayag, Einor; Shenhar-Tsarfaty, Shani; Ofek, Keren;

    2010-01-01

    To date there is no diagnostic biomarker for mild stroke, although elevation of inflammatory biomarkers has been reported at early stages. Previous studies implicated acetylcholinesterase (AChE) involvement in stroke, and circulating AChE activity reflects inflammatory response, since acetylcholi...

  2. [Post Stroke Dementia].

    Science.gov (United States)

    Ihara, Masafumi

    2016-07-01

    Post-stroke dementia (PSD) is a clinical entity that encompasses all types of dementia following an index stroke. Current evidence suggests that 25-30% of ischemic stroke survivors develop immediate or delayed vascular cognitive impairment or vascular dementia. The type of stroke can be either ischemic, hemorrhagic or hypoperfusive. There are multiple risk factors for PSD including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischemic attack or recurrent stroke and depressive illness. Pre-stroke dementia refers to the occurrence of cognitive impairment before the index stroke, which may be caused by a vascular burden as well as insidious neurodegenerative changes. Neuroimaging determinants of dementia after stroke include silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Published clinical trials have not been promising and there is little information on whether PSD can be prevented using pharmacological agents. Control of vascular disease risk and prevention of recurrent strokes are key to reducing the burden of cognitive decline and post-stroke dementia. Modern imaging and analysis techniques will help to elucidate the mechanism of PSD and establish better treatment. PMID:27395459

  3. Anterior vaginal wall repair

    Science.gov (United States)

    ... symptoms will go away. This improvement will often last for years. Alternative Names A/P repair; Vaginal wall repair; Anterior and/ ... writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Contact ... Institutes of Health Page last updated: 23 August 2016

  4. [Toxic anterior segment syndrome].

    Science.gov (United States)

    Cornut, P-L; Chiquet, C

    2011-01-01

    Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells. PMID:21176994

  5. Sequential strokes in a hyperacute stroke unit.

    Science.gov (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard

    2014-08-01

    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available. PMID:25289143

  6. Etiologic Classification in Ischemic Stroke

    OpenAIRE

    Hakan Ay

    2011-01-01

    Ischemic stroke is an etiologically heterogenous disorder. Classification of ischemic stroke etiology into categories with discrete phenotypic, therapeutic, and prognostic features is indispensible to generate consistent information from stroke research. In addition, a functional classification of stroke etiology is critical to ensure unity among physicians and comparability among studies. There are two major approaches to etiologic classification in stroke. Phenotypic systems define subtypes...

  7. Rapid identification of a major diffusion/perfusion mismatch in distal internal carotid artery or middle cerebral artery ischemic stroke

    Directory of Open Access Journals (Sweden)

    Hakimelahi Reza

    2012-11-01

    Full Text Available Abstract Background We tested the hypothesis that in patients with occlusion of the terminal internal carotid artery and/or the proximal middle cerebral artery, a diffusion abnormality of 70 ml or less is accompanied by a diffusion/perfusion mismatch of at least 100%. Methods Sixty-eight consecutive patients with terminal ICA and/or proximal MCA occlusions and who underwent diffusion/perfusion MRI within 24 hours of stroke onset were retrospectively identified. DWI and mean transit time (MTT volumes were measured. Prospectively, 48 consecutive patients were identified with the same inclusion criteria. DWI and time to peak (TTP lesion volumes were measured. A large mismatch volume was defined as an MTT or TTP abnormality at least twice the DWI lesion volume. Results In the retrospective study, 49 of 68 patients had a DWI lesion volume ≤ 70 ml (mean 20.2 ml; SEM 2.9 ml. A DWI/MTT mismatch of > 100% was observed in all 49 patients (P  100% was present in all 35 (P  Conclusions Acute stroke patients with major anterior circulation artery occlusion are exceedingly likely to have a major diffusion/perfusion mismatch if the diffusion lesion volume is 70 ml or less. This suggests that physiology-based patient assessments may be made using only vessel imaging and diffusion MRI as a simple alternative to perfusion imaging.

  8. High-altitude cerebral oedema mimicking stroke.

    Science.gov (United States)

    Yanamandra, Uday; Gupta, Amul; Patyal, Sagarika; Varma, Prem Prakash

    2014-01-01

    High-altitude cerebral oedema (HACO) is the most fatal high-altitude illness seen by rural physicians practising in high-altitude areas. HACO presents clinically with cerebellar ataxia, features of raised intracranial pressure (ICP) and coma. Early identification is important as delay in diagnosis can be fatal. We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. Neuroimaging revealed features suggestive of vasogenic oedema. The second patient presented with monoplegia of the lower limb. Neuroimaging revealed perfusion deficit in anterior cerebral artery territory. Both patients were managed with dexamethasone and they improved dramatically. Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. Recent travel to high altitude, young age, absence of atherosclerotic risk factors and features of raised ICP concomitantly directed the diagnosis to HACO. PMID:24671373

  9. Sleep apnea and stroke.

    Science.gov (United States)

    Culebras, Antonio

    2015-01-01

    Clinical evidence has established that sleep apnea is a risk factor for stroke. Patients with stroke have a high prevalence of sleep apnea that may have preceded or developed as a result of the stroke. Well-established concurrent stroke risk factors for stroke like hypertension and atrial fibrillation respond favorably to the successful treatment of sleep apnea. The gold standard diagnosis of sleep apnea is obtained in the sleep laboratory, but unattended polysomnography is gaining acceptance. Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea. Suggestive evidence indicates that stroke occurrence or recurrence may be reduced with treatment of sleep apnea. PMID:25407131

  10. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich;

    2013-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients in...... the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential...

  11. Stroke and Stroke-like Episodes in Muscle Disease

    OpenAIRE

    Finsterer, Josef

    2012-01-01

    Background: Though not obvious at a first glance, myopathies may be associated with ischemic stroke. Stroke-like episodes resemble ischemic stroke only to some extent but are a unique feature of certain mitochondrial disorders with a pathogenesis at variance from that of ischemic stroke. Only limited data are available about ischemic stroke in pri-mary myopathies and the management of stroke-like episodes in mitochondrial disorders. This review aims to summarize and discuss current knowledge ...

  12. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... confirm the diagnosis. It may also show other knee injuries. First aid for an ACL injury may include: ...

  13. Inflammatory Disequilibrium in Stroke.

    Science.gov (United States)

    Petrovic-Djergovic, Danica; Goonewardena, Sascha N; Pinsky, David J

    2016-06-24

    Over the past several decades, there have been substantial advances in our knowledge of the pathophysiology of stroke. Understanding the benefits of timely reperfusion has led to the development of thrombolytic therapy as the cornerstone of current management of ischemic stroke, but there remains much to be learned about mechanisms of neuronal ischemic and reperfusion injury and associated inflammation. For ischemic stroke, novel therapeutic targets have continued to remain elusive. When considering modern molecular biological techniques, advanced translational stroke models, and clinical studies, a consistent pattern emerges, implicating perturbation of the immune equilibrium by stroke in both central nervous system injury and repair responses. Stroke triggers activation of the neuroimmune axis, comprised of multiple cellular constituents of the immune system resident within the parenchyma of the brain, leptomeninges, and vascular beds, as well as through secretion of biological response modifiers and recruitment of immune effector cells. This neuroimmune activation can directly impact the initiation, propagation, and resolution phases of ischemic brain injury. To leverage a potential opportunity to modulate local and systemic immune responses to favorably affect the stroke disease curve, it is necessary to expand our mechanistic understanding of the neuroimmune axis in ischemic stroke. This review explores the frontiers of current knowledge of innate and adaptive immune responses in the brain and how these responses together shape the course of ischemic stroke. PMID:27340273

  14. Neurorestoration after stroke.

    Science.gov (United States)

    Azad, Tej D; Veeravagu, Anand; Steinberg, Gary K

    2016-05-01

    Recent advancements in stem cell biology and neuromodulation have ushered in a battery of new neurorestorative therapies for ischemic stroke. While the understanding of stroke pathophysiology has matured, the ability to restore patients' quality of life remains inadequate. New therapeutic approaches, including cell transplantation and neurostimulation, focus on reestablishing the circuits disrupted by ischemia through multidimensional mechanisms to improve neuroplasticity and remodeling. The authors provide a broad overview of stroke pathophysiology and existing therapies to highlight the scientific and clinical implications of neurorestorative therapies for stroke. PMID:27132523

  15. PET studies of stroke

    International Nuclear Information System (INIS)

    PET already has been helpful in ischemic stroke disease. It has given us new data on physiological events occurring after a stroke; PET indices of blood flow and metabolism have provided the basis for staging the severity of tissue injury and predicting outcome, and PET has shown alterations in tissue function in response to therapy. Experience with PET in hemorrhagic disease is more limited, but initial results suggest a useful role for PET in the evaluation of nontraumatic intracranial hemorrhage as well [Ackerman et al., 1983a]. This brief review discusses general problems in the study of stroke disease using PET and then the contribution of PET to the stroke field

  16. Heart Disease and Stroke Prevention

    Science.gov (United States)

    ... disease and stroke prevention Heart Health and Stroke Heart disease and stroke prevention Related information Learn more about ... well-being. Does menopausal hormone therapy (MHT) prevent heart disease? Once you reach menopause, your ovaries stop making ...

  17. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    2008-01-01

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (

  18. Circulation economics

    DEFF Research Database (Denmark)

    Ingebrigtsen, Stig; Jakobsen, Ove

    2006-01-01

    Purpose - This paper is an attempt to advance the critical discussion regarding environmental and societal responsibility in economics and business. Design/methodology/approach - The paper presents and discusses as a holistic, organic perspective enabling innovative solutions to challenges...... concerning the responsible and efficient use of natural resources and the constructive interplay with culture. To reach the goal of sustainable development, the paper argues that it is necessary to make changes in several dimensions in mainstream economics. This change of perspective is called a turn towards...... presupposes a perspective integrating economic, natural and cultural values. Third, to organize the interplay between all stakeholders we introduce an arena for communicative cooperation. Originality/value - The paper concludes that circulation economics presupposes a change in paradigm, from a mechanistic...

  19. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.;

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  20. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  1. Anterior Cruciate Ligament Injury

    OpenAIRE

    Vilaseca, Tomas; Chahla, Jorge; Rodriguez, Gustavo Gomez; Arroquy, Damián; Herrera, Gonzalo Perez; Orlowski, Belen; Carboni, Martín

    2015-01-01

    Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational...

  2. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  3. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  4. Stroke (For Kids)

    Science.gov (United States)

    ... on how bad the stroke was and how healthy the person was before the stroke. People who have had ... talk with someone if you have questions or worries about someone who has had a ... you love, especially if this person isn't able to do stuff with you ...

  5. GANGGUAN MOOD PADA STROKE

    Directory of Open Access Journals (Sweden)

    Gabriella Tantular

    2015-10-01

    Full Text Available Stroke adalah salah satu sindrom neurologi yang dapat menimbulkan kecacatan dalam kehidupanmanusia. Salah  satu gejala yang dapat  timbul  setelah  seseorang  terkena  stroke adalah gangguanmood. Gangguan mood berhubungan dengan disabilitas fisik, beratnya stroke dan gangguan kognitif.Gangguan mood yang ditemukan pada stroke adalah depresi, gangguan afektif bipolar dan mania.Gambaran  gejala  berhubungan dengan  lesi  anatomis  stroke. Terapi  yang diberikan dapat  berupafarmakologis, psikoterapi, dan rehabilitasi. [MEDICINA 2015;46:33-36].Stroke is one of neurology syndrome that cause disability in human life. One of the symptoms thatappear after stroke was mood disorder. Mood disorder were related to physical disability, severity ofstroke  and  cognitive  dysfunction. Mood  disorder  found  in  stroke was  depression,  affective  bipolardisorder, and mania. Symptoms were associated with anatomical lesion. Treatment for this disorderare pharmacologic treatment, psychotherapy, and rehabilitation. [MEDICINA 2015;46:33-36].

  6. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech;

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed in...... the golf stroke of a professional golfer....

  7. Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

    Directory of Open Access Journals (Sweden)

    Heitor Castelo Branco Rodrigues Alves

    2016-01-01

    Full Text Available ABSTRACT Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

  8. Hyperacute cognitive stroke syndromes.

    Science.gov (United States)

    Ferro, J M

    2001-10-01

    Cognitive syndromes are common clinical manifestations of hyperacute stroke and may be the single or dominant presenting features. They are related to acute dysfunction of complex integrated distributed functional networks serving different cognitive domains. The most common cortical syndromes include nonfluent or fluent aphasia, neglect, collor agnosia, pure alexia and Balint's syndrome. Disturbances of declarative memory are common following posterior cerebral artery and thalamic strokes. Abulia can follow thalamic, caudate and capsular lesions. Intraventricular and subarachnoid haemorrhages can cause preeminent neuropsychological changes. Disorientation is present in about 40% of acute stroke patients and delirium complicates the course of 25% of acute strokes. Some hyperacute cognitive stroke syndromes are useful indicators of later disability. Cognitive syndromes may pose special difficulties to neurology residents, unless formal teaching in neuropsychology and psychiatry is included in their training programs. PMID:11697519

  9. Stroke and Women

    Directory of Open Access Journals (Sweden)

    Gülçin Benbir

    2013-12-01

    Full Text Available OBJECTIVE: We aimed to investigate the differences in vascular risk factor and etiology of stroke in two sexes. METHODS: We reviewed the medical files of 2798 patients being followed-up in our Stroke Clinic between the years 1996-2011. The stroke subtypes and risk factors were recorded on the basis of clinical data, physical and neurological examinations, and neuroimaging findings. Data were collected in SPSS 11.5 system and Pearson chi-square and Mann-Whitney U tests were used for statistical analysis. RESULTS: Of a total of 2798 patients, 2564 patients (91,6% had ischemic stroke, and 234 of them (8,4% had hemorrhagic stroke. The mean follow-up duration was 50.2+42.7 months. Of whole study population, 1289 patients were women (46%, 1509 of them were men (54%. The analysis of stroke subtypes showed that the most common subtype was stroke of unknown etiology in both sexes. Following this, the most common subtype was atherothrombotic stroke in men, and cardioembolic stroke in women. Coronary heart disease was more common in men, while atrial fibrillation and other rhythm anomalies were more common in women. Smoking and alcohol consumption were more common in men. CONCLUSION: Our study showed that there are major differences in stroke subtypes and vascular risk factors. Better knowledge of these differences, as well as influencing factors, is of crucial value – in addition to the need of hormonal changes, pregnancy and depression to be better identified in women – for both primary and secondary prevention.

  10. The Influence of Laterality of Pharyngeal Bolus Passage on Dysphagia in Hemiplegic Stroke Patients

    OpenAIRE

    Kim, Min Seok; Lee, Seong Jae; Kim, Tae Uk; Seo, Dong Hyuk; Hyun, Jung Keun; Kim, Jae Il

    2012-01-01

    Objective To investigate swallowing laterality in hemiplegic patients with stroke and recovery of dysphagia according to the laterality. Method The sample was comprised of 46 dysphagic patients with hemiplegia after their first stroke. The sample's videofluoroscopic swallowing study (VFSS) was reviewed. Swallowing laterality was determined by the anterior-posterior view of VFSS. We measured width difference of barium sulfate liquid flow in the pharyngoesophageal segment. If there was double o...

  11. Anterior knee pain

    International Nuclear Information System (INIS)

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries

  12. The role of monocytes in ischemic stroke pathobiology: New avenues to explore

    Directory of Open Access Journals (Sweden)

    Ayman eElAli

    2016-02-01

    Full Text Available Ischemic stroke accounts for the majority of stroke cases and constitutes a major cause of death and disability in the industrialized world. Inflammation has been reported to constitute a major component of ischemic stroke pathobiology. In the acute phase of ischemic stroke, microglia, the resident macrophages of the brain, are activated, followed by several infiltration waves of different circulating immune cells into the brain. Among these circulating immune cells, monocytes have been shown to play a particularly important role. Following their infiltration, monocytes differentiate into potent phagocytic cells, monocyte-derived macrophages (MDMs in the ischemic brain. Initially, the presence of these cells was considered as marker of an exacerbated inflammatory response that contributes to brain damage. However, the recent reports are suggesting a more complex and multiphasic roles of these cells in ischemic stroke pathobiology. Monocytes constitute a heterogeneous group of cells, which comprises two major subsets in rodent and three major subsets in human. In both species, two equivalent subsets exist, the pro-inflammatory subset and the anti-inflammatory subset. Recent data have demonstrated that ischemic stroke differentially regulate monocyte subsets, which directly affect ischemic stroke pathobiology and may have direct implications in ischemic stroke therapies. Here we review the recent findings that addressed the role of different monocyte subsets in ischemic stroke pathobiology, and the implications on therapies.

  13. The anterior cingulate cortex

    Directory of Open Access Journals (Sweden)

    Pavlović D.M.

    2009-01-01

    Full Text Available The anterior cingulate cortex (ACC has a role in attention, analysis of sensory information, error recognition, problem solving, detection of novelty, behavior, emotions, social relations, cognitive control, and regulation of visceral functions. This area is active whenever the individual feels some emotions, solves a problem, or analyzes the pros and cons of an action (if it is a right decision. Analogous areas are also found in higher mammals, especially whales, and they contain spindle neurons that enable complex social interactions. Disturbance of ACC activity is found in dementias, schizophrenia, depression, the obsessive-compulsive syndrome, and other neuropsychiatric diseases.

  14. Stroke burden and stroke care system in Asia

    OpenAIRE

    Suwanwela, Nijasri C.; Niphon Poungvarin; the Asian Stroke Advisory Panel

    2016-01-01

    Background: Stroke is a major cause of death and disability. Asia is the largest and mostly populated continent of the world. The Asian Stroke Advisory Panel (ASAP) consists of stroke neurologists from 12 different countries in 13 Asian regions. It has been established for 17 years, and holds regular meetings for reviewing the stroke activities in Asia. It also helps in conducting several multinational research projects. This study is one of the ASAP projects and aims to explore stroke care s...

  15. Stroke and High Blood Pressure

    Science.gov (United States)

    ... Pressure Tools & Resources Stroke More Stroke and High Blood Pressure Updated:Jan 6,2015 Stroke is a leading ... heart disease and stroke. Start exploring today ! High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...

  16. Let's Talk about Ischemic Stroke

    Science.gov (United States)

    ... Tools & Resources Stroke More Let's Talk About Ischemic Stroke Updated:Dec 9,2015 The majority of strokes occur when blood vessels to the brain become ... cuts off blood flow to brain cells. A stroke caused by lack of blood reaching part of ...

  17. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer [West Virginia University Health Sciences Center, Interventional Neuroradiology (United States); Hobbs, Gerald R. [West Virginia University Health Sciences Center, Department of Community Medicine (United States)

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  18. The Migraine–Stroke Connection

    Science.gov (United States)

    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang

    2016-01-01

    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like headache and cerebrovascular disease. Future studies should be targeted on bidirectional influence of migraine on different stroke mechanisms and optimal prevention of stroke in migraine patients. PMID:27283278

  19. Argatroban versus aspirin plus clopidogrel in the treatment of acute ischemic stroke: a pilot, randomised, open-label study

    Directory of Open Access Journals (Sweden)

    Meng-chan LIU

    2015-07-01

    of patients in both groups were performed again after one-week treatment. There was no bleeding events (including intracranial hemorrhage and hemorrhage in other organs or impairment of hepatorenal function (P>0.05. 3. In both groups, OCSP classifications ofpatients were mainly divided into the partial anterior circulation infarction (PACI, lacunar infarction (LACI and posterior circulation infarction (POCI, while TOAST etiological analyses of patients were mainly large-artery atherosclerosis (LAA and small artery occlusion (SAO. In both groups, the neurological defects were improved after treatment, and there was no significant bleeding events during treatment period. There was no significant difference of NIHSS one week after enrollment between PACI subgroups (P>0.05, while better neurological improvement was showed in the POCI subgroup of argatroban group. Conclusions  Argatroban anticoagulant and combination antiplatelet therapy with aspirin plus clopidogrel can effectively improve neurological deficit of patients, reduce recurrence rate and deterioration of the illness in acute phase, and improve patients' daily activities (ADL. Argatroban therapy showed better neurological function improvement in the posterior circulation infarction patients. As a new anticoagulant drug, argatroban is safe in the treatment of acute ischemic stroke. For the patients who have infarction involving the posterior circulation, argatroban, as a more aggressive treatment, should be recommended. (The trial registered number: ChiCTRTRC-13003384 DOI: 10.11855/j.issn.0577-7402.2015.06.02

  20. Strokes in mitochondrial diseases

    Directory of Open Access Journals (Sweden)

    N V Pizova

    2012-06-01

    Full Text Available It is suggested that mitochondrial diseases might be identified in 22—33% of cryptogenic stroke cases in young subjects. The incidence of mitochondrial disorders in patients with stroke is unknown; it is 0.8 to 7.2% according to the data of some authors. The paper gives data on the prevalence, pathogenesis, and clinical manifestations of mitochondrial diseases, such as mitochondrial encephalopathy, lactic acidosis, and stroke-like syndrome (MELAS and insulin-like episodes; myoclonic epilepsy and ragged-red fibers (MERRF syndrome, and Kearns-Sayre syndrome (sporadic multisystem mitochondrial pathology.

  1. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke;

    2015-01-01

    BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients and...... attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls...

  2. Stroke: current concepts.

    Science.gov (United States)

    Albertson, Megan; Sharma, Jitendra

    2014-11-01

    Cerebrovascular accidents (CVAs) are the leading cause of disability and the fourth leading cause of death in the U.S. The WHO defines stroke as "rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours with no apparent cause other than of vascular origin." Strokes are subdivided into two major classifications: ischemic (80-87 percent) andhemorrhagic (13-20 percent). Ischemic strokes occur from thrombi, emboli, or global hypoperfusion. Hemorrhagic strokes are either parenchymal (10 percent of all strokes) or subarachnoid (3 percent of all strokes). There are a variety of recognized risk factors for stroke which include: age, race, family history, hypertension, diabetes mellitus, atherosclerosis, cardiac arrhythmias, prosthetic valves, hyperlipidemia, cigarette smoking, and others (drugs or hormones). The initial assessment of a patient suspected of stroke should be done quickly enough to ensure maximal reperfusion of brain tissue. The steps to achieve this goal are: 1) exclude an intracranial hemorrhage, 2) assess for contraindications to thrombolytics, 3) characterize the infarct. The workup for a patient should first include a history (especially the time when neurologic symptoms began), a physical exam (including the NIHSS), and imaging studies (to rule out hemorrhagic components). In addition, several lab studies can also be obtained including: PT/INR, glucose, complete blood count, metabolic panel, creatine kinase, ECG, echocardiogram, lipid panel, carotid Doppler, MRA or CTA. Acute management of a stroke is primarily focused on stabilizing the patient and allowing as much reperfusion as possible for at-risk brain tissue. Stroke management in the acute setting includes: use of thrombolytics if indicated, and re-assessment to monitor progression. Several trials have been completed in pursuit of safety and effectiveness of intra-arterial stroke therapy for patients outside the recommended thrombolytic time window

  3. Multidisciplinary management of anterior diastemata

    DEFF Research Database (Denmark)

    Furuse, Adilson Yoshio; Herkrath, Fernando José; Franco, Eduardo Jacomino;

    2007-01-01

    Anterior diastemata may compromise the harmony of a patient's smile. Consideration of etiologic factors, previous gingival conditioning, and individual treatment planning are essential in the proper management of anterior diastemata. An integrated orthodontic-restorative approach may enhance the...... aesthetic results when orthodontic therapy itself is not feasible. This article presents integrated orthodonticrestorative solutions of anterior diastemata, associated with the conditioning of the gingival tissue with composite resin, and discusses the most relevant aspects related to their etiology and...

  4. Hypertension and experimental stroke therapies

    OpenAIRE

    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W.

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

  5. T2* "susceptibility vessel sign" demonstrates clot location and length in acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Olivier Naggara

    Full Text Available OBJECTIVES: The aim of our study was to evaluate, in acute ischemic stroke patients, the diagnostic accuracy of the MRI susceptibility vessel sign (SVS against catheter angiography (DSA for the detection of the clot and its value in predicting clot location and length. MATERIALS AND METHODS: We identified consecutive patients (2006-2012 admitted to our center, where 1.5 T MRI is systematically implemented as first-line diagnostic work-up, with: (1 pre-treatment 6-mm-thick multislice 2D T2* sequence; (2 delay from MRI-to-DSA 94%. Inter- and intra-observer ICC was excellent for clot length as measured on T2* (ĸ ≥ 0.97 and as measured on DSA (ĸ ≥ 0.94. Correlation between T2* and DSA for clot length was excellent (ICC: 0.88, 95%CI: 0.81-0.92; Bland & Altman: mean bias of 1.6% [95%CI: -4.7 to 7.8%], Passing & Bablok: 0.91. CONCLUSIONS: SVS is a specific marker of clot location in the anterior and posterior circulation. Clot length greater than 6 mm can be reliably measured on T2*.

  6. Stroke Statistics in Korea: Part II Stroke Awareness and Acute Stroke Care, A Report from the Korean Stroke Society and Clinical Research Center For Stroke

    OpenAIRE

    Hong, Keun-Sik; Bang, Oh Young; Kim, Jong S.; Heo, Ji Hoe; Yu, Kyung-Ho; Bae, Hee-Joon; Kang, Dong-Wha; Lee, Jin Soo; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Yoon, Byung-Woo

    2013-01-01

    The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public's knowledge of stroke definition, risk factors, warning signs, and act on stroke generally remains low. According to studies using open-ended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than...

  7. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients with...... other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex was not...... involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  8. Stroke Briefing: Technical Documentation

    OpenAIRE

    Institute of Public Health in Ireland

    2012-01-01

    A stroke happens when blood flow to a part of the brain is interrupted by a blocked or burst blood vessel. A lack of blood supply can damage brain cells and affect body functions. IPH has systematically estimated and forecast the prevalence of stroke on the island of Ireland. This document details the methods used to calculate these estimates and forecasts. Technical documentation      

  9. Neonatal Stroke : Risk Factors

    OpenAIRE

    2005-01-01

    Neonatal stroke refers to cerebrovascular events between 28 weeks of gestational age and 28 days postnatal and includes thromboembolic cerebral infarction and all kinds of intracranial haemorrhage. Neonatal stroke may contribute to severe neurological deficit, such as cerebral palsy and even death. International reports suggest the incidence to be approximately 1/4000 live births per year (1). There are several etiological hypothesises regarding risk factors, such as maternal, obstetrical...

  10. Dysphagia in stroke patients

    OpenAIRE

    Singh, S; Hamdy, S.

    2006-01-01

    Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non‐dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dy...

  11. Anterior cruciate ligament reconstruction

    International Nuclear Information System (INIS)

    This paper determines the efficacy of MR imaging in evaluation of the anterior cruciate ligament (ACL) following reconstructive surgery. Forty-three MR examinations were performed in 33 patients who had undergone previous arthroscopic ACL reconstruction with patellar bone-tendon- bone autografts (postoperative period, 1-24 months; mean, 5.2 months). Of the 40 studies performed in clinically stable knees (30 patients), MR demonstrated a well-defined, signal void ACL graft in 36. Of the three studies performed in three patients with clinical ACL laxity or suspected tear, the neoligament was of intermediate definition in one and nondiscernible in the other two. As in the native knee, buckling of the PCL was suggestive of ACL insufficiency. Bone tunnel placement, patellar tendon changes, and joint effusions were also evaluated

  12. Anterior hip pain.

    Science.gov (United States)

    O'Kane, J W

    1999-10-15

    Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity. PMID:10537384

  13. The anterior temporal lobes support residual comprehension in Wernicke's aphasia.

    Science.gov (United States)

    Robson, Holly; Zahn, Roland; Keidel, James L; Binney, Richard J; Sage, Karen; Lambon Ralph, Matthew A

    2014-03-01

    Wernicke's aphasia occurs after a stroke to classical language comprehension regions in the left temporoparietal cortex. Consequently, auditory-verbal comprehension is significantly impaired in Wernicke's aphasia but the capacity to comprehend visually presented materials (written words and pictures) is partially spared. This study used functional magnetic resonance imaging to investigate the neural basis of written word and picture semantic processing in Wernicke's aphasia, with the wider aim of examining how the semantic system is altered after damage to the classical comprehension regions. Twelve participants with chronic Wernicke's aphasia and 12 control participants performed semantic animate-inanimate judgements and a visual height judgement baseline task. Whole brain and region of interest analysis in Wernicke's aphasia and control participants found that semantic judgements were underpinned by activation in the ventral and anterior temporal lobes bilaterally. The Wernicke's aphasia group displayed an 'over-activation' in comparison with control participants, indicating that anterior temporal lobe regions become increasingly influential following reduction in posterior semantic resources. Semantic processing of written words in Wernicke's aphasia was additionally supported by recruitment of the right anterior superior temporal lobe, a region previously associated with recovery from auditory-verbal comprehension impairments. Overall, the results provide support for models in which the anterior temporal lobes are crucial for multimodal semantic processing and that these regions may be accessed without support from classic posterior comprehension regions. PMID:24519979

  14. The impact of stroke on emotional intelligence

    Directory of Open Access Journals (Sweden)

    Hoffmann Bronwyn

    2010-10-01

    Full Text Available Abstract Background Emotional intelligence (EI is important for personal, social and career success and has been linked to the frontal anterior cingulate, insula and amygdala regions. Aim To ascertain which stroke lesion sites impair emotional intelligence and relation to current frontal assessment measurements. Methods One hundred consecutive, non aphasic, independently functioning patients post stroke were evaluated with the Bar-On emotional intelligence test, "known as the Emotional Quotient Inventory (EQ-i" and frontal tests that included the Wisconsin Card Sorting Test (WCST and Frontal Systems Behavioral Inventory (FRSBE for correlational validity. The results of a screening, bedside frontal network syndrome test (FNS and NIHSS to document neurological deficit were also recorded. Lesion location was determined by the Cerefy digital, coxial brain atlas. Results After exclusions (n = 8, patients tested (n = 92, mean age 50.1, CI: 52.9, 47.3 years revealed that EQ-i scores were correlated (negatively with all FRSBE T sub-scores (apathy, disinhibition, executive, total, with self-reported scores correlating better than family reported scores. Regression analysis revealed age and FRSBE total scores as the most influential variables. The WCST error percentage T score did not correlate with the EQ-i scores. Based on ANOVA, there were significant differences among the lesion sites with the lowest mean EQ-i scores associated with temporal (71.5 and frontal (87.3 lesions followed by subtentorial (91.7, subcortical gray (92.6 and white (95.2 matter, and the highest scores associated with parieto-occipital lesions (113.1. Conclusions 1 Stroke impairs EI and is associated with apathy, disinhibition and executive functioning. 2 EI is associated with frontal, temporal, subcortical and subtentorial stroke syndromes.

  15. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... and E-poly antioxidant-infused technology during a hip replacement through the anterior supine intramuscular approach. “OR- ... Dr. Keith Berend perform an anterior approach total hip replacement with the patient on a regular OR ...

  16. What You Need to Know about Stroke

    Science.gov (United States)

    ... mailed brochure What You Need to Know About Stroke Table of Contents Know Stroke Why is Stroke ... a healthy diet and exercising regularly. WHY IS STROKE TREATMENT URGENT? Every minute counts. The longer blood ...

  17. Patient's Guide to Antithrombotic Therapy in Stroke

    Science.gov (United States)

    ... bleeding into the brain. This is called a“hemorrhagic” stroke (see section C). ! Patients who have had strokes ... intermittent compression devices. C. Bleeding in the Brain (Hemorrhagic Stroke) 1. What is a hemorrhagic stroke? ! A hemorrhagic ...

  18. Stroke risk perception among participants of a stroke awareness campaign

    OpenAIRE

    Heuschmann Peter U; Heidrich Jan; Kraywinkel Klaus; Wagner Markus; Berger Klaus

    2007-01-01

    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  19. Hubungan Stres dan Sleep Stroke dengan Outcome Stroke

    OpenAIRE

    Surya, Anita

    2015-01-01

    Backgound and Purpose : The vascular events could be precipitated by acute factors, called triggers like acute stressors, such as stressful life events, might trigger stroke. Almost every fifth stroke occurs during the night, and patients wake from sleep with their handicap, having gone to sleep with no neurologic deficit. to investigate the association of known vascular risk factors with stroke occurring during sleep with first-ever stroke. Methods : We conducted a cross-sectional study o...

  20. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    International Nuclear Information System (INIS)

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66±17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb

  1. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring facilit

  2. An Economic Evaluation Comparing Stroke Telemedicine to Conventional Stroke Medicine

    Science.gov (United States)

    Budhram, Stanley Chandra

    2011-01-01

    Stroke is not only a serious medical problem, but it also poses an enormous economic burden on society. Stroke ranks the third as the leading cause of death in the United States behind heart disease and cancer. The survivors of stroke suffer from various degrees of long-term disability which create a severe financial burden on society. University…

  3. Echocardiographic Findings And Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Natalya Gamletovna Dadamyants

    2011-10-01

    Full Text Available In order to study cardiac pathology in different subtypes of ischemic stroke we examined 165 stroke patients. The 1st group included 90 (54.5% patients with hemodynamic stroke, the 2nd one - 75 (45.5% patients with cardioembolic stroke. Control group consisted of 45 individuals without cerebrovascular diseases. Cardiac pathologies with the prevalence of various types of ischemic heart disease were observed in all groups. The parameters of left ventricular stroke volume and ejection fraction were lower in patients with hemodynamic stroke than in other groups, but were within normal limits. Potential sources of cardiogenic embolism were found in all groups: in the 1st group at 74.4%, in the 2nd one at 100%. Thus, most patients with ischemic stroke have different heart defects related to the subtypes of ischemic stroke

  4. Stroke rehabilitation and discharge planning.

    Science.gov (United States)

    Kerr, Peter

    Nurses play a pivotal role in the rehabilitation and discharge planning process of patients who have had a stroke. The nurse's role in the wider stroke multidisciplinary team is complex and diverse and, as such, stroke nurses may find it hard to describe their role and how it fits into the rehabilitation and discharge planning process. A definition of the stroke nurse role in prominent publications such as those of the Scottish Intercollegiate Guidelines Network and the Royal College of Physicians is lacking. This article emphasises the role of the stroke nurse in the rehabilitation and discharge planning process in the stroke unit, while highlighting the complexity, diversity and importance of this role in providing holistic care and support for patients who have survived a stroke. The author draws on his clinical experience of stroke nursing practice in primary, secondary and tertiary care in west central Scotland. PMID:23082362

  5. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann;

    2013-01-01

    , 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend < 0.001), and decreased over the period 2000-2001 to 2006-2008 (ICH: from 53.1% to 35.8%, p-trend < 0.001; SAH: from 33.3% to 24.7%, p-trend = 0.02). Risk of death was significantly higher among stroke patients...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated...

  6. Microwave hemorrhagic stroke detector

    Energy Technology Data Exchange (ETDEWEB)

    Haddad, Waleed S. (Dublin, CA); Trebes, James E. (Livermore, CA)

    2002-01-01

    The microwave hemorrhagic stroke detector includes a low power pulsed microwave transmitter with a broad-band antenna for producing a directional beam of microwaves, an index of refraction matching cap placed over the patients head, and an array of broad-band microwave receivers with collection antennae. The system of microwave transmitter and receivers are scanned around, and can also be positioned up and down the axis of the patients head. The microwave hemorrhagic stroke detector is a completely non-invasive device designed to detect and localize blood pooling and clots or to measure blood flow within the head or body. The device is based on low power pulsed microwave technology combined with specialized antennas and tomographic methods. The system can be used for rapid, non-invasive detection of blood pooling such as occurs with hemorrhagic stroke in human or animal patients as well as for the detection of hemorrhage within a patient's body.

  7. Brain plasticity and stroke recovery

    OpenAIRE

    Laaksonen, Kristina

    2012-01-01

    Brain plasticity and stroke recovery Recovery from stroke is based on the capability of the brain to reorganize its structure and function after lesion. An acute stroke triggers a cascade of time-dependent metabolic and physiological reactions, which enable changes in the organization and function of widespread cortical regions. A wide range of studies, using various functional imaging methods, have thrown light on the reorganizational changes after stroke. However, less is known about t...

  8. Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Wen-Jie Zi

    Full Text Available BACKGROUND: It has been suggested that modestly elevated circulating D-dimer values may be associated with acute ischemic stroke (AIS. Thus, the purpose of this study was to investigate the association between plasma D-dimer level at admission and AIS in Chinese population. METHODS: In a prospective observational study, plasma D-dimer levels were measured using a particle-enhanced, immunoturbidimetric assay on admission in 240 Chinese patients with AIS. The National Institutes of Health Stroke Scale (NIHSS score was assessed on admission blinded to D-dimer levels. RESULTS: Plasma median D-dimer levels were significantly (P = 0.000 higher in AIS patients as compared to healthy controls (0.88; interquartiler range [IQR], 0.28-2.11 mg/L and 0.31; IQR, 0.17-0.74 mg/L. D-dimer levels increased with increasing severity of stroke as defined by the NIHSS score(r = 0.179, p = 0.005 and infarct volume(r = 0.425, p = 0.000. Those positive trends still existed even after correcting for possible confounding factors (P = 0.012, 0.000; respectively. Based on the Receiver operating characteristic (ROC curve, the optimal cut-off value of plasma D-dimer levels as an indicator for diagnosis of cardioembolic strokes was projected to be 0.91 mg/L, which yielded a sensitivity of 83.7% and a specificity of 81.5%, the area under the curve was 0.862(95% confidence interval [CI], 0.811-0.912. CONCLUSION: We had shown that plasma D-dimer levels increased with increasing severity of stroke as defined by the NIHSS score and infarct volume. These associations were independent other possible variables. In addition, cardioembolic strokes can be distinguished from other stroke etiologies by measuring plasma D-dimer levels very early (0-48 hours from stroke symptom onset.

  9. Stroke and neuroplasticity

    OpenAIRE

    Zavoreo, Iris; Bašić-Kes, Vanja; Demarin, Vida

    2012-01-01

    Stroke is one of the leading causes of mortality and disability in modern countries. Clinical manifestation of stroke is rapidly developing loss of brain function due to disturbance in the blood supply to the brain. Neuroplasticity, also known as cortical mapping, challenges the idea that brain functions are fixed in certain time. It refers to ability of the human brain to change as result of one’s experience, that the brain is »plastic« and »flexible«. Neuroplasticity can act through two pos...

  10. Biotherapies in stroke.

    Science.gov (United States)

    Detante, O; Jaillard, A; Moisan, A; Barbieux, M; Favre, I M; Garambois, K; Hommel, M; Remy, C

    2014-12-01

    Stroke is the second leading cause of death worldwide and the most common cause of severe disability. Neuroprotection and repair mechanisms supporting endogenous brain plasticity are often insufficient to allow complete recovery. While numerous neuroprotective drugs trials have failed to demonstrate benefits for patients, they have provided interesting translational research lessons related to neurorestorative therapy mechanisms in stroke. Stroke damage is not limited to neurons but involve all brain cell type including the extracellular matrix in a "glio-neurovascular niche". Targeting a range of host brain cells, biotherapies such as growth factors and therapeutic cells, currently hold great promise as a regenerative medical strategy for stroke. These techniques can promote both neuroprotection and delayed neural repair through neuro-synaptogenesis, angiogenesis, oligodendrogliogenesis, axonal sprouting and immunomodulatory effects. Their complex mechanisms of action are interdependent and vary according to the particular growth factor or grafted cell type. For example, while "peripheral" stem or stromal cells can provide paracrine trophic support, neural stem/progenitor cells (NSC) or mature neurons can act as more direct neural replacements. With a wide therapeutic time window after stroke, biotherapies could be used to treat many patients. However, guidelines for selecting the optimal time window, and the best delivery routes and doses are still debated and the answers may depend on the chosen product and its expected mechanism including early neuroprotection, delayed neural repair, trophic systemic transient effects or graft survival and integration. Currently, the great variety of growth factors, cell sources and cell therapy products form a therapeutic arsenal that is available for stroke treatment. Their effective clinical use will require prior careful considerations regarding safety (e.g. tumorgenicity, immunogenicity), potential efficacy, cell

  11. Stroke and Episodic Memory Disorders

    Science.gov (United States)

    Lim, Chun; Alexander, Michael P.

    2009-01-01

    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  12. Personal accounts of stroke experiences

    NARCIS (Netherlands)

    Wachters-Kaufmann, CSM

    2000-01-01

    As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics

  13. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... Taperloc Microplasty stem and E-poly antioxidant-infused technology during a hip replacement through the anterior supine ... renewed interest at this time due to several advantages that it brings. The approach that is performed ...

  14. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... an anterior approach total hip replacement with the patient on a regular OR table supine. My name ... less invasive without being small incision surgery. Obese patients can be easier due to less distribution of ...

  15. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... it to have any real negative or deleterious effect by removing the anterior capsule. Now I would ... is what happens with one of the competitive designs. Like I told you, I just take a ...

  16. Anterior approach for knee arthrography

    International Nuclear Information System (INIS)

    Objective. To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy.Design. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected.Results and conclusion. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort. (orig.)

  17. The infarction patterns and the compensatory effect of collateral circulation in patients with internal carotid artery occlusion: a correlative study

    International Nuclear Information System (INIS)

    Objective: To investigate the infarction patterns and the collateral circulation in patients with internal carotid artery occlusion with diffusion-weighted imaging and DSA, to analyze the mechanism of stroke caused by internal carotid artery occlusion and to discuss the correlation between the infarction patterns and the compensatory effect of collateral circulation. Methods: A total of 45 patients with acute cerebral infarction due to DSA-confirmed unilateral internal carotid artery occlusion, who were admitted to the hospital during the period from Jan. 2009 to Sep. 2010, were enrolled in this study. Diffusion-weighted imaging and DSA were performed in all patients. The infarction regions and the findings of PCoA/ACoA were recorded, and the ipsilateral infarction patterns were evaluated. The relationship between the infarction patterns and the compensatory effect of collateral circulation was statistically analyzed. Results: The ipsilateral infarction patterns caused by internal carotid artery occlusion were classified as small cortical infarcts (84.4%), internal watershed infarcts (48.9%), territory infarcts (46.7%), posterior watershed infarcts (22.2%), anterior watershed infarcts (13.3%), perforating artery infarcts (22.2%). Among them, 23 patients had small cortical infarcts together with cerebral watershed infarcts (60.5%). No territory infarcts were found in the patients with patent ACoA (0%, P=0.013), while 91.7% of the patients showing no patent PCoA and/or ACoA had territory infarcts (11/12, p=0.003). Conclusion: Both artery-to-artery embolism and hypoperfusion with impaired emboli clearance are involved in the mechanism of ipsilateral infarctions caused by internal carotid artery occlusion. Patent ACoA can reduce the incidence of territory infarcts, and it maybe protect patients from territory infarcts. (authors)

  18. Travoprost Induced Granulomatous Anterior Uveitis

    OpenAIRE

    Patrick Chiam

    2011-01-01

    Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was att...

  19. Update on anterior ankle impingement

    OpenAIRE

    Vaseenon, Tanawat; Amendola, Annunziato

    2012-01-01

    Anterior ankle impingement results from an impingement of the ankle joint by a soft tissue or osteophyte formation at the anterior aspect of the distal tibia and talar neck. It often occurs secondary to direct trauma (impaction force) or repetitive ankle dorsiflexion (repetitive impaction and traction force). Chronic ankle pain, swelling, and limitation of ankle dorsiflexion are common complaints. Imaging is valuable for diagnosis of the bony impingement but not for the soft tissue impingemen...

  20. Anterior chamber depth during hemodialysis

    Directory of Open Access Journals (Sweden)

    Gracitelli CPB

    2013-08-01

    Full Text Available Carolina Pelegrini Barbosa Gracitelli,1 Francisco Rosa Stefanini,1 Fernando Penha,1 Miguel Ângelo Góes,2 Sérgio Antonio Draibe,2 Maria Eugênia Canziani,2 Augusto Paranhos Junior1 1Ophthalmology Department, 2Division of Nephrology, Federal University of São Paulo – UNIFESP, São Paulo, Brazil Background: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD because of anterior chamber depth changes during this therapy. Purpose: To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results: There was no difference in the axial length between the three measurements (P = 0.241. We observed a significantly decreased anterior chamber depth (P = 0.002 during HD sessions. Conclusion: Our results support the idea that there is a change in anterior chamber depth in HD sessions. Keywords: anterior chamber, hemodialysis, axial length, acute angle-closure glaucoma

  1. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought of...

  2. Selection of Patients and Anesthetic Types for Endovascular Treatment in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Fubing Ouyang

    Full Text Available and Purpose Recent randomized controlled trials have demonstrated consistent effectiveness of endovascular treatment (EVT for acute ischemic stroke, leading to update on stroke management guidelines. We conducted this meta-analysis to assess the efficacy and safety of EVT overall and in subgroups stratified by age, baseline stroke severity, brain imaging feature, and anesthetic type.Published randomized controlled trials comparing EVT and standard medical care alone were evaluated. The measured outcomes were 90-day functional independence (modified Rankin Scale ≤2, all-cause mortality, and symptomatic intracranial hemorrhage.Nine trials enrolling 2476 patients were included (1338 EVT, 1138 standard medical care alone. For patients with large vessel occlusions confirmed by noninvasive vessel imaging, EVT yielded improved functional outcome (pooled odds ratio [OR], 2.02; 95% confidence interval [CI], 1.64-2.50, lower mortality (OR, 0.75; 95% CI, 0.58-0.97, and similar symptomatic intracranial hemorrhage rate (OR, 1.12; 95% CI, 0.72-1.76 compared with standard medical care. A higher proportion of functional independence was seen in patients with terminus intracranial artery occlusion (±M1 (OR, 3.16; 95% CI, 1.64-6.06, baseline Alberta Stroke Program Early CT score of 8-10 (OR, 2.11; 95% CI, 1.25-3.57 and age ≤70 years (OR, 3.01; 95% CI, 1.73-5.24. EVT performed under conscious sedation had better functional outcomes (OR, 2.08; 95% CI, 1.47-2.96 without increased risk of symptomatic intracranial hemorrhage or short-term mortality compared with general anesthesia.Vessel-imaging proven large vessel occlusion, a favorable scan, and younger age are useful predictors to identify anterior circulation stroke patients who may benefit from EVT. Conscious sedation is feasible and safe in EVT based on available data. However, firm conclusion on the choice of anesthetic types should be drawn from more appropriate randomized controlled trials.

  3. Heart Disease and Stroke

    Centers for Disease Control (CDC) Podcasts

    2013-09-03

    In this podcast, Dr. Tom Frieden, CDC Director, discusses the number one killer in the United States - heart disease and stroke.  Created: 9/3/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 3/6/2014.

  4. Ischemic strokes and migraine

    International Nuclear Information System (INIS)

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG)

  5. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  6. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature is...... directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought of...

  7. [Therapy of acute ischemic stroke].

    Science.gov (United States)

    Sobesky, J

    2009-11-01

    New diagnostic and therapeutic developments have led to an innovative approach to stroke therapy. The slogan "time is brain" emphasizes that stroke is a medical emergency comparable to myocardial infarction. The stroke unit conception is an evidence based therapy for all stroke patients and improves outcome significantly. The monitoring of vital signs and the management of stroke specific complications are highly effective. Early secondary prophylaxis reduces the risk of recurrence. The effect of CT based thrombolysis within the time window of 4,5 h has been substantiated by current data. Stroke MRI holds the promise for an improved therapy by patient stratification and by opening the time window. Interventional recanalisation, vascular interventions and hemicraniectomy complement the therapeutic options in the acute phase of stroke. PMID:19838656

  8. Gangguan Psikotik Akibat Stroke Iskemik

    Directory of Open Access Journals (Sweden)

    Rini Gusya Liza

    2015-05-01

    Full Text Available AbstrakStroke atau yang disebut juga dengan penyakit serebrovaskuler berkontribusi terhadap timbulnya delusi dan halusinasi di kemudian hari.Pengobatan yang diberikan pada kondisi medis sering menghasilkan remisi dari psikosistetapi hal tersebut tidaklah selalu terjadi. Gejala psikosis dapat bertahan lama setelah kondisi medis yangmenyebabkannya sembuh. Dilaporkan seorang pasien yang mengalami gangguan psikotik setelah mengalami strokeiskemik. Gangguan psikotik akibat stroke iskemik merupakan suatu kasus dalam Consultation Liaison Psychiatry.Kata kunci: gangguan psikotik, stroke iskemik, delusi dan halusinasiAbstract Stroke or also called cerebrovascular disease contributed to the emergence of delusions and hallucinations inthe future. Treatment given to medical conditions often produce remission of psychosis but it is not always happen.Psychotic symptoms can persist longer after recovery.  Reported a patient who suffered a psychotic disorder afterischemic stroke. Psychotic disorders due to ischemic stroke is a case in Consultation Liaison PsychiatryKeywords: psychotic disorder, ischemic stroke, delusions and hallucinations

  9. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond

    2006-06-01

    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  10. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  11. Antigen-specific immune reactions to ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xabier eUrra

    2014-09-01

    Full Text Available Brain proteins are detected in the CSF and blood of stroke patients and their concentration is related to the extent of brain damage. Antibodies against brain antigens develop after stroke, suggesting a humoral immune response to the brain injury. Furthermore, induced immune tolerance is beneficial in animal models of cerebral ischemia. The presence of circulating T cells sensitized against brain antigens, and antigen presenting cells (APCs carrying brain antigens in draining lymphoid tissue of stroke patients support the notion that stroke might induce antigen-specific immune responses. After stroke, brain proteins that are normally hidden from the periphery, inflammatory mediators, and danger signals can exit the brain through several efflux routes. They can reach the blood after leaking out of the damaged blood-brain barrier or following the drainage of interstitial fluid to the dural venous sinus, or reach the cervical lymph nodes through the nasal lymphatics following CSF drainage along the arachnoid sheaths of nerves across the nasal submucosa. The route and mode of access of brain antigens to lymphoid tissue could influence the type of response. Central and peripheral tolerance prevents autoimmunity, but the actual mechanisms of tolerance to brain antigens released into the periphery in the presence of inflammation, danger signals, and APCs, are not fully characterized. Stroke does not systematically trigger autoimmunity, but under certain circumstances, such as pronounced systemic inflammation or infection, autoreactive T cells could escape the tolerance controls. Further investigation is needed to elucidate whether antigen-specific immune events could underlie neurological complications impairing stroke outcome.

  12. Stroke: indications for emergent surgical intervention.

    Science.gov (United States)

    Pikus, H J; Heros, R C

    1999-01-01

    As the brain attack message is disseminated throughout our medical community and the awareness of the public increases, neurosurgeons will have the opportunity to treat patients with stroke at a much earlier time in the evolution of the process than we have been accustomed. Are the relatively unimpressive results of acute surgical intervention in patients operated on later in the course of the disease applicable to those who seek medical attention early, within the first few hours of ictus? There is little firm data. However, there is an overwhelming amount of anecdotal and experimental evidence supporting the potential for ultra-early intervention, which frequently should be surgical. New surgical techniques may improve safety and feasibility of emergent operations. In the coming years, diagnostic techniques such as perfusion/diffusion magnetic resonance imaging will allow the clinician to determine who may benefit from intervention. These determinations will be made on physiological data, addressing the issues of tissue viability and degree of compromise of the blood-brain barrier. In the future, the window of opportunity for intervention will not be solely a function of time from ictus or a qualitative impression based on collateral circulation as extrapolated from angiography, transcranial Doppler, or magnetic resonance angiography. These new magnetic resonance imaging techniques, which are beginning to be tested clinically or are still in the developmental stages, will provide the functional data now provided by positron emission tomography and xenon computed tomography, but with improved sensitivity, specificity, and logistical ease. Neurosurgeons have been leaders in stroke care and have provided some of the most important experimental rationale for the brain attack concept. These contributions include demonstration of the ischemic penumbra, the importance of time and potential collateral circulation as factors determining viability of ischemic tissue, and

  13. Understanding Stroke - Know Stroke • Know the Signs • Act in Time

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section Understanding Stroke Know Stroke • Know the Signs • Act in Time Past Issues / ... Julie Harris, and motivational speaker David Layton. Preventing Stroke "Until I had my stroke, I didn't ...

  14. Challenging comparison of stroke scales

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2013-01-01

    Full Text Available Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS and Barthel index (BI are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.

  15. Travoprost Induced Granulomatous Anterior Uveitis

    Science.gov (United States)

    Chiam, Patrick

    2011-01-01

    Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was attempted in one eye. The inflammation recurred in this eye only. This subsided with the cessation of travoprost alone without topical steroid. Conclusion. This is the first case report of travoprost causing granulomatous anterior uveitis. The uveitis recurred with a rechallenge. Changing the prostaglandin analogue to another topical treatment may be adequate to cease the inflammation. PMID:22606464

  16. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  17. Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

    OpenAIRE

    Georgios K Matis; Chrysou, Olga I; Birbilis, Theodossios A.

    2013-01-01

    Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabi...

  18. Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand?

    OpenAIRE

    DEPLANQUE, D; Corea, F; Arquizan, C; Parnetti, L.; Mas, J.; Gallai, V.; Leys, D; the, S

    1999-01-01

    OBJECTIVE—To undertake a pilot study before conducting a large European multicentre prospective study, to determine the proportion of patients with atrial fibrillation who were not receiving antithrombotic treatment before stroke onset, and their characteristics.
DESIGN AND PATIENTS—The stroke in atrial fibrillation ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation consecutively admitted in 1997 to three European centres for an acute stroke ...

  19. Microwave hemorrhagic stroke detector

    Energy Technology Data Exchange (ETDEWEB)

    Haddad, Waleed S. (Dublin, CA); Trebes, James E. (Livermore, CA)

    2007-06-05

    The microwave hemorrhagic stroke detector includes a low power pulsed microwave transmitter with a broad-band antenna for producing a directional beam of microwaves, an index of refraction matching cap placed over the patients head, and an array of broad-band microwave receivers with collection antennae. The system of microwave transmitter and receivers are scanned around, and can also be positioned up and down the axis of the patients head. The microwave hemorrhagic stroke detector is a completely non-invasive device designed to detect and localize blood pooling and clots or to measure blood flow within the head or body. The device is based on low power pulsed microwave technology combined with specialized antennas and tomographic methods. The system can be used for rapid, non-invasive detection of blood pooling such as occurs with hemorrhagic stoke in human or animal patients as well as for the detection of hemorrhage within a patient's body.

  20. Family stroke education.

    Science.gov (United States)

    Evans, R L; Held, S; Kleinman, L; Halar, E M

    1985-01-01

    To increase families' involvement in rehabilitation, an informational session called Family Stroke Education Class was implemented at a 305 bed medical center serving disabled veterans and their families. After a year, a study of questionnaires completed by family and patients at the meetings showed that anxiety level about their illness had decreased significantly. Twenty-six (86.7 percent) of thirty participants felt more comfortable about approaching team members with questions in the future, and 76.7 percent felt more informed as a result of taking the class. Knowledge scores improved significantly on the post tests. Thus it appears that the educational format is a practical way of including the needs and soliciting participation of families as well as a means for providing basic information to patients on stroke rehabilitation. PMID:23952227

  1. MODEL PELAYANAN STROKE TERPADU DI RUMAH SAKIT ADI HUSADA UNDAAN WETAN SURABAYA

    Directory of Open Access Journals (Sweden)

    Koosnadi Saputra

    2012-11-01

    Full Text Available Stroke or brain attack is basically brain dysfunction as the effect of disparity on vascular circulation of the brain that caused by various factors. The basic aspect of the brain are influenced by various factors. The basic physiology and psychology aspects of the stroke is essential to understand, especially the correlation to underlying diseases and psychological stress as a social trigger aspect phenomenon. Although stroke could occur at all ages, generally it attacks adult people, and its incidence is increasing at the older age groups. Considering doctor needs to propmtly recognize the symptoms of stroke including its problems, as to manage the problems and to prevent are the most important things to do. The Adi Husada Undaan Wetan Hospital of Surabaya has built the Pelayanan Stroke Terpadu (PST as a system to manage stroke patients which composed of a stroke team specialists who work in prompt responses, prompt treatments and prompt rehabilitation. The PST was developed based on experiences on stroke patient treatment during 12 year period (1 994-2006 in Adi Husada Hospital Surabaya and the data of computerized axial tomography comparing•year 1995 to 2006 (pre-programof the PST condition. Key words:

  2. Chloride channels in stroke

    Institute of Scientific and Technical Information of China (English)

    Ya-ping ZHANG; Hao ZHANG; Dayue Darrel DUAN

    2013-01-01

    Vascular remodeling of cerebral arterioles,including proliferation,migration,and apoptosis of vascular smooth muscle cells (VSMCs),is the major cause of changes in the cross-sectional area and diameter of the arteries and sudden interruption of blood flow or hemorrhage in the brain,ie,stroke.Accumulating evidence strongly supports an important role for chloride (Clˉ) channels in vascular remodeling and stroke.At least three Clˉ channel genes are expressed in VSMCs:1) the TMEM16A (or Ano1),which may encode the calcium-activated Clˉ channels (CACCs); 2) the CLC-3 Clˉ channel and Clˉ/H+ antiporter,which is closely related to the volume-regulated Clˉ channels (VRCCs); and 3) the cystic fibrosis transmembrane conductance regulator (CFTR),which encodes the PKA-and PKC-activated Clˉ channels.Activation of the CACCs by agonist-induced increase in intracellular Ca2+ causes membrane depolarization,vasoconstriction,and inhibition of VSMC proliferation.Activation of VRCCs by cell volume increase or membrane stretch promotes the production of reactive oxygen species,induces proliferation and inhibits apoptosis of VSMCs.Activation of CFTR inhibits oxidative stress and may prevent the development of hypertension.In addition,Clˉ current mediated by gammaaminobutyric acid (GABA) receptor has also been implicated a role in ischemic neuron death.This review focuses on the functional roles of Clˉ channels in the development of stroke and provides a perspective on the future directions for research and the potential to develop Clˉ channels as new targets for the prevention and treatment of stroke.

  3. Ischemic stroke following abuse of Marijuana in a Nigerian adult male

    Directory of Open Access Journals (Sweden)

    Olalekan Oyinloye

    2014-01-01

    Full Text Available Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies.

  4. Ischemic stroke following abuse of Marijuana in a Nigerian adult male.

    Science.gov (United States)

    Oyinloye, Olalekan; Nzeh, Donald; Yusuf, Ayodeji; Sanya, Emmanuel

    2014-10-01

    Cannabis is the most widely used illicit drug among adolescents and young adults. Despite its widespread use, only a few reports exist on the association of cannabis use and stroke. A 26-year-old Nigerian male, developed right-sided ischemic stroke few hours after smoking three wraps of cannabis. He had smoked cannabis consistently for the past 4 years prior to the development of the stroke. Known stroke etiology and abuse of other illicit drugs were ruled out from history and investigations. Neuroimaging studies of the brain revealed infarcts in basal ganglia secondary to occlusion of blood flow in the left anterior and middle cerebral arteries. The mechanism of stroke in this patient was thought to be a cannabis-induced vasculopathy. Many cases of stroke in the young are increasingly being seen in hospitals in resource scarce countries. There seems to be a predilection for the basal ganglia in ischemic stroke following cannabis abuse. Therefore, cannabis abuse should be considered in young adults with basal ganglia infarcts, after excluding other known etiologies. PMID:25288854

  5. Factors associated with post-stroke depression and emotional incontinence: lesion location and coping styles.

    Science.gov (United States)

    Wei, Changjuan; Gao, Juan; Chen, Li; Zhang, Fang; Ma, Xiaofeng; Zhang, Nan; Zhang, Wei; Xue, Rong; Luo, Lanlan; Hao, Junwei

    2016-07-01

    Post-stroke depression (PSD) and post-stroke emotional incontinence (PSEI) have attracted worldwide interest in recent years. These emotional disturbances have a negative impact on the rehabilitation process and the associated worse outcome. Consequently, defining the risk factors for development of PSD and PSEI is important. In this study, we evaluated 368 consecutive patients with acute ischemic stroke at admission and at three months later. PSD was evaluated by using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Multivariate analyses showed that anterior cortex infarction was associated with PSEI three months after stroke occurrence. The appearance of PSD was not related to lesion location. Both motor and sensory dysfunctions was independently associated with PSD at admission, whereas low degree of social utilization was the independent factor associated with PSD 3 months after stroke. Acceptance-resignation is related to PSD and PSEI both at admission and 3 months after stroke. Avoidance was the independent factor related to PSD at 3 months after stroke onset. PMID:26005045

  6. Calorie restriction and stroke

    Directory of Open Access Journals (Sweden)

    Manzanero Silvia

    2011-09-01

    Full Text Available Abstract Stroke, a major cause of disability and mortality in the elderly, occurs when a cerebral blood vessel is occluded or ruptured, resulting in ischemic damage and death of brain cells. The injury mechanism involves metabolic and oxidative stress, excitotoxicity, apoptosis and inflammatory processes, including activation of glial cells and infiltration of leukocytes. In animal models, dietary energy restriction, by daily calorie reduction (CR or intermittent fasting (IF, extends lifespan and decreases the development of age-related diseases. Dietary energy restriction may also benefit neurons, as suggested by experimental evidence showing that CR and IF protect neurons against degeneration in animal models. Recent findings by our group and others suggest the possibility that dietary energy restriction may protect against stroke induced brain injury, in part by inducing the expression of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF and basic fibroblast growth factor (bFGF; protein chaperones, including heat shock protein 70 (Hsp70 and glucose regulated protein 78 (GRP78; antioxidant enzymes, such as superoxide dismutases (SOD and heme oxygenase-1 (HO-1, silent information regulator T1 (SIRT1, uncoupling proteins and anti-inflammatory cytokines. This article discusses the protective mechanisms activated by dietary energy restriction in ischemic stroke.

  7. Khat and stroke

    Directory of Open Access Journals (Sweden)

    Sanjay V Kulkarni

    2012-01-01

    Full Text Available Khat chewing, though a tradition followed majorly in African countries, has of late spread widely across the globe due to faster transport systems and advanced preservation techniques. Many complications such as psychosis, arterial hypertension, angina pectoris, and myocardial infarction have been reported in connection to khat abuse. We present a case of a young man who presented with acute onset left-sided weakness. He was a known khat addict for over three decades. A diagnosis of left hemiplegia due to right middle cerebral artery infarction was established. Detailed evaluation revealed no significant underlying cause for stroke. Since the main central nervous system effects of khat are comparable with those of amphetamines and there are established reports of stroke in amphetamine abuse, the former was assumed to be the etiological factor. The patient was discontinued from taking khat and was managed conservatively. The subject showed significant recovery with no further complications or similar episodes during follow-up. To the best of our knowledge, this is the second case of stroke associated with khat. Since the management is essentially conservative, a vigilant history eliciting of khat abuse in prevalent countries would cut down unnecessary healthcare costs.

  8. Microwave circulator design

    CERN Document Server

    Linkhart, Douglas K

    2014-01-01

    Circulator design has advanced significantly since the first edition of this book was published 25 years ago. The objective of this second edition is to present theory, information, and design procedures that will enable microwave engineers and technicians to design and build circulators successfully. This resource contains a discussion of the various units used in the circulator design computations, as well as covers the theory of operation. This book presents numerous applications, giving microwave engineers new ideas about how to solve problems using circulators. Design examples are provided, which demonstrate how to apply the information to real-world design tasks.

  9. Cerebrogenic tachyarrhythmia in acute stroke

    OpenAIRE

    A S Praveen Kumar; Babu, E; D K Subrahmanyam

    2012-01-01

    The electrocardiac abnormalities following acute stroke are frequent and seen in both ischemic and hemorrhagic stroke. The changes seen in electrocardiogram (ECG) consist of repolarization abnormalities such as ST elevation, ST depression, negative T waves, and QT prolongation. Among tachyarrhythmias, atrial fibrillation is the most common and occurrence of focal atrial tachycardia is very rare though any cardiac arrhythmias can follow acute stroke. We report a case of focal atrial tachycardi...

  10. Multifaceted web resources for stroke.

    Science.gov (United States)

    Hanif, Kashif; Raghubir, Ram

    2008-01-01

    The Internet is an increasingly important tool for stroke survivors, their family members, and health care providers and researchers. An immense amount of information on stroke, ranging from pathophysiology and treatment to poststroke management, is available on the World Wide Web. This article presents lists of Internet search engines related to life science research, web pages of societies working in the field of stroke, and links to websites providing information on treatment, support, and poststroke survival and rehabilitation programs. Policies should be made to promote use of the Internet by patients, caregivers, and researchers working in the field of stroke to encourage improved patient care, communication, and research. PMID:18589343

  11. Cerebrogenic tachyarrhythmia in acute stroke

    Directory of Open Access Journals (Sweden)

    A S Praveen Kumar

    2012-01-01

    Full Text Available The electrocardiac abnormalities following acute stroke are frequent and seen in both ischemic and hemorrhagic stroke. The changes seen in electrocardiogram (ECG consist of repolarization abnormalities such as ST elevation, ST depression, negative T waves, and QT prolongation. Among tachyarrhythmias, atrial fibrillation is the most common and occurrence of focal atrial tachycardia is very rare though any cardiac arrhythmias can follow acute stroke. We report a case of focal atrial tachycardia following acute ischemic stroke in 50-year-old female without structural heart disease, and their mechanisms and clinical implications.

  12. Cerebrovascular stroke at high altitude

    International Nuclear Information System (INIS)

    Objective: To asses the high altitude as a risk factor for cerebrovascular stroke in people residing at a height greater than 15,000 feet above sea level. Results: Ten patients suffered from stroke at high altitude while just one case had stroke in indexed age group at lower heights (p-value<0.05). Relative risk was 10 times greater at high altitude. Conclusion: High altitude is a risk factor for stroke in persons residing at altitudes of over 15, 000 ft. (author)

  13. Chinese Ischemic Stroke Subclassification (CISS

    Directory of Open Access Journals (Sweden)

    ShanGAO

    2011-02-01

    Full Text Available Accurate classification of stroke has significant impact on patient care and conduction of stroke clinical trials. The current systems such as TOAST, SSS-TOAST, Korean TOAST and A-S-C-O have limitations. With the advent of new imaging technology, there is a need to have a more accurate stroke subclassification system. Chinese Ischemic Stroke Subclassification (CISS system is a new two step system aims at the etiology and then underlying mechanism of a stroke. The first step classifies stroke into five categories: large artery atherosclerosis (LAA, including atherosclerosis of aortic arch and intra-/extracranial large arteries, cardiogenic stroke (CS, penetrating artery disease (PAD, other etiology (OE and undetermined etiology (UE. The second step is to further classify the underlying mechanism of ischemic stroke from the intracranial and extracranial large artery atherosclerosis into the parent artery (plaque or thrombosis occluding penetrating artery, artery-to-artery embolism, hypoperfusion/impaired emboli clearance and multiple mechanisms. Although clinical validation of CISS is being planned, CISS is an innovative system that offers much more detailed information on the pathophysiology of a stroke.

  14. Stroke scale score and early prediction of outcome after stroke

    International Nuclear Information System (INIS)

    Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)

  15. Stroke in Saudi children

    International Nuclear Information System (INIS)

    To describe the epidemiology and clinical features of stroke in a prospective and retrospective cohort of Saudi children and ascertain the causes, pathogenesis, and risk factors. The Retrospective Study Group (RSG) included children with stroke who were evaluated at the Division of Pediatric Neurology, or admitted to King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the period July 1992 to February 2001. The Prospective Study Group (PSG) included those seen between February 2001 and March 2003. During the combined study periods of 10 years and 7 months, 117 children (61 males and 56 females, aged one month-12 years) were evaluated; the majority (89%) of these were Saudis. The calculated annual hospital frequency rate of stroke was 27.1/100,000 of the pediatric (1month-12 years) population The mean age at onset of the initial stroke in the 104 Saudi children was 27.1 months (SD=39.3 months) median and median was 6 months. Ischemic strokes accounted for the majority of cases (76%). Large-vessel infarcts (LVI, 51.9%) were more common than small-vessel lacunar lesions (SVLL, 19.2%). Five patients (4.8%) had combined LVI and SVLL. Intracranial hemorrhage was less common (18.2%), whereas sinovenous thrombosis was diagnosed in 6 (5.8%) patients. A major risk factor was identified in 94 of 104 (89.4%) Saudi children. Significantly more hematologic disorders and coagulopathies were identified in the PSG compared to the RSG (p=0.001), reflecting a better yield following introduction of more comprehensive hematologic and cogulation laboratory tests during the prospective study period. Hematologic disorders were the most common risk factor (46.2%); presumed perinatal ischemic cerebral injury was risk factor in 23 children (22.1) and infectious and inflammatory disorders of the circulatory system in 18 (17.3%). Congenital and genetic cerebrovascular anomalies were the underlying cause in 7 patients (6.7%) and

  16. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... during a hip replacement through the anterior supine intramuscular approach. “OR-Live,” the vision of improving health. ... the approach are operating through an internervous and intramuscular anatomic interval. It’s not necessary to detach any ...

  17. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... got coming out in “JBJS,” the early six-week recovery is dramatically different between a direct lateral abductor splitting approach and this anterior supine approach. Let me get this head on. My experience, these patients have full leg control in about 24 hours. Yeah. They can get out of bed and ...

  18. Anterior Approach Total Hip Replacement

    Medline Plus

    Full Text Available ... the anterior supine intramuscular approach. “OR-Live,” the vision of improving health. Good evening and welcome to ... should know that this is done under direct vision. Yeah. You are seeing everything you’re doing. ...

  19. The burden of stroke in Pakistan.

    Science.gov (United States)

    Khealani, Bhojo A; Wasay, Mohammad

    2008-11-01

    Epidemiologic literature on stroke burden, patterns of stroke is almost non existent from Pakistan. However, several hospital-based case series on the subject are available, mainly published in local medical journals. Despite the fact that true stroke incidence and prevalence of stroke in Pakistan is not known, the burden is assumed to be high because of highly prevalent stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, dyslipidemia and smoking) in the community. High burden of these conventional stroke risk factors is further compounded by lack of awareness, poor compliance hence poor control, and inappropriate management/treatment practices. In addition certain risk factors like rheumatic valvular heart disease may be more prevalent in Pakistan. We reviewed the existing literature on stroke risk factors in community, the risk factor prevalence among stroke patients, patterns of stroke, out come of stroke, availability of diagnostic services/facilities related to stroke and resources for stroke care in Pakistan. PMID:18811747

  20. Recovery After Stroke: Managing Life at Home

    Science.gov (United States)

    ... installed for safety.  Consider an over-the-stove mirror to help you see stovetop contents if cooking ... Contact your local stroke association.  Subscribe to Stroke Smart magazine at www.stroke.org to view the ...

  1. Stroke and Native Hawaiians/Pacific Islanders

    Science.gov (United States)

    ... Population Profiles > Native Hawaiian/Other Pacific Islander > Stroke Stroke and Native Hawaiians/Pacific Islanders Native Hawaiians/Pacific ... non-Hispanic white adults to die from a stroke in 2010. In general, Native Hawaiian/Pacific Islander ...

  2. What to Know - and Do! - about Stroke

    Science.gov (United States)

    ... page please turn Javascript on. Feature: Stroke Rehabilitation What to Know – and Do! – About Stroke Past Issues / ... around them recognizes the symptoms and acts quickly. What are the symptoms of a stroke?— The symptoms ...

  3. Dual isotope scintigraphy in stroke patients

    International Nuclear Information System (INIS)

    Platelet scintigraphy is a useful technique to detect atherosclerotic lesions of the neck vessels in stroke patients. The habitual one isotope technique causes false positive and false negative results due to circulating platelet-bound activity. To eliminate these confusing results we performed a dual isotope technique on 20 stroke patients. The new method consists of simultaneous injections of 111-Indium labelled blood platelets and 99mTc labelled red cells, and achieves a calculation of the ratio 111-In/99mTc. Thus the subtraction of the red cell blood flow image can render a pure thrombus formation visible. The habitual visually evaluated one isotope scintigraphy showed positive scans in 11 out of 20 patients, whereas under dual isotope scintigraphy 3 patients showed no 111-Indium excess after subtraction of the red cell image; they can thus be qualified as false positive. In the case of another patient with a visually negative image a thrombus formation could be observed after the subtraction procedure. It seems, that the dual isotope technique in platelet scintigraphy is a valuable refinement on the way to verifiable results. (orig.)

  4. Reduction of common motoneuronal drive on the affected side during walking in hemiplegic stroke patients

    DEFF Research Database (Denmark)

    Nielsen, Jens Bo; Brittain, John-Stuart; Halliday, David M.; Marchand-Pauvert, Véronique; Mazevet, D.; Conway, Bernard A.

    2008-01-01

    OBJECTIVE: The objective of this study was to use motor unit coupling in the time and frequency domains to obtain evidence of changes in motoneuronal drive during walking in subjects with stroke. METHODS: Paired tibialis anterior (TA) EMG activity was sampled during the swing phase of treadmill...... walking in eight subjects with unilateral stroke. RESULTS: On the unaffected side, short-term synchronization was evident from the presence of a narrow central peak in cumulant densities and from the presence of significant coherence between these signals in the 10-25 Hz band. Such indicators of short...

  5. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

    2012-01-15

    Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

  6. Stroke prevention in atrial fibrillation.

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2006-01-01

    The only major and potentially fatal risk for patients with atrial fibrillation is the development of systemic thromboembolism. Stroke occurs five times more frequently in patients with atrial fibrillation than in comparable patients in sinus rhythm. The yearly incidence of stroke in atrial fibrilla

  7. Specific antismoking advice after stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete; Larsen, Klaus; Brink-Kjær, Tove;

    2014-01-01

    INTRODUCTION: Many stroke survivors would benefit from modification of their lifestyle in order to reduce their risk of recurrent stroke. We investigated if tailored smoking cessation advice would yield a higher smoking cessation rate and a higher rate with sustained abstinence in ex-smokers in the...

  8. Stroke and restricted sensory syndromes

    International Nuclear Information System (INIS)

    There have been sporadic case reports of a restricted sensory syndrome caused by stroke, most often as a cheiro-oral syndrome. We describe 14 patients with stroke who showed various restricted sensory syndromes and correlated their symptoms with the radiological findings. (orig./MG)

  9. One Stroke at a Time

    Science.gov (United States)

    Hollibaugh, Molly

    2012-01-01

    At first glance, a Zentangle creation can seem intricate and complicated. But, when you learn how it is done, you realize how simple it is. Zentangles are patterns, or "tangles," that have been reduced to a simple sequence of elemental strokes. When you learn to focus on each stroke you find yourself capable of things that you may have once…

  10. 38 CFR 3.379 - Anterior poliomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it...

  11. The imaging of ischaemic stroke

    International Nuclear Information System (INIS)

    Stroke is a clinical syndrome of a rapidly developing focal neurological deficit that may be classified for practical purposes into ischaemic and haemorrhagic. The role of imaging is to exclude mimics of ischaemic stroke or intracranial haemorrhage and confirm the presence of an ischaemic stroke. Computed tomography (CT) remains the investigation of choice to exclude acute intracranial haemorrhage but diffusion weighted magnetic resonance (MR) has proved to be a sensitive method of detecting early ischaemic infarction. Perfusion weighted MR allows further assessment at the same examination that could help guide the clinician in the risk/benefit analysis of treatment with thrombolytics or neuroprotective agents under evaluation. This can also be achieved with CT. This review article discusses the imaging of ischaemic stroke, relating the pathophysiology of stroke to it. It deals separately in more detail with these newer MR techniques. Hoggard, N. et al. (2001)

  12. Auditory Hallucinations in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Yair Lampl

    2005-01-01

    Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

  13. Cyclin-dependent kinase-5 targeting for ischaemic stroke.

    Science.gov (United States)

    Slevin, Mark; Krupinski, Jerzy

    2009-04-01

    Recovery from ischaemic stroke is dependent on survival of neurones, particularly in peri-infarcted regions. Angiogenesis is critical for the development of new microvessels resulting in the re-formation of collateral circulation associated with enhanced neuronal survival and reduced morbidity and mortality. Recently, the identification of a neurovascular niche has been described, where the co-ordinated effects of angiogenesis and migration of neuroprogenitor cells to damaged stroke regions were shown to be vital in the process of tissue remodelling. Cdk5, a serine/threonine kinase is highly expressed in the central nervous system, particularly following ischaemic stroke and its aberrant activation is directly associated with neuronal apoptosis and death. In contrast, recent evidence suggests that increased expression of Cdk5 by endothelium might be protective against cell death and/or promote angiogenesis leading to increased vessel formation and reperfusion. Owing to its known interaction with over 20 substrates including caspase-3, MEF2, Tau and p53, Cdk5 could be a master switch controlling both neuronal survival and revascularisation. Therefore its cell-specific pharmacological or genetic modulation using novel nanotechnology-based delivery systems could be of benefit when considering future stroke therapies. PMID:18983942

  14. Rehabilitative Games for Stroke Patients

    Directory of Open Access Journals (Sweden)

    A. Pyae

    2015-07-01

    Full Text Available Stroke is one of the major problems in medical and healthcare that can cause severe disability and death of patients especially for older population. Rehabilitation plays an important role in stroke therapy. However, most of the rehabilitative exercises are monotonous and tiring for the patients. For a particular time, they can easily get bored in doing these exercises. The role of patient’s motivation in rehabilitation is vital. Motivation and rehabilitative outcomes are strongly related. Digital games promise to help stroke patients to feel motivated and more engaged in rehabilitative training through motivational gameplay. Most of the commercial games available in the market are not well-designed for stroke patients and their motivational needs in rehabilitation. This study aims at understanding the motivational requirements of stroke patients in doing rehabilitative exercises and living in a post-stroke life. Based on the findings from the literature review, we report factors that can influence the stroke patients’ level of motivation such as social functioning, patient-therapist relationship, goal-setting, and music. These findings are insightful and useful for ideating and designing interactive motivation-driven games for stroke patients. The motivational factors of stroke patients in rehabilitation may help the game designers to design motivation-driven game contexts, contents, and gameplay. Moreover, these findings may also help healthcare professionals who concern stroke patient’s motivation in rehabilitative context. In this paper, we reported our Virtual Nursing Home (VNH concept and the games that we are currently developing and re-designing. Based on this literature review, we will present and test out the ideas how we can integrate these motivational factors in our future game design, development, and enhancement.

  15. Pediatric anterior cruciate ligament reconstruction

    OpenAIRE

    McConkey, Mark O.; Bonasia, Davide Edoardo; Amendola, Annunziato

    2011-01-01

    An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor. Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth disturbance. Delaying ACL reconstruction until maturity is possible but risks instability episodes and intra-articular damage. S...

  16. Anterior impingement syndrome in dancers

    OpenAIRE

    O’Kane, John William; Kadel, Nancy

    2007-01-01

    Anterior impingement is a common problem in dancers occurring primarily secondary to the repetitive forced ankle dorsiflexion inherent in ballet. Symptoms generally occur progressively and may respond to conservative treatment including addressing biomechanical faults that contribute to the problem. As impingement progresses, movements essential to ballet may become impossible and arthroscopic ankle surgery is often effective for both diagnosis and treatment, allowing athletes to return to da...

  17. [Neurorehabilitation after stroke].

    Science.gov (United States)

    Freimüller, Manfred; Fheodoroff, Klemens

    2003-01-01

    After stroke most patients need to undergo extensive neurological and neuropsychological rehabilitation (neurorehabilitation). It is important to have an individual treatment programme that takes into account that the stroke patient is impaired in terms of his receptive skills, his capacity to act and his personal integrity. Based on the "phase model" of the Austrian Society for Neurological Rehabilitation (OGNR) individual goals have to be agreed and measures have to be taken. After maintaining the vital functions and a stable vegetative state, the remaining abilities have to be stimulated, functions have to be regained and deficits have to be compensated. An interdisciplinary neurological rehabilitation team has, for example, the following responsibilities: treatment of impaired motor skills and balance, treatment of swallowing and breathing impairments, training of activities of daily living, and special concepts for the treatment of cognitive deficits and impaired behaviour. A decisive factor for rehabilitation success is the relationship between therapists and patients and their relatives/carers. Preparation for independent or care-managed life after inpatient rehabilitation is of paramount importance, this means organization of continuing out-patient treatment, out-patient care management, as well as measurement and documentation of rehabilitation success. Regaining quality of life is an active process of analysing and working on the remaining activity limitations and participation restrictions in society. The work of the interdisciplinary neurological rehabilitation team contributes decisively to this process. PMID:12621687

  18. Effects of fast and slow squat exercises on the muscle activity of the paretic lower extremity in patients with chronic stroke

    OpenAIRE

    Choi, Young-Ah; Kim, Jin-Seop; Lee, Dong-Yeop

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of the speed of squat exercises on paretic lower extremity muscle activity in patients with hemiplegia following a stroke. [Subjects and Methods] Ten stroke patients performed fast and slow squat exercises for 2 seconds and 8 seconds, respectively. The muscle activities of the paretic and non-paretic sides of the rectus femoris muscle, the biceps femoris muscle, and the tibialis anterior muscle were assessed and compared using...

  19. Anterior nucleus of the thalamus: functional organization and clinical implications.

    Science.gov (United States)

    Child, Nicholas D; Benarroch, Eduardo E

    2013-11-19

    The anterior nucleus of thalamus (ANT) is a key component of the hippocampal system for episodic memory. The ANT consist of 3 subnuclei with distinct connectivity with the subicular cortex, retrosplenial cortex, and mammillary bodies. Via its connections with the anterior cingulate and orbitomedial prefrontal cortex, the ANT may also contribute to reciprocal hippocampal-prefrontal interactions involved in emotional and executive functions. As in other thalamic nuclei, neurons of the ANT have 2 different state-dependent patterns of discharge, tonic and burst-firing; some ANT neurons also contribute to propagation of the theta rhythm, which is important for mechanisms of synaptic plasticity of the hippocampal circuit. Clinical and experimental evidence indicate that damage of the ANT or its inputs from the mammillary bodies are primarily responsible for the episodic memory deficit observed in Wernicke-Korsakoff syndrome and thalamic stroke. Experimental models also indicate that the ANT may have a role in the propagation of seizure activity both in absence and in focal seizures. Because of its central connectivity and possible role in propagation of seizure activity, the ANT has become an attractive target for deep brain stimulation (DBS) for treatment of medically refractory epilepsy. The ANT is one of the nuclei preferentially affected in prion disorders, such as fatal familial insomnia, but the relationship between ANT involvement and the clinical manifestations of these disorders remains unclear. The connectivity patterns and electrophysiology of the ANT have been the subject of several reviews.(1-4.) PMID:24142476

  20. Successful recanalization for internal carotid artery occlusion with persistent primitive trigeminal artery manifesting only as ischemia of the posterior circulation

    OpenAIRE

    Hiramatsu, Ryo; Ohnishi, Hiroyuki; Kawabata, Shinji; Miyachi, Shigeru; KUROIWA, Toshihiko

    2016-01-01

    Background Internal carotid artery (ICA) occlusion mainly manifests as ischemia of the anterior circulation. There are very few reports of ICA occlusion manifesting as only ischemia of the posterior circulation related to a fetal type posterior communicating artery or other arteries. Case presentation The authors experienced a case of ICA occlusion with persistent primitive trigeminal artery (PPTA) manifesting only as ischemia of the posterior circulation. In this case, the initial NIHSS scor...

  1. Atrial Fibrillation and Stroke – Increasing Stroke Risk With Intervention

    Directory of Open Access Journals (Sweden)

    Christopher V. DeSimone; Malini Madhavan; Elisa Ebrille; Alejandro A. Rabinstein; Paul A. Friedman; Samuel J. Asirvatham

    2013-12-01

    Full Text Available In this review, we focus on the important newly recognized appreciation for the paradoxical increase in stroke and TIA as a result of intervention meant to treat atrial fibrillation (AF with the hope of decreasing stroke risk in the long term. The impact of silent cerebral lesions recently appreciated as a potentially major limitation and risk with AF ablation is explained. We categorize our present understanding of how we can minimize risk and provide a platform for what will undoubtedly be newer study, changes in the way procedures are done today, and possibly vascular-based stroke-reduction strategies.

  2. Quantitative videofluoroscopic analysis of penetration-aspiration in post-stroke patients

    Directory of Open Access Journals (Sweden)

    Bingjie Li

    2010-01-01

    Full Text Available Background : Dysphagia is a common complication of stroke and is a potential cause for aspiration and malnutrition and is also associated with poor outcome. Videofluoroscopic Swallowing Study (VFSS is the most objective method for evaluation of swallowing disorders. Aim : To investigate the incidence and characteristics of penetration-aspiration in post-stroke patients, and to study the relationship between penetration-aspiration and kinematic parameters of swallow. Materials and Methods : We prospectively studied swallowing function in 105 consecutive post-stroke patients and 100 normal adults by videofluoroscopic swallowing studies. The severity of airway invasion, penetration-aspiration, was studied quantitatively and kinematic parameters of swallow i.e. oral transit time, pharyngeal transit time (PTT, pharyngeal delay timem (PDT, maximal extent of vertical and anterior movement of larynx and hyoid bone for four kinds of boluses were also studied. Logistic regression was used to analyze the association between aspiration and kinematic parameters of swallow. Results : Stroke patients scored significantly higher scores on penetration-aspiration scale than the normal subjects (P < 0.001 during four bolus swallows. Logistic regression analysis showed that PTT, PDT, maximal extent of vertical laryngeal and hyoid movement were statistically associated with the prevalence of aspiration (P < 0.05. Conclusion : Penetration-aspiration is common in stroke patients. Several kinematic parameters of swallow are associated with the presence of aspiration on fluoroscopy. These data demonstrate that VFSS may be helpful for objective identification of dysphagia in stroke patients.

  3. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    NARCIS (Netherlands)

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    2012-01-01

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was investiga

  4. Concepts in Assisted Circulation

    OpenAIRE

    Lefemine, Armand A.; Dunbar, Jacob; DeLucia, Anthony

    1986-01-01

    Assisted circulation by extracorporeal and extracardiac bypass techniques must be based on the requirements of the heart and of the total body, though these may differ. The cardiac problem in cardiogenic shock is more likely to be a biventricular problem demanding decompression of both sides. Extra pulmonary oxygenation should be avoided because of complexity in long-term use. Principles of assisted circulation may be applied in an extra-thoracic temporary manner or as an intracorporeal long-...

  5. Let's Talk about Emotional Changes After Stroke

    Science.gov (United States)

    ... Stroke More Let's Talk About Emotional Changes After Stroke Updated:Dec 9,2015 Right after a stroke, a survivor may respond one way, yet weeks ... because of biological or psychological causes due to stroke. These changes may vary with time and can ...

  6. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J;

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome. In...... addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  7. What's Your Stroke I.Q.?

    Science.gov (United States)

    What's Your Stroke I.Q.? Often, it is believed that stroke is a disease of old age. You may be surprised to learn that stroke ... to help prevent it. Test your stroke I.Q. by answering these six questions. By knowing the ...

  8. Stroke in Childhood and New Treatment Modalities

    OpenAIRE

    Ozlem Herguner

    2003-01-01

    The risk factors for stroke in chidren are very different from those leading to stroke in adults. In recent years, several potential treatments for various specific stroke syndromes have been made. In this article, the risk factors and new treatment modalities for stroke in children and adolescents are reviewed. [Archives Medical Review Journal 2003; 12(3.000): 177-198

  9. Stroke in Childhood and New Treatment Modalities

    OpenAIRE

    Hergüner, Özlem

    2003-01-01

    The risk factors for stroke in chidren are very different from those leading to stroke in adults. In recent years, several potential treatments for various specific stroke syndromes have been made. In this article, the risk factors and new treatment modalities for stroke in children and adolescents are reviewed.

  10. The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients

    International Nuclear Information System (INIS)

    Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3 5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found

  11. The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yu Mi; Lee, Deok Hee; Kim, Ho Sung; Ryu, Chang Woo; Lee, Jeong Hyun; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2006-12-15

    Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3 5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found

  12. Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients

    International Nuclear Information System (INIS)

    This study aimed to relate growth of the infarct core with time to recanalization in patients receiving mechanical recanalization in whom the time of recanalization is known. We analyzed data from patients with anterior circulation acute ischemic stroke who underwent mechanical recanalization. Demographic and angiographic characteristics, initial apparent diffusion coefficient (ADC) infarct volume, time-to-peak defect volume, revascularization grade, 24-48 h nonenhanced computed tomography (CT) infarct volume, symptom onset to recanalization time, diffusion-weighted imaging to recanalization time, and discharge National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were compared between minimal and substantial infarct growth groups. Substantial infarct growth was defined as an increase of infarct volume >10 cm3 assessed by subtracting initial ADC infarct core volume from infarct volume at 24-48 h CT. Of 25 patients, 9 had minimal infarct growth (median 0 cm3, interquartile range (IQR) -3 to 5 cm3) and 16 had substantial infarct growth (median 103 cm3, IQR 48-132 cm3). Patients with minimal infarct growth had a median time from symptom onset to recanalization of 329 min (IQR 314-412 min) and a median time from imaging to recanalization of 231 min (IQR 198-309 min). On univariate analysis, minimal infarct growth was related to male gender (p = 0.04), smaller initial ADC volume (p = 0.04), higher recanalization grade (p < 0.001), and lower discharge NIHSS (p = 0.04) and mRS grades (p = 0.04). There was no or minimal infarct core growth in at least one third of patients despite an exceptionally long median time from magnetic resonance imaging to recanalization of almost 4 h. (orig.)

  13. Stroke rehabilitation: recent advances and future therapies.

    LENUS (Irish Health Repository)

    Brewer, L

    2012-09-27

    Despite advances in the acute management of stroke, a large proportion of stroke patients are left with significant impairments. Over the coming decades the prevalence of stroke-related disability is expected to increase worldwide and this will impact greatly on families, healthcare systems and economies. Effective neuro-rehabilitation is a key factor in reducing disability after stroke. In this review, we discuss the effects of stroke, principles of stroke rehabilitative care and predictors of recovery. We also discuss novel therapies in stroke rehabilitation, including non-invasive brain stimulation, robotics and pharmacological augmentation. Many trials are currently underway, which, in time, may impact on future rehabilitative practice.

  14. Morphometric Analysis of Bone Resection in Anterior Petrosectomies.

    Science.gov (United States)

    Ahmed, Osama; Walther, Jonathan; Theriot, Krystle; Manuel, Morganne; Guthikonda, Bharat

    2016-06-01

    Introduction The anterior petrosectomy is a well-defined skull base approach to lesions such as petroclival meningiomas, posterior circulation aneurysms, petrous apex lesions (chondrosarcomas, cholesteatomas), ventrolateral brainstem lesions, clival chordomas, trigeminal neurinomas, and access to cranial nerves III, IV, V, and VII. Methods and Materials Fourteen anterior petrosectomies on eight cadaveric heads were performed in a skull base dissection laboratory. Predissection and postdissection thin-cut computed tomography scans were obtained to compare the bone resection. A computer program was used (InVivo5, Anatomage, San Jose, California, United States) to measure the bone resection and the improved viewing angle. Results The average bone removed in each plane was as follows: anterior to posterior plane was 10.57 mm ± 2.00 mm, superior to inferior was 9.39 mm ± 1.67 mm, and lateral to medial was 17.46 mm ± 4.64 mm. The average increased angle of view was 13.01 ± 2.35 degrees (Table 1). The average volume was 1786.94 ± 827.40 mm(3). Conclusions Anterior petrosectomy is a useful approach to access the ventrolateral brainstem region. We present a cadaveric study quantitating the volume of bone resection and improvement in the viewing angle. These data provide useful preoperative information on the utility of this skull base approach and the gain in the viewing angle after bony removal. PMID:27175319

  15. Stroke Unit: General principles and standards

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2015-04-01

    Full Text Available Evidence-based medicinal methods have convincingly shown that stroke unit approach reduces mortality and disability rates, improves the quality of life and economic burden resulting from acute ischemic and hemorrhagic stroke. Any contemporary stroke system of care cannot be successful without putting the stroke unit concept in the center of its organization. Stroke units are the main elements of primary and comprehensive stroke centers. As a modernization process, this article focuses on practical issues and suggestions related to integration of the stroke unit approach to a regionally organized stroke system of care for perusal by not only national health authorities and service providers, but also neurologists. Stroke unit quality metrics revisited herein are of critical importance for hospitals establishing or renovating primary and comprehensive stroke centers.

  16. [Cerebrolysin for acute ischemic stroke].

    Science.gov (United States)

    iganshina, L E; Abakumova, T R

    2013-01-01

    The review discusses existing evidence of benefits and risks of cerebrolysin--a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue with proposed neuroprotective and neurotrophic properties, for acute ischemic stroke. The review presents results of systematic search and analysis of randomised clinical trials comparing cerebrolysin with placebo in patients with acute ischemic stroke. Only one trial was selected as meeting quality criteria. No difference in death and adverse events between cerebrolysin and placebo was established. The authors conclude about insufficiency of evidence to evaluate the effect of cerebrolysin on survival and dependency in people with acute ischemic stroke. PMID:23805635

  17. Plasma cytokines in acute stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne Krarup; Boysen, Gudrun; Christensen, Erik;

    2011-01-01

    months later plasma levels of interleukin 1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), interleukin 10 (IL-10), soluble tumor necrosis factor receptor 1 (sTNF-R1), and soluble tumor necrosis factor receptor 2 (sTNF-R2) were......GOALS: The aim of this study was to test the relations between plasma cytokines and the clinical characteristics, course, and risk factors in acute stroke. PATIENTS AND METHODS: The analysis was based on 179 patients with acute stroke included within 24 hours of stroke onset. On inclusion and 3...

  18. Antioxidants and Stroke Prevention Management

    OpenAIRE

    Komanapali, Christopher

    1998-01-01

    Stroke is the third leading cause of death in the U.S. Many of these strokes can be prevented using a bit of dietary management with dietary, non-supplementary, antioxidants. Vitamins C, B-complex, E, and beta-carotene due their part in stroke prevention by preventing oxidation of LDL and free-radical oxidation in aqueous phase, a mechanism in part responsible for atherosclerotic plaques. Vitamin B12, another antioxidant vitamin, does its part in the equation by preventing hyperhomocysteinemi...

  19. ACUTE STROKE: FUNCTIONAL OUTCOME PREDICTORS

    Directory of Open Access Journals (Sweden)

    Sujatha

    2016-03-01

    Full Text Available BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess functional outcome in these patients using Barthel Index at admission and at discharge. MATERIALS AND METHODS The present study was undertaken under the Department of Internal Medicine, Govt. Stanley Hospital, Chennai, in 75 patients above 18 yrs. of age presenting with symptoms suggestive of acute stroke at medical OPD/wards/ICU, proven by imaging as ischemic stroke after proper consent were subjected to detailed history taking, complete physical examination and the relevant laboratory investigations as per proforma. Subjects were grouped under mild/moderate/severe categories as per Barthel scoring. A prospective observational study design was chosen and descriptive statistics was done for all data and suitable statistical tests of comparison were done. RESULTS The groups contain subjects with the same basic demographic characteristics, age and gender. The duration of stay in hospital increases with Barthel score. There is an increasing trend of diabetes mellitus and hypertension with stroke severity assessed functionally as per Barthel scores. There is an increasing trend of raised CRP, ESR levels, Uric Acid and Fibrinogen levels with stroke severity. By assessing the functional outcome using Barthel index in ischemic stroke patients at admission and discharge, the average Barthel score in patients at the time of admission was 52.27 in comparison to significantly increased Barthel score at discharge (56 with a p-value of 0.0000 according to paired t-test. CONCLUSION CRP

  20. [Post-stroke apathy].

    Science.gov (United States)

    López-Dóriga Bonnardeaux, Pedro; Andrino Díaz, Nuria

    2016-01-01

    Apathy is a motivational disturbance that can be defined as a quantitative reduction of goal-directed behaviour. Patients present with loss of motivation, concern, interest, and emotional response, resulting in a loss of initiative, decreased interaction with their environment, and a reduced interest in social life. Apathy not only appears to be common in stroke patients, but it has also been related to a wide range of negative consequences for the patients and their caregivers, including poor functional recovery, loss of social independence, and caregiver distress. Clear definition and consensus diagnostic criteria for apathy are needed to accomplish an accurate assessment and an individualised treatment plan. Although there have been reports of successful behavioural therapy treatment of apathetic states, there is a paucity of controlled clinical trials on the efficacy of apathetic behaviours using pharmacotherapy. PMID:26522489

  1. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    International Nuclear Information System (INIS)

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

  2. Pediatric Stroke: Clinical Findings and Radiological Approach

    OpenAIRE

    Alessandra Di Sibio; Massimo Gallucci; Amalia Paonessa; Laura Conti; Alessia Catalucci; Giuseppe Lanni

    2011-01-01

    This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis) and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addit...

  3. Strokes in young adults: epidemiology and prevention

    Directory of Open Access Journals (Sweden)

    Smajlović D

    2015-02-01

    Full Text Available Dževdet Smajlović Department of Neurology, University Clinical Centre Tuzla, School of Medicine, University of Tuzla, Bosnia and Herzegovina Abstract: Strokes in young adults are reported as being uncommon, comprising 10%–15% of all stroke patients. However, compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults. This is important given the fact that younger stroke patients have a clearly increased risk of death compared with the general population. The prevalence of standard modifiable vascular risk factors in young stroke patients is different from that in older patients. Modifiable risk factors for stroke, such as dyslipidemia, smoking, and hypertension, are highly prevalent in the young stroke population, with no significant difference in geographic, climatic, nutritional, lifestyle, or genetic diversity. The list of potential stroke etiologies among young adults is extensive. Strokes of undetermined and of other determined etiology are the most common types among young patients according to TOAST (Trial of Org 10172 in Acute Stroke Treatment criteria. Prevention is the primary treatment strategy aimed at reducing morbidity and mortality related to stroke. Therefore, primary prevention is very important with regard to stroke in young adults, and aggressive treatment of risk factors for stroke, such as hypertension, smoking, and dyslipidemia, is essential. The best form of secondary stroke prevention is directed toward stroke etiology as well as treatment of additional risk factors. However, there is a lack of specific recommendations and guidelines for stroke management in young adults. In conclusion, strokes in young adults are a major public health problem and further research, with standardized methodology, is needed in order to give us more

  4. Secondary stroke prevention: challenges and solutions

    OpenAIRE

    Esenwa C; Gutierrez J

    2015-01-01

    Charles Esenwa, Jose GutierrezDepartment of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USAAbstract: Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dy...

  5. Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction.

    LENUS (Irish Health Repository)

    Kinsella, Justin A

    2010-01-01

    Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations\\/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. \\'Unheralded\\' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed \\'cardioembolic\\' stroke, and that potential \\'pulmonary venous thromboembolic\\' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

  6. Post-stroke seizures in consecutive elderly stroke patients

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Maomao Han; Chunlan Cui; Shichao Liu

    2011-01-01

    This prospective study sought to investigate the clinical, radiological and electroencephalographic (EEG) characteristics of seizures in elderly stroke patients, and their outcomes. Over a 2-year study period, 158 consecutive eldedy patients with stroke were examined and followed up. Of these patients, 32 (20%) developed seizures, primarily related to stroke, within a follow up period between 5 months and 2 years. Of these 32 cases, 20 experienced infarctions, and 12 experienced hemorrhages. Involvement of cortical regions was detected in most of the patients exhibiting seizures. In these patients, 44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography (CT) images. Twenty-five patients (78%)developed early seizures (within 2 weeks after stroke), and half exhibited immediate post-stroke seizures. None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy, while 57% of late onset seizures (four cases) developed epilepsy. No specific EEG patterns were apparent in those who later developed epilepsy. Overall, early onset seizures after stroke were found to be relatively common, and did not affect outcome. Late onset seizures were less common, but were associated with chronic epilepsy.

  7. Event related desynchronization-modulated functional electrical stimulation system for stroke rehabilitation: A feasibility study

    Directory of Open Access Journals (Sweden)

    Takahashi Mitsuru

    2012-08-01

    Full Text Available Abstract Background We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD reflecting motor intent was continuously detected from the primary cortical motor area. Methods We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. Results After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. Conclusions The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.

  8. Absence of scalenus anterior muscle.

    OpenAIRE

    Murakami S; Horiuchi K; Yamamoto C; Ohtsuka A; Murakami T.

    2003-01-01

    A rare anomaly of the scalenus muscles is described. In this case, the right scalenus anterior muscle was absent. As a substitute for this muscle, some aberrant muscle slips arose from the lower vertebrae and descended in front of the ventral rami of the lower cervical nerves. These aberrant slips then ran between the ventral rami of the the eighth cervical and first thoracic nerves, and were fused with the right scalenus medius muscle. Thus, the subclavian artery and vein ran in front of the...

  9. Lesiones del ligamento cruzado anterior

    OpenAIRE

    Alejandro Álvarez López; Yenima García Lorenzo

    2015-01-01

    Fundamento: el ligamento cruzado anterior desempeña un papel muy importante en la estabili-dad de la rodilla. La incidencia de esta afección es alta en pacientes que practican deportes de contacto y de no ser tratados de forma adecuada, los resultados son desfavorables. Objetivo: profundizar en los factores necesarios para el tratamiento adecuado de enfermos con esta lesión y evitar las complicaciones. Método: se realizó una revisión bibliográfica de un total de 300 artículos publicados en Pu...

  10. Hemorrhagic and Ischemic Strokes Compared Stroke Severity, Mortality, and Risk Factors

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, T. S.; Dehlendorff, Christian;

    2009-01-01

    were diabetes, atrial fibrillation, previous myocardial infarction, previous stroke, and intermittent arterial claudication. Smoking and alcohol consumption favored HS, whereas age, sex, and hypertension did not herald stroke type. Compared with ischemic strokes, HS was associated with an overall...

  11. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... of Diabetes Educators JDRF American Heart Association MedlinePlus Diabetes Disease Organizations Many organizations provide support to patients ... Disease Organizations (PDF, 293 KB). Alternate Language URL Diabetes, Heart Disease, and Stroke Page Content On this ...

  12. Clinical neurorestorative progress in stroke

    Directory of Open Access Journals (Sweden)

    Qiao L

    2015-03-01

    Full Text Available Liyan Qiao,1,* Jun Lu,2,* Hongyun Huang3–5 1Department of Neurology, Tsinghua University Yuquan Hospital, 2Department of Emergency, 2nd Artillery Hospital, 3Center of Neurorestoratology, Beijing Rehabilitation Hospital, Capital Medical University, 4Beijing Hongtianji Neuroscience Academy, Beijing, 5Neuroscience Institute of Taishan Medical University, Shandong, People’s Republic of China *These authors are co-first authors Abstract: Stroke is the second most common single cause of death worldwide, with over five million deaths per year globally. So far, conventional therapy has failed to restore neurological function poststroke. Neurorestorative strategy has provided therapeutic benefit for the treatment of stroke. This review outlines the clinical advances, in which cell-based neurorestorative strategies offer the broadest range of potential treatments for stroke. Keywords: stroke, cerebral infarction, treatment, neurorestorative strategy, neurological function recovery, cell therapy

  13. Blood glucose in acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj

    2009-01-01

    Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation of...... infarcts. For a number of years, tight glycemic control has been regarded as beneficial in critically illness, but recent research has been unable to support this notion. The only completed randomized study on glucose-lowering therapy in stroke has failed to demonstrate effect, and concerns relating to the...... risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....

  14. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, and Other Dental Problems Diabetic Eye Disease Diabetes, Heart Disease, and Stroke Having diabetes or prediabetes ... can help prevent future health problems. What is diabetes? Diabetes is a disorder of metabolismthe way our ...

  15. Gaussian Fibonacci Circulant Type Matrices

    Directory of Open Access Journals (Sweden)

    Zhaolin Jiang

    2014-01-01

    Full Text Available Circulant matrices have become important tools in solving integrable system, Hamiltonian structure, and integral equations. In this paper, we prove that Gaussian Fibonacci circulant type matrices are invertible matrices for n>2 and give the explicit determinants and the inverse matrices. Furthermore, the upper bounds for the spread on Gaussian Fibonacci circulant and left circulant matrices are presented, respectively.

  16. Relationship between plasma glutamate levels and post-stroke depression in patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    钱方媛

    2014-01-01

    Objective To test the association between the plasma glutamate levels during acute ischemic stroke andpost-stroke depression(PSD)initially.Methods Seventy-four ischemic stroke patients admitted to the hospital within the first day of stroke onset were evaluated at a follow-up of 2 weeks.The Beck Depression Inventory(BDI,21-item)and DSM-Ⅳcriteria was used to diagnose post-stroke depression(PSD)at 2 weeks after stroke.

  17. The relation between oxidative stress parameters, ischemic stroke,and hemorrhagic stroke

    OpenAIRE

    İçme, Ferhat; EREL, ÖZCAN; AVCİ, AKKAN; SATAR, SALİM; Gülen, Müge; Acehan, Selen

    2015-01-01

    Background/aim: The aims of this study were to investigate the significance of oxidative stress parameters in the pathogenesis of ischemic stroke and hemorrhagic stroke and to investigate their effects on stroke severity using the National Institutes of Health Stroke Scale (NIHSS). Materials and methods: A total of 92 patients, including 74 with ischemic stroke and 18 with hemorrhagic stroke, and 75 volunteers were enrolled in the study. Total oxidant status (TOS), total antioxidant status (...

  18. Stroke and Disorders of Consciousness

    OpenAIRE

    Zikrija Dostović; Dževdet Smajlović; Ernestina Dostović; Omer Ć. Ibrahimagić

    2012-01-01

    Objectives. To determine the severity of stroke and mortality in relation to the type of disturbance of consciousness and outcome of patients with disorders of consciousness. Patients and Methods. We retrospectively analyzed 201 patients. Assessment of disorders of consciousness is performed by Glasgow Coma Scale (Teasdale and Jennet, 1974) and the Diagnostic and Statistical Manual of Mental Disorders (Anonymous, 2000). The severity of stroke was determined by National Institutes of Health St...

  19. Stroke in Canon of Medicine

    Science.gov (United States)

    Alorizi, Seyed Morteza Emami; Nimruzi, Majid

    2016-01-01

    Background: Stroke has a huge negative impact on the society and more adversely affect women. There is scarce evidence about any neuroprotective effects of commonly used drug in acute stroke. Bushnell et al. provided a guideline focusing on the risk factors of stroke unique to women, including reproductive factors, metabolic syndrome, obesity, atrial fibrillation, and migraine with aura. The ten variables cited by Avicenna in Canon of Medicine would compensate for the gaps mentioned in this guideline. The prescribed drugs should be selected qualitatively opposite to Mizaj (warm-cold and wet-dry qualities induced by disease state) of the disease and according to ten variables, including the nature of the affected organ, intensity of disease, sex, age, habit, season, place of living, occupation, stamina and physical status. Methods: Information related to stroke was searched in Canon of Medicine, which is an outstanding book in traditional Persian medicine written by Avicenna. Results: A hemorrhagic stroke is the result of increasing sanguine humor in the body. Sanguine has warm-wet quality, and should be treated with food and drugs that quench the abundance of blood in the body. An acute episode of ischemic stroke is due to the abundance of phlegm that causes a blockage in the cerebral vessels. Phlegm has cold-wet quality and treatment should be started with compound medicines that either solve the phlegm or eject it from the body. Conclusion: Avicenna has cited in Canon of Medicine that women have cold and wet temperament compared to men. For this reason, they are more prone to accumulation of phlegm in their body organs including the liver, joints and vessels, and consequently in the risk of fatty liver, degenerative joint disease, atherosclerosis, and stroke especially the ischemic one. This is in accordance with epidemiological studies that showed higher rate of ischemic stroke in women rather than hemorrhagic one. PMID:26722147

  20. Stroke prevention in atrial fibrillation.

    OpenAIRE

    Michael Katsnelson,; Sebastian Koch; Tatjana Rundek

    1997-01-01

    Non-valvular atrial fibrillation is a common and from a neurological perspective the most significant cardiac arrhythmia with a growing world-wide incidence. It also carries a significant associated morbidity and mortality, with cardioembolic strokes arguably being the most disabling sequelae. This brief review will highlight the important studies and the latest treatment modalities available for stroke prevention in patients with non-valvular atrial fibrillation.

  1. Anterior chest wall examination reviewed

    Directory of Open Access Journals (Sweden)

    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  2. Dolor anterior de la rodilla

    Directory of Open Access Journals (Sweden)

    Alejandro Álvarez López

    2010-01-01

    Full Text Available Introducción:el dolor anterior de la rodilla constituye una importante causa de consulta en la especialidad de Ortopedia y Traumatología. La incidencia de otras enfermedades relacionadas con este síntoma es cada vez mayor, ejemplo de ello es la condromalacia de rótula, tendinitis patelar, osteoartritis patelofemoral entre otras, el diagnóstico de estas enfermedades se debe al cúmulo de experiencia y a la introducción de técnicas y equipos imagenológicos de avanzada. Desarrollo: se realizó una revisión bibliográfica sobre el dolor anterior de la rodilla, con especial énfasis en las teorías involucradas en su fisiopatología, entre las que se encuentran la mala-alineación patelo-femoral, equilibrio de la homeostasis tisular y aumento de la presión intra-ósea, además de brindar brevemente el cuadro clínico de la enfermedad. Para finalizar se expone el enfoque terapéutico que se basa fundamentalmente en el tratamiento conservador, se mencionan además las modalidades de tratamiento quirúrgico.

  3. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  4. The sensitivity of CT and rCBF-studies for the pathology of strokes

    International Nuclear Information System (INIS)

    A localized pathology of the cerebral circulation or cerebral metabolism and the morphology of the brain tissue can be visualized by the use of new techniques in radiology and nuclear medicine: measurements of rCBF by radioactive diffusible isotopes, of the densitiy of the brain tissue, by CT, and of the cerebral metabolism regionally by positron-emission tomography. Having studied 475 stroke patients par rCBF measurements and 335 by CT we think it useful to compare the value of these two methods in revealing information on the pathology underlying focal disorders of brain functions due to stroke. (orig./VJ)

  5. Positioning of anterior teeth in removable dentures

    Directory of Open Access Journals (Sweden)

    Strajnić Ljiljana

    2002-01-01

    Full Text Available Introduction The aim of this paper was to present methods of placement of artificial anterior teeth in edentulous individuals. The following review takes account of the majority of papers published during the last 100 years. The review has been divided into sections regarding the method used to determine the position of artificial anterior teeth. Geometric aspect Gysi (1895-1920 produced the first scientific theory about the position of artificial anterior teeth. Physiognomic theory The aim of this theory is to find the most natural position for artificial anterior teeth for each individual. Camper's "face angle" as a physiognomic criterion, has been introduced in papers of Wehrli (1961, Marxhors (1966, Tanzer (1968, Lombardi (1973. Esthetic aspect Important names in the field of dental esthetics are: Schön and Singer (1961, Arnheim (1965, Krajiček (1969, Tanzer (1968, Lombardi (1973, Goldstein (1976. They have introduced principles of visual aspects for selection of contours, dimension and position of artificial anterior teeth. Constitution aspect Flagg (1880, Williams (1913 and Hrauf (1957, 1958, have considered body constitution and individual characteristics regarding position of artificial anterior teeth. Physiological theory In 1971, Marxhors pointed to the fact that the position of artificial teeth corresponds with the function of the surrounding soft tissue and from the aspect of physiognomy as well. Phonetic aspect According to Silverman (1962 artificial anterior teeth are nearest when we pronounce the sound "S". Cephalometrical research Rayson (1970, Watson (1989, Strajnić Lj. (1999, Bassi F. (2001 have presented cephalometric radiographic analyses of natural anterior teeth compared with cephalometric radiographic analyses of artificial anterior teeth. A review of dental literature shows several factors suggesting modalities which should determine the position of artificial anterior teeth. Numerous methods have been designed for

  6. Pharyngocutaneous fistula after anterior cervical spine surgery

    OpenAIRE

    Sansur, Charles A.; Early, Stephen; Reibel, James; Arlet, Vincent

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closu...

  7. Fatigue after Stroke: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Victoria Louise Barbour

    2012-01-01

    Full Text Available Background. Fatigue after stroke is common and distressing to patients. Aims. Our aims were to explore patients' perceptions of post-stroke fatigue, including the causes of fatigue and the factors that alleviate fatigue, in a mixed methods study. Results. We interviewed 15 patients who had had a stroke and were inpatients on stroke rehabilitation wards. A substantial proportion of patients reported that their fatigue started at the time of their stroke. Various different factors were reported to improve fatigue, including exercise, good sleep, rehabilitation and rest. Fatigue influences patients' sense of “control” after their stroke. Conclusion. Our results are consistent with the possibility that poststroke fatigue might be triggered by factors that occur at the time of the stroke (e.g., the stroke lesion itself, or admission to hospital and then exacerbated by poor sleep and boredom. These factors should be considered when developing complex interventions to improve post-stroke fatigue.

  8. A novel crustacean swimming stroke: coordinated four-paddled locomotion in the cypridoidean ostracode Cypridopsis vidua (Müller).

    Science.gov (United States)

    Hunt, Gene; Park, Lisa E; Labarbera, Michael

    2007-02-01

    Despite the diversity and ecological importance of cypridoidean ostracodes, there have been no kinematic studies of how they swim. We used regular and high-speed video of tethered ostracodes to document locomotion in the cypridoidean species Cypridopsis vidua. Swimming in this species is drag-based, with thrust provided by both antennulae and antennae. About 15 complete power and recovery strokes occur per second; maximal speeds for the limb tips were about 30 mm/s for the antennulae and 50 mm/s for the antennae. These speeds correspond to Reynolds numbers on the order of 10(-1) to 10(0) for the limb tips and 10(-2) to 10(-1) for the setae that extend outward from the swimming limbs and provide much of the surface area of the limb. The strokes of the four thrust-producing limbs are coordinated in a manner that seems to be unique among aquatic arthropods. When viewed from the anterior, power strokes are synchronized diagonally: left antennula and right antenna power strokes start at the same time and terminate just as the power strokes for the right antennula and left antenna begin. Because power strokes occur throughout the stroke cycle, swimming in this species is smoothly continuous, without the rapid accelerations and decelerations characteristic of most small aquatic arthropods. PMID:17301332

  9. Stroke injury, cognitive impairment and vascular dementia☆

    Science.gov (United States)

    Kalaria, Raj N.; Akinyemi, Rufus; Ihara, Masafumi

    2016-01-01

    The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700

  10. Stroke injury, cognitive impairment and vascular dementia.

    Science.gov (United States)

    Kalaria, Raj N; Akinyemi, Rufus; Ihara, Masafumi

    2016-05-01

    The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25-30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood-brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700

  11. PULMONARY CIRCULATION AT EXERCISE

    OpenAIRE

    R. Naeije; CHESLER, N

    2012-01-01

    The pulmonary circulation is a high flow and low pressure circuit, with an average resistance of 1 mmHg.min.L−1 in young adults, increasing to 2.5 mmHg.min.L−1 over 4–6 decades of life. Pulmonary vascular mechanics at exercise are best described by distensible models. Exercise does not appear to affect the time constant of the pulmonary circulation or the longitudinal distribution of resistances. Very high flows are associated with high capillary pressures, up to a 20–25 mmHg threshold associ...

  12. Herniation of the anterior lens capsule

    Directory of Open Access Journals (Sweden)

    Pereira Nolette

    2007-01-01

    Full Text Available Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous in the area of herniation giving it a characteristic appearance.

  13. Measurement of cerebral circulation time in man

    International Nuclear Information System (INIS)

    A simple, inexpensive method for measuring the cerebral circulation time (CCT) was developed. The CCT was considered to be equal to the time that an intravenously injected bolus of sodium pertechnetate Tc 99m took to go from the subclavian artery to the posterior venous confluence. The dilution curves were externally recorded at these two vessels. Particular attenion was given to the curve treatment. The computer programmes were specially conceived in order to detect and, if possible, correct the experimental curve defects. Several reliability criteria were also defined in order to test the validity of each measurement. From a physiological point of view, the CCT is equal to the ratio of the global cerebral blood volume to the global cerebral blood flow. Thus, it can be widely applied in clinical research. For example, in a study of the relationship between CCT and age, sex and light cerebrovascular impairment, the technique was sensitive enough to discriminate between healthy subjects and patients suffering from-transient ischemic attack, or regressive stroke, and to show the action of a drug on the cerebral circulation in such patients. (orig.)

  14. Perawatan Gigitan Terbalik Anterior Dengan Menggunakan Inclined Plane

    OpenAIRE

    Siregar, Wilda A.

    2008-01-01

    Gigitan terbalik anterior adalah suatu anomali posisi gigi anterior atas yang lebih ke lingual dibandingkan gigi anterior bawah. Anomali gigitan terbalik anterior dapat ditemui pada periode gigi sulung, gigi bercampur, dan gigi permanen. Faktor etiologi gigitan terbalik anterior dibedakan atas dental, fungsional atau skeletal. Untuk menentukan etiologi dari anomali gigitan terbalik anterior perlu dilakukan diagnosa yang tepat. Perawatan gigitan terbalik anterior ini dapat dilakukan de...

  15. Stroke and the "stroke belt" in dialysis: contribution of patient characteristics to ischemic stroke rate and its geographic variation.

    Science.gov (United States)

    Wetmore, James B; Ellerbeck, Edward F; Mahnken, Jonathan D; Phadnis, Milind A; Rigler, Sally K; Spertus, John A; Zhou, Xinhua; Mukhopadhyay, Purna; Shireman, Theresa I

    2013-12-01

    Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index >30 kg/m(2) was inversely associated with stroke (P1.0 were all in the South: North Carolina, Mississippi, and Oklahoma. Regional efforts to increase primary prevention in the "stroke belt" or to better educate dialysis patients on the signs of stroke so that they may promptly seek care may improve stroke care and outcomes in dialysis patients. PMID:23990675

  16. Monocyte function and plasma levels of interleukin-8 in acute ischemic stroke.

    Science.gov (United States)

    Grau, A J; Reis, A; Buggle, F; Al-Khalaf, A; Werle, E; Valois, N; Bertram, M; Becher, H; Grond-Ginsbach, C

    2001-11-15

    Activated monocytes may contribute to the pathogenesis of ischemic stroke. We tested the hypothesis that release products and procoagulant activity of monocytes are increased in acute ischemic stroke. In patients on days 1, 3 and 7 after ischemic stroke and in age- and sex-matched healthy control subjects, we assessed plasma levels of interleukin 8 (IL-8) and neopterin (enzyme linked immunosorbent assay, ELISA) and investigated superoxidanion release (ferricytochrome C reduction), procoagulant activity (one-stage clotting assay) and tissue factor (TF) gene transcription (reverse transcriptase polymerase chain reaction) by monocytes. As compared to control subjects (n=23), IL-8 levels were increased on day 1 after stroke (n=22; p=0.005) and remained elevated on days 3 and 7. Neopterin levels were elevated on days 3 and 7 (p<0.05, respectively) but not on day 1. Neopterin and IL-8 were not correlated with monocyte counts. Superoxid anion production by stimulated and unstimulated monocytes was not different between groups. TF mRNA could neither be detected in monocytes from patients investigated within 12 h after ischemia (n=12) nor in control subjects (n=10) and procoagulant activity of cells was similar in both groups. Our results indicate increased monocyte activation after ischemic stroke although not all activation parameters were elevated. We found no support for the hypothesis that circulating monocytes express TF and possess increased procoagulant activity. Elevated IL-8 may contribute to stroke pathophysiology by activating polymorphonuclear leukocyte (PMNL) activation early after ischemia. PMID:11701151

  17. Absence of scalenus anterior muscle.

    Directory of Open Access Journals (Sweden)

    Murakami S

    2003-06-01

    Full Text Available A rare anomaly of the scalenus muscles is described. In this case, the right scalenus anterior muscle was absent. As a substitute for this muscle, some aberrant muscle slips arose from the lower vertebrae and descended in front of the ventral rami of the lower cervical nerves. These aberrant slips then ran between the ventral rami of the the eighth cervical and first thoracic nerves, and were fused with the right scalenus medius muscle. Thus, the subclavian artery and vein ran in front of the aberrant slips, together with the ventral ramus of the first thoracic nerve. The aberrant muscle slips issued 2 accessory bundles. One bundle ran between the ventral rami of the fourth and fifth cervical nerves and was fused with the scalenus medius muscle; the other bundle ran between the ventral rami of the fifth and sixth cervical nerves and was fused with the scalenus medius muscle.

  18. Toxic Anterior Segment Syndrome (TASS

    Directory of Open Access Journals (Sweden)

    Özlem Öner

    2011-12-01

    Full Text Available Toxic anterior segment syndrome (TASS is a sterile intraocular inflammation caused by noninfectious substances, resulting in extensive toxic damage to the intraocular tissues. Possible etiologic factors of TASS include surgical trauma, bacterial endotoxin, intraocular solutions with inappropriate pH and osmolality, preservatives, denatured ophthalmic viscosurgical devices (OVD, inadequate sterilization, cleaning and rinsing of surgical devices, intraocular lenses, polishing and sterilizing compounds which are related to intraocular lenses. The characteristic signs and symptoms such as blurred vision, corneal edema, hypopyon and nonreactive pupil usually occur 24 hours after the cataract surgery. The differential diagnosis of TASS from infectious endophthalmitis is important. The main treatment for TASS formation is prevention. TASS is a cataract surgery complication that is more commonly seen nowadays. In this article, the possible underlying causes as well as treatment and prevention methods of TASS are summarized. (Turk J Oph thal mol 2011; 41: 407-13

  19. Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery

    Directory of Open Access Journals (Sweden)

    Su-Na Lee

    2014-01-01

    Full Text Available Toxic anterior segment syndrome (TASS is an acute sterile postoperative anterior segment inflammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.

  20. Study and Analysis of Six Stroke Engine

    Directory of Open Access Journals (Sweden)

    B. Ramya

    2014-09-01

    Full Text Available Six Stroke engine, the name itself indicates a cycle of six strokes out of which two are useful power strokes. According to its mechanical design, the six-stroke engine with external and internal combustion and double flow is similar to the actual internal reciprocating combustion engine. However, it differentiates itself entirely, due to its thermodynamic cycle and a modified cylinder head with two supplementary chambers: combustion and an air heating chamber, both independent from the cylinder. In this the cylinder and the combustion chamber are separated which gives more freedom for design analysis. In addition to the two valves in the four stroke engine two more valves are incorporated which are operated by a piston arrangement. The Six Stroke is thermodynamically more efficient because the change in volume of the power stroke is greater than the intake stroke and the compression stroke. The main advantages of six stroke engine includes reduction in fuel consumption by 40%, two power strokes in the six stroke cycle, dramatic reduction in pollution, adaptability to multi fuel operation. Six stroke engine’s adoption by the automobile industry would have a tremendous impact on the environment and world economy .

  1. Altered Functional Connectivity of Cognitive-Related Cerebellar Subregions in Well-Recovered Stroke Patients

    Directory of Open Access Journals (Sweden)

    Wei Li

    2013-01-01

    Full Text Available The cerebellum contains several cognitive-related subregions that are involved in different functional networks. The cerebellar crus II is correlated with the frontoparietal network (FPN, whereas the cerebellar IX is associated with the default-mode network (DMN. These two networks are anticorrelated and cooperatively implicated in cognitive control, which may facilitate the motor recovery in stroke patients. In the present study, we aimed to investigate the resting-state functional connectivity (rsFC changes in 25 subcortical ischemic stroke patients with well-recovered global motor function. Consistent with previous studies, the crus II was correlated with the FPN, including the dorsolateral prefrontal cortex (DLPFC and posterior parietal cortex, and the cerebellar IX was correlated with the DMN, including the posterior cingulate cortex/precuneus (PCC/Pcu, medial prefrontal cortex (MPFC, DLPFC, lateral parietal cortices, and anterior temporal cortices. No significantly increased rsFCs of these cerebellar subregions were found in stroke patients, suggesting that the rsFCs of the cognitive-related cerebellar subregions are not the critical factors contributing to the recovery of motor function in stroke patients. The finding of the disconnection in the cerebellar-related cognitive control networks may possibly explain the deficits in cognitive control function even in stroke patients with well-recovered global motor function.

  2. When Coughing Can Cause Stroke - A Case-Based Update on Cerebral Air Embolism Complicating Biopsy of the Lung

    International Nuclear Information System (INIS)

    Introducing gas to the circulation is a largely iatrogenic problem which can result in serious morbidity and even death. We report a case of CT-guided needle biopsy of a pulmonary lesion complicated by acute stroke. The English literature on cerebral air embolism is reviewed, including an update of current opinions on its pathomechanism, diagnostic findings, therapeutic strategies, and means of prevention.

  3. [New aspects of stroke medicine].

    Science.gov (United States)

    Diener, H C; Frank, B; Hajjar, K; Weimar, C

    2014-08-01

    Systemic thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) remains the only effective and approved medical treatment of acute ischemic stroke. Several studies have demonstrated the importance of rapid recanalization. The efficacy of thrombectomy has so far not been sufficiently shown in randomized clinical trials; therefore, inclusion of suitable patients in one of the currently ongoing randomized trials is of great importance. The early treatment with magnesium after acute ischemic stroke during the pre-hospital phase did not prove to be neuroprotective. Intermittent pneumatic compression of the lower extremities in immobilized stroke patients effectively prevents deep venous thrombosis and pulmonary embolism. In patients with lacunar stroke the combination of aspirin and clopidogrel is not superior to aspirin alone and causes more bleeding complications. The novel oral anticoagulants are superior to warfarin in secondary prevention and carry a lower risk of intracranial and systemic bleeding complications. New studies will investigate whether dabigatran or rivaroxaban are superior to aspirin in secondary prevention after cryptogenic stroke. PMID:24969949

  4. Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ritzenthaler, Thomas; Cho, Tae-Hee; Derex, Laurent; Nighoghossian, Norbert [Hospices Civils de Lyon, Cerebrovascular Unit, Hopital Neurologique Pierre Wertheimer, Bron (France); Claude Bernard Lyon 1 University, Creatis-LRMN, UMR 5520-Inserm 630, Lyon (France); Wiart, Marlene; Berthezene, Yves [Claude Bernard Lyon 1 University, Creatis-LRMN, UMR 5520-Inserm 630, Lyon (France); Berthiller, Julien [Hospices Civils de Lyon, Pole Information Medicale Evaluation Recherche, Lyon (France); Universite Lyon 1, Lyon (France); Oestergaard, Leif [University of Aarhus, Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus (Denmark); Hermier, Marc [Hospices Civils de Lyon, Neuroradiology Department, Hopital Neurologique Pierre Wertheimer, Lyon (France)

    2011-08-15

    The value of perfusion MRI for identifying the tissue at risk has been questioned. Our objective was to assess baseline perfusion-weighted imaging parameters within infarct progression areas. Patients with anterior circulation stroke without early reperfusion were included from a prospective MRI database. Sequential MRI examinations were performed on admission, 2-3 h (H2), 2-3 days (D2), and between 15 and 30 days after the initial MRI. Maps of baseline time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were calculated. Lesion extension areas were defined as pixels showing de novo lesions between each MRI and were generated by subtracting successive lesion masks: V{sub 0}, baseline diffusion-weighted imaging (DWI) lesion; V{sub 1}, lesion extension between baseline and H2 DWI; V{sub 2}, lesion extension from H2 to D2 DWI; and V{sub 3}, lesion extension from D2 DWI to final FLAIR. Repeated measures analysis was used to compare hemodynamic parameters within the baseline diffusion lesion and subsequent lesion extension areas. Thirty-two patients were included. Baseline perfusion parameters were significantly more impaired within the acute DWI lesion compared to lesion extension areas (TTP, p<0.0001; MTT, p<0.0001; CBF p<0.0001; CBV, p<0.0001). A significant decrease in MTT (p = 0.01) and TTP (p = 0.01) was found within successive lesion growth areas. A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas. (orig.)

  5. Assessment of baseline hemodynamic parameters within infarct progression areas in acute stroke patients using perfusion-weighted MRI

    International Nuclear Information System (INIS)

    The value of perfusion MRI for identifying the tissue at risk has been questioned. Our objective was to assess baseline perfusion-weighted imaging parameters within infarct progression areas. Patients with anterior circulation stroke without early reperfusion were included from a prospective MRI database. Sequential MRI examinations were performed on admission, 2-3 h (H2), 2-3 days (D2), and between 15 and 30 days after the initial MRI. Maps of baseline time-to-peak (TTP), mean transit time (MTT), cerebral blood volume (CBV), and cerebral blood flow (CBF) were calculated. Lesion extension areas were defined as pixels showing de novo lesions between each MRI and were generated by subtracting successive lesion masks: V0, baseline diffusion-weighted imaging (DWI) lesion; V1, lesion extension between baseline and H2 DWI; V2, lesion extension from H2 to D2 DWI; and V3, lesion extension from D2 DWI to final FLAIR. Repeated measures analysis was used to compare hemodynamic parameters within the baseline diffusion lesion and subsequent lesion extension areas. Thirty-two patients were included. Baseline perfusion parameters were significantly more impaired within the acute DWI lesion compared to lesion extension areas (TTP, p<0.0001; MTT, p<0.0001; CBF p<0.0001; CBV, p<0.0001). A significant decrease in MTT (p = 0.01) and TTP (p = 0.01) was found within successive lesion growth areas. A decreasing gradient of severity for TTP and MTT was observed within successive infarct growth areas. (orig.)

  6. Totally thrombosed giant anterior communicating artery aneurysm

    Directory of Open Access Journals (Sweden)

    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  7. Anterior capsular rupture following blunt ocular injury

    OpenAIRE

    Gremida, Anas; Kassem, Iris; Traish, Aisha

    2011-01-01

    A 10-year-old boy suffered a large, oblique anterior capsular tear following blunt injury to his right eye. The boy was followed daily for hyphema resolution and progressive traumatic cataract formation. After the hyphema had resolved, the lens was removed using an anterior approach and an intraocular lens was placed with excellent visual outcome.

  8. Dentulous Appliance for Upper Anterior Edentulous Span

    OpenAIRE

    Chalakkal, Paul; Devi, Ramisetty Sabitha; Srinivas, G Vijay; Venkataramana, Pammi

    2013-01-01

    This article discusses about a fixed dentulous appliance that was constructed to replace the primary upper anterior edentulous span in a four year old girl. It constituted a design, whereby the maxillary primary second molars were used to support the appliance through bands and a wire that contained an acrylic flange bearing trimmed acrylic teeth, anteriorly. The appliance was functionally and aesthetically compliant.

  9. Anterior cervical hypertrichosis: a sporadic case.

    Science.gov (United States)

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  10. Aspirin After Mini-Stroke May Help Prevent Full-Blown Stroke

    Science.gov (United States)

    ... gov/news/fullstory_158939.html Aspirin After Mini-Stroke May Help Prevent Full-Blown Stroke Study finds risk is reduced by as much ... HealthDay News) -- Taking aspirin immediately after a mini-stroke significantly reduces the risk of a major stroke, ...

  11. Aspirin After Mini-Stroke May Help Prevent Full-Blown Stroke

    Science.gov (United States)

    ... medlineplus/news/fullstory_158939.html Aspirin After Mini-Stroke May Help Prevent Full-Blown Stroke Study finds risk is reduced by as much ... HealthDay News) -- Taking aspirin immediately after a mini-stroke significantly reduces the risk of a major stroke, ...

  12. Sleep Apnea and Heart Disease, Stroke

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Sleep Apnea and Heart Disease, Stroke Updated:Sep 16, ... be life-threatening. It’s a condition known as sleep apnea, in which the person may experience pauses ...

  13. Flu and Heart Disease and Stroke

    Science.gov (United States)

    ... What's this? Submit Button Past Newsletters Flu and Heart Disease & Stroke Language: English Español Recommend on Facebook Tweet Share Compartir People with Heart Disease* and Those Who Have Had a Stroke Are ...

  14. What Are Heart Disease and Stroke?

    Science.gov (United States)

    ... Blood Pressure Tools & Resources Stroke More What Are Heart Disease and Stroke? Updated:Dec 8,2015 There are ... include: High blood pressure Smoking Diabetes High cholesterol Heart disease Atrial fibrillation (Abnormal heart rhythm) Call 9-1- ...

  15. Stroke Rehabilitation: What Research is Being Done?

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation What Research is Being Done? Past Issues / ... Table of Contents To Find Out More MedlinePlus: Stroke Rehabilitation medlineplus.gov/strokerehabilitation.html National Institute of ...

  16. Kirk Douglas: "My Stroke of Luck"

    Science.gov (United States)

    ... Issue Past Issues Special Section Kirk Douglas: "My Stroke of Luck" Past Issues / Summer 2007 Table of ... active. Photo courtesy of Kirk Douglas When a stroke felled actor and writer Kirk Douglas in 1996, ...

  17. FastStats: Cerebrovascular Disease or Stroke

    Science.gov (United States)

    ... this? Submit Button NCHS Home Cerebrovascular Disease or Stroke Recommend on Facebook Tweet Share Compartir Data are ... Morbidity Number of adults who ever had a stroke: 6.3 million Percent of adults who ever ...

  18. Anemia Boosts Stroke Death Risk, Study Finds

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_160476.html Anemia Boosts Stroke Death Risk, Study Finds Blood condition ... 2016 (HealthDay News) -- Older stroke victims suffering from anemia -- a lack of red blood cells -- may have ...

  19. African-Americans and Heart Disease, Stroke

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More African-Americans and Heart Disease, Stroke Updated:Apr 18, ... of getting those diseases are even higher for African-Americans. The good news is, African-Americans can ...

  20. Professionals' views on interprofessional stroke team functioning

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2011-01-01

    markdownabstractIntroduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals’ perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their e

  1. Diabetes - preventing heart attack and stroke

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000080.htm Diabetes - preventing heart attack and stroke To use the sharing features on ... with diabetes have a higher chance of having heart attacks and strokes. Smoking and having high blood pressure ...

  2. EXPERT-SYSTEM BASED MEDICAL STROKE PREVENTION

    Directory of Open Access Journals (Sweden)

    Anindito

    2013-01-01

    Full Text Available Stroke always comes unexpected and the general public is not usually aware of its symptoms. Individuals who have had their first stroke with permanent damage could become an economic burden to their family and a social burden to the society due to their unproductive nature. Stroke could be prevented and its risk factors have been identified. Through a stroke prevention information system, the user could be made more aware of stroke risks and symptoms. An expert system would be able to direct and motivate users to keep themselves healthy therefore preventing first and recurrent strokes. The expert system is built using an inference engine that provides stroke risk level based on information provided by the user. Information collected are self measured blood pressure, cigarettes consumed, amount of physical activity and body mass index. Users are presented with suggested preventive tasks to reduce their stroke risk.

  3. New Guidelines Recommend Inpatient Rehab After Stroke

    Science.gov (United States)

    ... computer, books, music and virtual reality games could help enhance rehabilitation for stroke patients, making it more engaging and mentally stimulating. Stroke patients who have trouble speaking should undergo speech therapy. Patients who have vision problems and have trouble ...

  4. STATINS IN PREVENTION OF ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    A. V. Susekov

    2015-09-01

    Full Text Available The evidence base of statin therapy in primary and secondary prevention of ischemic stroke is surveyed. Results of classical trails with statins in ischemic stroke prevention as well as results of meta-analyses are discussed.

  5. Statins in prevention of ischemic stroke

    OpenAIRE

    A.V. Susekov; A. B. Blohin; Z. G. Luginova; E. J. Soloveva; N. V. Maltseva; O.E. Tarasova; V.V. Kuharchuk

    2013-01-01

    The evidence base of statin therapy in primary and secondary prevention of ischemic stroke is surveyed. Results of classical trails with statins in ischemic stroke prevention as well as results of meta-analyses are discussed.

  6. Air Pollution and Heart Disease, Stroke

    Science.gov (United States)

    ... High Blood Pressure Tools & Resources Stroke More Air Pollution and Heart Disease, Stroke Updated:Aug 30,2016 ... routine or in a less populated place, tiny pollution particles in the air can lead to big ...

  7. Multisensory stimulation in stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Barbro Birgitta Johansson

    2012-04-01

    Full Text Available The brain has a large capacity for automatic simultaneous processing and integration of sensory information. Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli, and learning is often optimal in a multisensory environment. Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery, action observation, training with a mirror or in a virtual environment, or various kinds of music therapy. Several studies have shown positive effects been reported but to give general recommendation more studies are needed. Patient heterogeneity and the interactions of age, gender, genes and environment are discussed. Randomized controlled longitudinal trials starting earlier post stroke are needed. The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation.

  8. Fabry disease and early stroke

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, U

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from deficient activity of the enzyme a-galactosidase A. Affected males with the classic phoenotype have acroparaesthesias, hypohidrosis, and corneal opacities in childhood and develop renal failure, cardiac hypertrophy or strokes in...... the third to fifth decade of life. Some female heterozygotes are asymptomatic, some as severely affected as males. The natural history of Fabry patients includes transitory cerebral ischaemia and strokes, even in very young persons of both genders. The mechanism is partly due to vascular endothelial...... accumulation of GL-3. White matter lesions on MRI occur. Both males and females can be safely treated with enzyme replacement; and thus screening for Fabry disease of young stroke populations should be considered. There are, however, no hard data of treatment effect on mortality and morbidity. The analyses of...

  9. Fabry disease and early stroke

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, U

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from deficient activity of the enzyme α-galactosidase A. Affected males with the classic phoenotype have acroparaesthesias, hypohidrosis, and corneal opacities in childhood and develop renal failure, cardiac hypertrophy or strokes in...... the third to fifth decade of life. Some female heterozygotes are asymptomatic, some as severely affected as males. The natural history of Fabry patients includes transitory cerebral ischaemia and strokes, even in very young persons of both genders. The mechanism is partly due to vascular endothelial...... accumulation of GL-3. White matter lesions on MRI occur. Both males and females can be safely treated with enzyme replacement; and thus screening for Fabry disease of young stroke populations should be considered. There are, however, no hard data of treatment effect on mortality and morbidity. The analyses of...

  10. Visual attention in posterior stroke

    DEFF Research Database (Denmark)

    Fabricius, Charlotte; Petersen, Anders; Iversen, Helle K;

    Objective: Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere. However, attentional effects of more posterior lesions are less clear. The aim of this study was to characterize visual processing speed and...... apprehension span following posterior cerebral artery (PCA) stroke. We also relate these attentional parameters to visual word recognition, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Methods: Nine patients with MR-verified focal lesions in the PCA......-territory (four left PCA; four right PCA; one bilateral, all >1 year post stroke) were compared to 25 controls using single case statistics. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific speed and span measurements. We also characterized visual field defects and...

  11. Study and Analysis of Six Stroke Engine

    OpenAIRE

    B. Ramya

    2014-01-01

    Six Stroke engine, the name itself indicates a cycle of six strokes out of which two are useful power strokes. According to its mechanical design, the six-stroke engine with external and internal combustion and double flow is similar to the actual internal reciprocating combustion engine. However, it differentiates itself entirely, due to its thermodynamic cycle and a modified cylinder head with two supplementary chambers: combustion and an air heating chamber, both independen...

  12. Autoimmune Responses to Brain Following Stroke

    OpenAIRE

    Becker, Kyra

    2012-01-01

    This review provides a synthesis of the work done by our laboratory that demonstrates the presence of cellular immune responses directed towards brain antigens in animals following experimental stroke as well as in patients following ischemic stroke. These responses include both antigenspecific Th1(+) responses, which are associated with worse stroke outcome, and antigen-specific Treg responses, which are associated with better stroke outcome. The likelihood of developing a detrimental Th1(+)...

  13. Current Status of Cell Therapies in Stroke

    OpenAIRE

    Bang, Oh Young

    2009-01-01

    Stroke is a leading cause of death and disability in adults. Recovery after stroke is usually limited as there is no definite therapy to restore lost brain function. Cell therapy is an emerging paradigm in stroke therapy for patients with fixed neurologic deficits. Cell therapy for stroke may be greatly different from cell therapy for other disease conditions; the complexity of central nervous system structures and functions may limit its effectiveness. Recently, there have been several clini...

  14. Strokes in young adults: epidemiology and prevention

    OpenAIRE

    Smajlović D

    2015-01-01

    Dževdet Smajlović Department of Neurology, University Clinical Centre Tuzla, School of Medicine, University of Tuzla, Bosnia and Herzegovina Abstract: Strokes in young adults are reported as being uncommon, comprising 10%–15% of all stroke patients. However, compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of str...

  15. Stroke Prevention: Managing Modifiable Risk Factors

    OpenAIRE

    Silvia Di Legge; Giacomo Koch; Marina Diomedi; Paolo Stanzione; Fabrizio Sallustio

    2012-01-01

    Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEI...

  16. Recent Advances in Childhood Arterial Ischemic Stroke

    OpenAIRE

    Fox, Christine K.; Fullerton, Heather J.

    2010-01-01

    Although many underlying diseases have been reported in the setting of childhood arterial ischemic stroke, emerging research demonstrates that non-atherosclerotic intracerebral arteriopathies in otherwise healthy children are prevalent. Minor infections may play a role in arteriopathies that have no other apparent underlying cause. Although stroke in childhood differs in many aspects from adult stroke, few systematic studies specific to pediatrics are available to inform stroke management. Tr...

  17. Recognition of tennis strokes using key postures

    OpenAIRE

    Connaghan, Damien; Ó Conaire, Ciarán; Kelly, Philip; O''Connor, Noel E.

    2010-01-01

    In this paper we describe an approach for automatic recognition of tennis strokes using a single low cost camera. Professional tennis is played at high speed so the ability to classify tennis strokes on camera is hindered by the rapid movement of the players. We have developed an accurate recognition system which can automatically index tennis strokes from video footage. We aim to evolve this system so that meta data, such as time codes and descriptions of the strokes played, can be automatic...

  18. Prehospital care of the acute stroke patient.

    Science.gov (United States)

    Rajajee, Venkatakrishna; Saver, Jeffrey

    2005-06-01

    Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed. PMID:16194754

  19. Generalized Myoclonus: A Rare Manifestation of Stroke

    OpenAIRE

    Inoa, Violiza; McCullough, Louise D.

    2015-01-01

    Movement disorders have been reported as rare complications of stroke. The basal ganglia have been implicated in the pathophysiology of most post-stroke dyskinesias. We outline different types of post-stroke myoclonus and their possible pathophysiology. A middle-aged man developed generalized myoclonus after an ischemic stroke in the superior midbrain and subthalamic nuclei. Spontaneous resolution was seen by 72 hours. A lesion to the subthalamic nuclei disrupted the normal thalamic inhibitio...

  20. Anterior Shoulder Instability with Concomitant Superior Labrum from Anterior to Posterior (SLAP) Lesion Compared to Anterior Instability without SLAP Lesion

    Science.gov (United States)

    Durban, Claire Marie C.; Kim, Je Kyun; Kim, Sae Hoon

    2016-01-01

    Background The aims of this study were to investigate the clinical characteristics of patients with combined anterior instability and superior labrum from anterior to posterior (SLAP) lesions, and to analyze the effect of concomitant SLAP repair on surgical outcomes. Methods We retrospectively reviewed patients who underwent arthroscopic stabilization for anterior shoulder instability between January 2004 and March 2013. A total of 120 patients were available for at least 1-year follow-up. Forty-four patients with reparable concomitant detached SLAP lesions (group I) underwent combined SLAP and anterior stabilization, and 76 patients without SLAP lesions (group II) underwent anterior stabilization alone. Patient characteristics, preoperative and postoperative pain scores, Rowe scores, and shoulder ranges of motion were compared between the 2 groups. Results Patients in group I had higher incidences of high-energy trauma (p = 0.03), worse preoperative pain visual analogue scale (VAS) (p = 0.02), and Rowe scores (p = 0.04). The postoperative pain VAS and Rowe scores improved equally in both groups without significant differences. Limitation in postoperative range of motion was similar between the groups (all p-value > 0.05). Conclusions Anterior instability with SLAP lesion may not be related to frequent episodes of dislocation but rather to a high-energy trauma. SLAP fixation with anterior stabilization procedures did not lead to poor functional outcomes if appropriate surgical techniques were followed. PMID:27247742

  1. Atrial fibrillation and stroke: epidemiology.

    Science.gov (United States)

    Reiffel, James A

    2014-04-01

    The statistics for AFib are impressive. (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). The principal risk with AFib, stroke or thrombotic embolism, is increased 5-fold in some series; AFib accounts for ≥15% of all strokes in the United States, 36% of strokes for individuals aged >80, and up to 20% of cryptogenic strokes, which means >100,000-125,000 embolic strokes per year, of which >20% are fatal. Patients with ischemic stroke and AFib are significantly (PPrevention of these thromboembolic outcomes requires prophylactic anticoagulation therapy. The "gold standard" for anticoagulation has been warfarin, despite its well-known side effects and adherence challenges for patients. The recent approvals of several new, novel oral anticoagulation (NOAC) agents, however, presents physicians with a benefit/risk profile that represents an important advance over warfarin prophylaxis. The principal risk with all oral anticoagulants is bleeding. An important misconception about warfarin is that if anticoagulated patients bleed, the risk can be quickly reversed, but most trial experience has found that warfarin reversal requires 24 hours to halve the INR value. Reversal of anticoagulation with the NOACs is unproven at present; possible approaches are presented in this review, but since the NOACs have both rapid onsets of action and short biologic half-lives, they do not present the same reversal challenges as warfarin. Finally, physicians must be aware of thromboembolic risk assessment. The principal risk assessment scores are CHADS2, updated with the more recent CHA2DS2-VASc to provide more accurate assessment of low-risk patients; this review concludes with a novel flow-chart showing physicians how the CHADS2/CHA2DS2-VASc scoring systems can be used. PMID:24655742

  2. Medical image of the week: paradoxical stroke

    Directory of Open Access Journals (Sweden)

    Zaid LA

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. A 23-year-old man with a history of intravenous drug abuse (IVDA was admitted to the intensive care unit (ICU secondary to sepsis. His blood cultures were positive for methicillin sensitive Staphylococcus aureus. Transthoracic echocardiogram showed vegetation on the tricuspid valve (Figure 1. He had multiple systemic emboli leading to suspicion for right to left shunt, which was confirmed by the agitated saline test during the echocardiogram (Figure 2. Cerebellar strokes likely secondary to posterior circulation embolic phenomenon was also seen (Figure 3. Overall, after a protracted ICU course complicated by multi-organ failure, he improved and is continuing treatment and rehabilitation at this time. Right-sided infective endocarditis (IE incidence is low, accounting for 5-10% of all cases of IE (1. IVDA is a well-known cause of tricuspid valve endocarditis. Usual features of tricuspid endocarditis are fever, bacteremia and pulmonary septic emboli. Patent foramen ovale (PFO is estimated in up to 25% ...

  3. INTERNAL CIRCULATION ENVELOPES

    CERN Multimedia

    Mail Office

    2001-01-01

    Internal mail envelopes often finish up in large piles in certain offices, thus creating a shortage for other users of the mail service, who would be grateful if everyone with an unused stock could deposit them in their mail box, after attaching them together with an elastic band or a piece of string. The messengers will then collect them so that the Mail Office can put them back in circulation. Thank you for your understanding and collaboration.

  4. Stroke survivors' experiences of rehabilitation

    DEFF Research Database (Denmark)

    Peoples, Hanne; Satink, Ton; Steultjens, Esther

    2011-01-01

    needs, 3) Physical and non-physical needs, 4) Being personally valued and treated with respect, 5) Collaboration with health care professionals and 6) Assuming responsibility and seizing control. DISCUSSION: The synthesis showed that stroke survivors' experiences of rehabilitation reflected individual......INTRODUCTION: The aim was to obtain the best available knowledge on stroke survivors' experiences of rehabilitation. The increase in demands for accountability in health care and acknowledgement of the importance of client participation in health decisions calls for systematic ways of integrating...

  5. CT perfusion in acute stroke

    International Nuclear Information System (INIS)

    Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it

  6. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    of recurrent stroke. Mortality was significantly lower in overweight (hazard ratio 0·72; confidence interval 0·68–0·78) and obese (hazard ratio 0·80; confidence interval 0·73–0·88) patients while significantly higher in underweight patients (hazard ratio 1·66; confidence interval 1·49–1·84) compared...... with normal weight patients. Risk of readmission for recurrent stroke was significantly lower in obese than in normal weight patients (hazard ratio 0·84; confidence interval 0·72–0·92). CONCLUSIONS: Obesity was not only associated with reduced mortality relative to normal weight patients. Compared with normal...

  7. Potential blood biomarkers for stroke.

    Science.gov (United States)

    Laborde, Carlos M; Mourino-Alvarez, Laura; Akerstrom, Finn; Padial, Luis R; Vivanco, Fernando; Gil-Dones, Felix; Barderas, Maria G

    2012-08-01

    Stroke is one of the most common causes of death worldwide and a major cause of acquired disability in adults. Despite advances in research during the last decade, prevention and treatment strategies still suffer from significant limitations, and therefore new theoretical and technical approaches are required. Technological advances in the proteomic and metabolomic areas, during recent years, have permitted a more effective search for novel biomarkers and therapeutic targets that may allow for effective risk stratification and early diagnosis with subsequent rapid treatment. This review provides a comprehensive overview of the latest candidate proteins and metabolites proposed as new potential biomarkers in stroke. PMID:22967080

  8. Stroke Prevention Trials in Sickle Cell Anemia

    OpenAIRE

    J Gordon Millichap

    2006-01-01

    As part of an International Pediatric Stroke Study launched in 2002, the Stroke Prevention Trial in Sickle Cell Anemia (STOP) reports a reduction in the number of overt clinical strokes in children with critically high transcranial Doppler velocities (>200 cm/sec) who were regularly transfused.

  9. An overview of antithrombotics in ischemic stroke.

    Science.gov (United States)

    Schweickert, Patricia A; Gaughen, John R; Kreitel, Elizabeth M; Shephard, Timothy J; Solenski, Nina J; Jensen, Mary E

    2016-06-19

    The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke. PMID:27153001

  10. Stroke Prevention Trials in Sickle Cell Anemia

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-06-01

    Full Text Available As part of an International Pediatric Stroke Study launched in 2002, the Stroke Prevention Trial in Sickle Cell Anemia (STOP reports a reduction in the number of overt clinical strokes in children with critically high transcranial Doppler velocities (>200 cm/sec who were regularly transfused.

  11. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N;

    2014-01-01

    BACKGROUND AND PURPOSE: There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass graftin...... associated with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677....

  12. Administration of Uric Acid in the Emergency Treatment of Acute Ischemic Stroke.

    Science.gov (United States)

    Llull, Laura; Amaro, Sergio; Chamorro, Ángel

    2016-01-01

    Oxidative stress is one of the main mechanisms implicated in the pathophysiology of inflammatory and neurodegenerative diseases of the central nervous system (CNS). Uric acid (UA) is the end product of purine catabolism in humans, and it is the main endogenous antioxidant in blood. Low circulating UA levels have been associated with an increased prevalence and worse clinical course of several neurodegenerative and inflammatory diseases of the CNS, including Parkinson's disease and multiple sclerosis. Moreover, the exogenous administration of UA exerts robust neuroprotective properties in experimental models of CNS disease, including brain ischemia, spinal cord injury, meningitis, and experimental allergic encephalitis. In experimental brain ischemia, exogenous UA and the thrombolytic agent alteplase exert additive neuroprotective effects when administered in combination. UA is rapidly consumed following acute ischemic stroke, and higher UA levels at stroke admission are associated with a better outcome and reduced infarct growth at follow-up. A recent phase II trial demonstrated that the combined intravenous administration of UA and alteplase is safe and prevents an early decrease of circulating UA levels in acute ischemic stroke patients. Moreover, UA prevents the increase in the circulating levels of the lipid peroxidation marker malondialdehyde and of active matrix metalloproteinase (MMP) 9, a marker of blood-brain barrier disruption. The moderately sized URICOICTUS phase 2b trial showed that the addition of UA to thrombolytic therapy resulted in a 6% absolute increase in the rate of excellent outcome at 90 days compared to placebo. The trial also showed that UA administration resulted in a significant increment of excellent outcome in patients with pretreatment hyperglycemia, in females and in patients with moderate strokes. Overall, the encouraging neuroprotective effects of UA therapy in acute ischemic stroke warrants further investigation in adequately

  13. Social Participation after Stroke: One-Year Follow-Up of Stroke Survivors in Nigeria

    OpenAIRE

    Vincent-Onabajo, Grace O.

    2013-01-01

    Background. Stroke may negatively affect social participation in survivors. Aims. This study assessed the pattern of social participation in a sample of Nigerian stroke survivors across the first 12 months after stroke. Methods. Stroke survivors were consecutively recruited while on admission at a tertiary health institution. The London handicap scale was used to assess social participation at 1, 3, 6, 9, and 12 months at the homes of the stroke survivors. Overall and domain-specific patterns...

  14. Family history and stroke outcome in a bi-ethnic, population-based stroke surveillance study

    Directory of Open Access Journals (Sweden)

    Uchino Ken

    2005-10-01

    Full Text Available Background The genetic epidemiology of ischemic stroke remains relatively unstudied, and information about the genetic epidemiology of ischemic stroke in populations with significant minority representation is currently unavailable. Methods The Brain Attack Surveillance in Corpus Christi project (BASIC is a population-based stroke surveillance study conducted in the bi-ethnic community of Nueces County, Texas, USA. Completed ischemic strokes were identified among patients 45 years or older seen at hospitals in the county between January 1, 2000 – December 31, 2002. A random sample of ischemic stroke patients underwent an in-person interview and detailed medical record abstraction (n = 400. Outcomes, including initial stroke severity (NIH stroke scale, age at stroke onset, 90-day mortality and functional outcome (modified Rankin scale ≥2, were studied for their association with family history of stroke among a first degree relative using multivariable logistic and linear regression. A chi-square test was used to test the association between family history of stroke and ischemic stroke subtype. Results The study population was 53.0% Mexican American and 58.4% female. Median age was 73.2 years. Forty percent reported a family history of stroke among a first degree relative. Family history of stroke was borderline significantly associated with stroke subtype (p = 0.0563. Family history was associated with poor functional outcome in the multivariable model (OR = 1.87; 95% CI: 1.14–3.09. Family history was not significantly related to initial stroke severity, age at stroke onset, or 90-day mortality. Conclusion Family history of stroke was related to ischemic stroke subtype and to functional status at discharge. More research is needed to understand whether stroke subtype would be a useful selection criterion for genetic association studies and to hypothesize about a possible genetic link to recovery following ischemic stroke.

  15. Neurosurgical management of L-asparaginase induced haemorrhagic stroke.

    LENUS (Irish Health Repository)

    Ogbodo, Elisha

    2012-01-01

    The authors describe a case of L-asparaginase induced intracranial thrombosis and subsequent haemorrhage in a newly diagnosed 30-year-old man with acute lymphoblastic leukaemia who was successfully managed by surgical intervention. At presentation, he had a Glasgow Coma Score of 7\\/15, was aphasic and had dense right hemiplegia. Neuroimaging revealed an acute anterior left middle cerebral artery infarct with parenchymal haemorrhagic conversion, mass effect and subfalcine herniation. He subsequently underwent left frontal craniotomy and evacuation of large frontal haematoma and decompressive craniectomy for cerebral oedema. Six months postoperatively he underwent titanium cranioplasty. He had made good clinical recovery and is currently mobilising independently with mild occasional episodes of expressive dysphasia, difficulty with fine motor movement on the right side, and has remained seizure free. This is the first documented case of L-asparaginase induced haemorrhagic stroke managed by neurosurgical intervention. The authors emphasise the possible role of surgery in managing chemotherapy induced intracranial complications.

  16. Lipid profiles and ischemic stroke risk: variations by sex within racial/ethnic groups

    Directory of Open Access Journals (Sweden)

    Gezmu T

    2014-05-01

    Full Text Available Tefera Gezmu,1 Dona Schneider,1 Kitaw Demissie,2 Yong Lin,2 Christine Giordano,3 Martin S Gizzi4 1Edward J. Bloustein School of Planning and Public Policy, Rutgers, the State University of New Jersey, New Brunswick, NJ, 2Rutgers School of Public Health, Department of Epidemiology, Piscataway, NJ, 3Rutgers New Jersey Medical School, Newark, NJ, 4New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, NJ, USA Abstract: Evidence implicates lipid abnormalities as important but modifiable risk factors for stroke. This study assesses whether hypercholesterolemia can be used to predict the risk for etiologic subtypes of ischemic stroke between sexes within racial/ethnic groups. Data elements related to stroke risk, diagnosis, and outcomes were abstracted from the medical records of 3,290 acute stroke admissions between 2006 and 2010 at a regional stroke center. Sex comparison within racial/ethnic groups revealed that South Asian and Hispanic men had a higher proportion of ischemic stroke than women, while the inverse was true for Whites and African Americans (P=0.0014. All women, except South Asian women, had higher mean plasma total cholesterol and higher blood circulating low-density lipoprotein levels (≥100 mg/dL than men at the time of their admissions. The incidence of large-artery atherosclerosis (LAA was more common among women than men, except among Hispanics, where men tended to have higher incidences. A regression analysis that considered patients diagnosed with either LAA or small-artery occlusion etiologic subtype as the outcomes and high-density lipoproteins and triglycerides as predictors showed inconsistent associations between lipid profiles and the incidence of these subtypes between the sexes within racial/ethnic groups. In conclusion, our investigation suggests that women stroke patients may be at increased risk for stroke etiologic subtype LAA than men. Although the higher prevalence of stroke

  17. Prevention and management of stroke in sickle cell disease

    Directory of Open Access Journals (Sweden)

    Y. Kilinç

    2011-12-01

    Full Text Available Sickle Cell Disease(SCD is one of the most common hemoglobinopathies in the world which causes stroke. The management of stroke depends on the manifestations and the age of the patient. Especially in childhood, anatomic and physiological abnormalities of CNS may be a predisposing factors. Stroke mostly affects the distal segments of the Internal Carotid Artery, but also middle and anterior segments of the cerebral arteries are involved. The most important predisposing factors are the arterial malformations, stenosis and obstructions in cranial arteries, generally involving Internal Carotid Artery, frequently Proximal Middle Cerebral or Anterior Cerebral Arteries. After infarcts at brain vessels, most frequent clinical findings are hemiparesis or hemiplegia, impaired speech, focal seizures, gait disturbances. Risk factors for predisposing stroke are prior transient ischemia, baseline Hb decrease, acute chest sydrome within previous two weeks, systolic blood pressure rises, leucocyte increases. The patient with silent stroke or transient ischemic attacks may be asymptomatic or without neurological symptoms. Neuroimaging abnormalities may be seen without significant clinical findings in children with SCD. We talk about silent stroke if there are neuroradiological abnormalities without clinical findings. Children with silent strokes are more prone to new strokes. If there is a significant stroke a ischemic stroke often present with focal neurological signs and symptoms. If patient is asymptomatic or have suspected stroke, first step may be performance of Transcranial Doppler Ultrasonography (TCD. Children with time-averaged mean velocity (TAMV, measured in Middle Carotid Artery or in distal internal carotid Artery abnormally elevated, defined as TAMV≥200cm/sec, have sixfold increase for stroke than those with normal TAMV≤170cm/sec. For these patients under the risk of stroke, chronic blood transfusion is recommended for prevention of primary

  18. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation.

    Science.gov (United States)

    Valderrábano, Miguel; Price, Matthew J

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion strategies. PMID:26306126

  19. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Valderrábano, Miguel; Price, Matthew J.

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion stra...

  20. Anterior retropharyngeal approach to the cervical spine.

    OpenAIRE

    Behari S; Banerji D; Trivedi P; Jain V; Chhabra D

    2001-01-01

    The anterior retropharyngeal approach (ARPA) accesses anteriorly situated lesions from the clivus to C3, in patients with a short neck, Klippel Feil anomaly or those in whom the C2-3 and C3-4 disc spaces are situated higher in relation to the hyoid bone and the angle of mandible where it is difficult to approach this region using the conventional anterior approach, due to the superomedial obliquity of the trajectory. The ARPA avoids the potentially contaminated oropharyngeal cavity providing ...

  1. Mini-open anterior lumbar interbody fusion.

    Science.gov (United States)

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ . PMID:27364424

  2. Anterior Temporal Lobe Connectivity Correlates with Functional Outcome after Aphasic Stroke

    Science.gov (United States)

    Warren, Jane E.; Crinion, Jennifer T.; Ralph, Matthew A. Lambon; Wise, Richard J. S.

    2009-01-01

    Focal brain lesions are assumed to produce language deficits by two basic mechanisms: local cortical dysfunction at the lesion site, and remote cortical dysfunction due to disruption of the transfer and integration of information between connected brain regions. However, functional imaging studies investigating language outcome after aphasic…

  3. Recurrent stroke: what have we learnt?

    Science.gov (United States)

    Rabia, K; Khoo, Em

    2007-01-01

    Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described. PMID:25606084

  4. Sleep-wake disturbances after stroke

    Directory of Open Access Journals (Sweden)

    DENG Li-ying

    2013-06-01

    Full Text Available Sleep-wake disturbances (SWD after stroke is a sleep-wake disorder resulting from central nervous system lesion caused by stroke. SWD includes hypersomnia, excessive daytime sleepiness (EDS, fatigue and so on. The prevalence rate of SWD is only less than sleep-related breathing disturbances (SBD. Recent studies suggest that SWD is frequent and negatively affects rehabilitation and quality of life of patients with stroke, and treatment of poststroke SWD may favorably influence stroke outcome. SWD may become a new target of treatment and rehabilitation of stroke. This paper reviewed the progress of this issue.

  5. Patient Education Among Stroke Survivor Patients

    OpenAIRE

    Martin, Ruth

    2014-01-01

    Stroke is one of the most serious health problems in the world, cited as being the second leading cause of death. After stroke, there is a greater risk of suffering second and further subsequent stroke-events. Given the heavy burden of disease present by stroke, there is a great need to improve patient education for stroke survivors, who are at an increased risk of another cerebrovascular accident. The purpose of this thesis is to develop the quality of patient education in nursing care o...

  6. Supernumerary phantom limb after stroke

    OpenAIRE

    Bakheit, A; Roundhill, S

    2005-01-01

    The perception of a phantom limb is commonly reported after amputations. However, only a few cases have been described after a stroke. This article presents a patient who reported a supernumerary phantom limb (pseudopolymelia) after spontaneous intracerebral haemorrhage and discusses the possible underlying mechanisms for this rare phenomenon.

  7. Predictors of Perinatal Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-04-01

    Full Text Available The prevalence and predictors of perinatal hemorrhagic stroke were determined in a case-control study of infants born from 1993 to 2003 in the Northern California Kaiser Permanente Medical Care Program, Oakland, CA, and reported from the University of California, San Francisco, CA.

  8. Predictors of Perinatal Hemorrhagic Stroke

    OpenAIRE

    J Gordon Millichap

    2009-01-01

    The prevalence and predictors of perinatal hemorrhagic stroke were determined in a case-control study of infants born from 1993 to 2003 in the Northern California Kaiser Permanente Medical Care Program, Oakland, CA, and reported from the University of California, San Francisco, CA.

  9. Road traffic noise and stroke

    DEFF Research Database (Denmark)

    Sørensen, Mette; Hvidberg, Martin; Andersen, Zorana J;

    2011-01-01

    Epidemiological studies suggest that long-term exposure to road traffic noise increases the risk of cardiovascular disorders. The aim of this study was to investigate the relation between exposure to road traffic noise and risk for stroke, which has not been studied before....

  10. Ischemic strokes and oral contraception

    International Nuclear Information System (INIS)

    The authors describe the epidemiology and the physiopathological aspects of ischemic strokes in patients with history of oestroprogestogen use. They then study their main radiological correlates: arterial infarcts at CT scan and angiographic non-specific lesions which can be included in the extremely wide framework of arteritis, much more rarely venous thrombophlebitis. (orig.)

  11. Ischemic strokes and oral contraception

    International Nuclear Information System (INIS)

    The authors describe the epidemiology and the physiopathological aspects of ischemic strokes in patients with a history of oestroprogestogen use. They then study their main radiological correlates: arterial infarcts at CT scan and angiographic non-specific lesions which can be included in the extremely wide framework of arteritis and, much more rarely, venous thrombophlebitis

  12. 急性缺血性卒中患者进行超早期康复对功能结局的改善%Effect of functional improvement of rehabilitation on patients with acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    王丽平; 樊东升; 李小刚; 张新宇

    2012-01-01

    OBJECTIVE To investigate whether the rehabilitation can improve the functional outcomes of patients with acute is-chemic stroke. METHODS A total of 96 patients with acute ischemic stroke in anterior cerebral circulation who were admitted < 24 hours after stroke onset were recruited in our study. Patients were randomized into rehabilitation group who received rehabilitation including out-of-bed activity within 24 hours and standard rehabilitation group who received rehabilitation started from 72 hours between 7 days after stroke. Hie rehabilitation was performed by professional person, and one time per day, and each time would be less than 30 mine. A duration was last 14 days. The primary outcome was the number of days required to return to walking 50 meters. The secondary outcomes were the Barthel index and NIHSS score at 30 days and 90 days after stroke. RESULTS 41 patients were regarded as early rehabilitation group and 55 patients were regarded as standard rehabilitation group. Patients in early rehabilitation group returned to walking significantly faster [ (8.71 ± 14.162) d vs (16.64 ± 20.338) d, t = -2.138, P = 0.035) ] and had greater ratio to gain the 95-100 Barthel index on 90 days after stroke (75.6% vs 56.4%, χ2 = 3.891, P = 0.049) than patients in control group. CONCLUSION Early rehabilitation after ischemic stroke may fast-track return to unassisted walking and improve functional recovery.%目的 研究在急性缺血性卒中患者中进行超早期康复治疗能否更好地改善共日常生活的独立性.方法 将96名发病24h内入院的前循环急性缺血性卒中患者随机分为2组,超早期康复组在发病24 h内开始接受包括下床站立活动的康复治疗;标准康复组在发病72 h至7d开始康复治疗.康复治疗均由专业治疗师进行,每日1次,每次不少于30 min,共14 d.主要观察指标包括恢复至独立行走50m所需的天数,次要指标包括发病后30 d和90d

  13. A checklist for endonasal transsphenoidal anterior skull base surgery.

    Science.gov (United States)

    Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

    2016-06-01

    OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management

  14. Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype

    DEFF Research Database (Denmark)

    Albieri, Vanna; Olsen, Tom Skyhøj; Andersen, Klaus Kaae

    2016-01-01

    for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FINDINGS: Of the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income......, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01-1.14) and ischemic strokes (RR 1.07; CI 1.00-1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11-1.79). Risk was for mild strokes (RR 1.31; CI 1...

  15. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  16. A systematic approach to the definition of stroke

    OpenAIRE

    Cheung, RTF

    2014-01-01

    The 24-hour time-line for symptomsin the current definition of stroke is arbitrary. Moreover, this definition does not include silent stroke, encourage acute stroke therapy and consider dramatic recovery after successful therapy. Silent stroke, which is five times more common than symptomatic stroke, is a risk factor for future stroke and is associated with adverse neurological and cognitive functions. Whilst pathological confirmation remains the gold standard in defining stroke and its under...

  17. Identification of Stroke Mimics in the Emergency Department Setting

    OpenAIRE

    W. Oliver Tobin; Joseph G. Hentz; Bobrow, Bentley J.; Demaerschalk, Bart M.

    2009-01-01

    Background and Purpose Previous studies have shown a stroke mimic rate of 9%–31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics. Methods This was a retrospective cohort observational study. Consecutive “stroke alert” patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as “stroke”...

  18. Resolvability in Circulant Graphs

    Institute of Scientific and Technical Information of China (English)

    Muhammad SALMAN; Imran JAVAID; Muhammad Anwar CHAUDHRY

    2012-01-01

    A set W of the vertices of a connected graph G is called a resolving set for G if for every two distinct vertices u,v ∈ V(G) there is a vertex w ∈ W such that d(u,w) ≠ d(v,w).A resolving set of minimum cardinality is called a metric basis for G and the number of vertices in a metric basis is called the metric dimension of G,denoted by dim(G).For a vertex u of G and a subset S of V(G),the distance between u and S is the number mins∈s d(u,s).A k-partition H ={S1,S2,...,Sk} of V(G) is called a resolving partition if for every two distinct vertices u,v ∈ V(G) there is a set Si in Π such that d(u,Si) ≠ d(v,Si).The minimum k for which there is a resolving k-partition of V(G) is called the partition dimension of G,denoted by pd(G).The circulant graph is a graph with vertex set Zn,an additive group ofintegers modulo n,and two vertices labeled i and j adjacent if and only if i - j (mod n) ∈ C,where C C Zn has the property that C =-C and 0(∈) C.The circulant graph is denoted by Xn,△ where A =|C|.In this paper,we study the metric dimension of a family of circulant graphs Xn,3 with connection set C ={1,-n/2,n - 1} and prove that dim(Xn,3) is independent of choice of n by showing that 3 for all n =0 (mod 4),dim(X,n,3) ={ 4 for all n =2 (mod 4).We also study the partition dimension of a family of circulant graphs Xn,4 with connection set C ={±1,±2} and prove that pd(Xn,4) is independent of choice of n and show that pd(X5,4) =5 and 3 forall odd n≥9,pd(Xn,4) ={ 4 for all even n ≥ 6 and n =7.

  19. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Sagar Badachi

    2015-01-01

    Full Text Available Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i Failure of patient to recognize stroke symptoms, ii patient′s awareness of thrombolysis as a treatment modality for stroke, iii failure of patient′s relative to recognize stroke, iv failure of primary care physician to recognize stroke, v transport delays, vi lack of neuroimaging and thrombolysis facility, and vii nonaffordability. Results: The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%, followed by lack of neuroimaging facility (58%, nonaffordability (56%, failure of patient′s relative to recognize stroke (38%, failure of the primary care physician to recognize stroke (21%, and transport problems (13%. Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%. Conclusion: Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.

  20. Secondary anterior crocodile shagreen of Vogt.

    Science.gov (United States)

    Tripathi, R C; Bron, A J

    1975-01-01

    The clincopathological features and pathogenesis of secondary mosaic degeneration of the cornea (anterior crocodile shagreen of Vogt) are described. The structural basis for the normal anterior corneal mosaic pattern seems to lie in the particular arrangement of many prominent collagen lamellae of the anterior stroma that thake an oblique course to gain insertion into Bowman's layer. Since, at normal intraocular pressure, Bowman's layer is under tension, when viewed from the anterior surface the cornea appears smooth. By releasing the tension, however, a reproducible polygonal ridge pattern becomes manifest. It is suggested that a prolonged phthisical state of the eye is one condition wherein the mosaic pattern may become permanent and that, as a secondary event, this is followed by irregular calcification of Bowman's layer which particularly involves the ridges projecting into the epithelium. Biomicroscopically these ridges corresponded to the branching reticular arrangement of the mosaic opacities. Images PMID:1079137

  1. Anterior Cervical Discectomy and Fusion with Plating

    Medline Plus

    Full Text Available Anterior Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I'm Dr. Matthew Moore, head of the Spine Care Center here at North Broward Medical Center. And ...

  2. Trypan blue dye for anterior segment surgeries

    OpenAIRE

    Jhanji, V; Chan, E.; Das, S.; Zhang, H; Vajpayee, R B

    2011-01-01

    Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy ...

  3. Regulation of the cerebral circulation: bedside assessment and clinical implications.

    Science.gov (United States)

    Donnelly, Joseph; Budohoski, Karol P; Smielewski, Peter; Czosnyka, Marek

    2016-01-01

    Regulation of the cerebral circulation relies on the complex interplay between cardiovascular, respiratory, and neural physiology. In health, these physiologic systems act to maintain an adequate cerebral blood flow (CBF) through modulation of hydrodynamic parameters; the resistance of cerebral vessels, and the arterial, intracranial, and venous pressures. In critical illness, however, one or more of these parameters can be compromised, raising the possibility of disturbed CBF regulation and its pathophysiologic sequelae. Rigorous assessment of the cerebral circulation requires not only measuring CBF and its hydrodynamic determinants but also assessing the stability of CBF in response to changes in arterial pressure (cerebral autoregulation), the reactivity of CBF to a vasodilator (carbon dioxide reactivity, for example), and the dynamic regulation of arterial pressure (baroreceptor sensitivity). Ideally, cerebral circulation monitors in critical care should be continuous, physically robust, allow for both regional and global CBF assessment, and be conducive to application at the bedside. Regulation of the cerebral circulation is impaired not only in primary neurologic conditions that affect the vasculature such as subarachnoid haemorrhage and stroke, but also in conditions that affect the regulation of intracranial pressure (such as traumatic brain injury and hydrocephalus) or arterial blood pressure (sepsis or cardiac dysfunction). Importantly, this impairment is often associated with poor patient outcome. At present, assessment of the cerebral circulation is primarily used as a research tool to elucidate pathophysiology or prognosis. However, when combined with other physiologic signals and online analytical techniques, cerebral circulation monitoring has the appealing potential to not only prognosticate patients, but also direct critical care management. PMID:27145751

  4. Functional Outcomes of Primary Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft

    OpenAIRE

    Başar, Selda; Büyükafşar, Enes; Hazar, Zeynep; Ataoğlu, Baybars; Kanatlı, Ulunay

    2014-01-01

    Objectives: Allografts have potential advantages in primary anterior cruciate ligament reconstruction (ACLR), including the absence of donor site morbidity, shorter operative times, improved cosmesis, and easier rehabilitation. There is limited and conflicting outcome data for ACLR with tibialis anterior allograft. The purpose of this study was to evaluate the functional outcomes of ACLR with tibialis anterior allograft. Methods: We retrospectively evaluated patients underwent ACLR using with...

  5. Recurrent ischemic strokes in a young celiac woman with MTHFR gene mutation

    Institute of Scientific and Technical Information of China (English)

    Elisa Fabbri; Lisa Rustignoli; Antonio Muscari; Giovanni M Puddu; Maria Guarino; Rita Rinaldi; Elena Minguzzi

    2012-01-01

    Celiac disease (CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption (with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.

  6. Anterior Eye Imaging with Optical Coherence Tomography

    Science.gov (United States)

    Huang, David; Li, Yan; Tang, Maolong

    The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

  7. Asymptomatic acute ischemic stroke after primary percutaneous coronary intervention in patients with acute coronary syndrome might be caused mainly by manipulating catheters or devices in the ascending aorta, regardless of the approach to the coronary artery

    International Nuclear Information System (INIS)

    Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure. (author)

  8. Circulation of Stars

    Science.gov (United States)

    Boitani, P.

    2016-01-01

    Since the dawn of man, contemplation of the stars has been a primary impulse in human beings, who proliferated their knowledge of the stars all over the world. Aristotle sees this as the product of primeval and perennial “wonder” which gives rise to what we call science, philosophy, and poetry. Astronomy, astrology, and star art (painting, architecture, literature, and music) go hand in hand through millennia in all cultures of the planet (and all use catasterisms to explain certain phenomena). Some of these developments are independent of each other, i.e., they take place in one culture independently of others. Some, on the other hand, are the product of the “circulation of stars.” There are two ways of looking at this. One seeks out forms, the other concentrates on the passing of specific lore from one area to another through time. The former relies on archetypes (for instance, with catasterism), the latter constitutes a historical process. In this paper I present some of the surprising ways in which the circulation of stars has occurred—from East to West, from East to the Far East, and from West to East, at times simultaneously.

  9. 5-year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore

    OpenAIRE

    Sun, Yan; Lee, Sze Haur; Heng, Bee Hoon; Chin, Vivien S

    2013-01-01

    Background Stroke is the 4th leading cause of death and 1st leading cause of disability in Singapore. However the information on long-term post stroke outcomes for Singaporean patients was limited. This study aimed to investigate the post stroke outcomes of 5-year survival and rehospitalization due to stroke recurrence for hemorrhagic and ischemic stroke patients in Singapore. The outcomes were stratified by age, ethnic group, gender and stroke types. The causes of death and stroke recurrence...

  10. Lesiones del ligamento cruzado anterior

    Directory of Open Access Journals (Sweden)

    Alejandro Álvarez López

    2015-01-01

    Full Text Available Fundamento: el ligamento cruzado anterior desempeña un papel muy importante en la estabili-dad de la rodilla. La incidencia de esta afección es alta en pacientes que practican deportes de contacto y de no ser tratados de forma adecuada, los resultados son desfavorables. Objetivo: profundizar en los factores necesarios para el tratamiento adecuado de enfermos con esta lesión y evitar las complicaciones. Método: se realizó una revisión bibliográfica de un total de 300 artículos publicados en Pubmed, Hinari y Medline mediante el localizador de información Endnote, de ellos se utilizaron 52 citas selecciona-das para realizar la revisión, 48 de ellas de los últimos cinco años donde se incluyeron seis libros. Desarrollo: se discuten los aspectos relacionados con el diagnóstico clínico e imaginológico. Se aborda la clasificación de esta lesión en cuanto a varios aspectos como: tiempo, lesión de ligamentos u ósea, aislada o combinada y parcial o total. Se mencionan los parámetros para obtener resultados satisfac-torios al considerar factores como la edad del enfermo, lesiones asociadas y tiempo de la lesión. Se relacio-nan los requisitos para la selección del implante y se mostró las ventajas y desventajas de cada tipo de in-jerto. Las complicaciones de esta cirugía están relacionadas con la técnica quirúrgica y médicas. Conclusiones: las lesiones del ligamento son entidades traumáticas que afectan por lo general a pacientes jóvenes. Para lograr un resultado satisfactorio en el tratamiento es necesario el conocimiento de su anatomía, clasificación, tipo de injerto a emplear según sus ventajas y desventajas.

  11. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... or higher or Taking medication for elevated blood glucose levels Source: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung,and Blood Institute Scientific Statement. Circulation. 2005;112: ...

  12. Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke

    OpenAIRE

    Hong, Keun-Sik; Bang, Oh Young; Kang, Dong-Wha; Yu, Kyung-Ho; Bae, Hee-Joon; Lee, Jin Soo; Heo, Ji Hoe; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Kim, Jong S.; Yoon, Byung-Woo

    2013-01-01

    The aim of the Part I of Stroke Statistics in Korea is to summarize nationally representative data of the epidemiology and risk factors of stroke in a single document. Every year, approximately 105,000 people experience a new or recurrent stroke and more than 26,000 die of stroke, which indicates that every 5 minutes stroke attacks someone and every 20 minutes stroke kills someone in Korea. Stroke accounts for roughly 1 of every 10 deaths. The estimated stroke prevalence is about 795,000 in p...

  13. Acute [corrected] stroke thrombolysis: an update [corrected].

    Science.gov (United States)

    Mehdiratta, Manu; Caplan, Louis R

    2007-01-01

    Acute stroke therapy took a major step forward in 1996 after the approval of Intravenous (IV) tissue plasminogen activator (t-PA) by the US Food and Drug Administration for patients presenting within 3 hours of the onset of stroke symptoms. Since that time, there have been considerable advances in imaging techniques as well as the advent of devices to help in the management of acute stroke patients. As a result, the arsenal to treat acute stroke has grown, and the field of stroke as a subspecialty of neurology has emerged. Despite these advances, only 3% to 8% of eligible patients with acute stroke in the United States are administered thrombolytics.(1) We herein review the use of thrombolytics in stroke and provide an overview of the imaging advances, new devices, and recent trials that are shaping modern stroke therapy. Finally, we provide a practical approach to the management of acute stroke, specifically for the practicing cardiologist, who may encounter stroke during cardiac catheterization, post myocardial infarction (MI), and in a variety of other settings. PMID:17498523

  14. Secondary stroke prevention: challenges and solutions.

    Science.gov (United States)

    Esenwa, Charles; Gutierrez, Jose

    2015-01-01

    Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking cessation. Changes in lifestyle like a healthy diet and aerobic exercise are also recommended strategies. In the case of cardioembolism due to atrial fibrillation, mechanical valves, or cardiac thrombus, anticoagulation is the mainstay of therapy. The role of anticoagulation is less evident in the case of bioprosthetic valves, patent foramen ovale, and dilated cardiomyopathy with low ejection fraction. Strokes due to larger artery atherosclerosis account for approximately a third of all strokes. In the case of symptomatic extracranial carotid stenosis, surgical intervention as close as possible in time to the index event seems highly beneficial. In the case of intracranial large artery atherosclerosis, the best medical therapy consists of antiplatelets, high-dose statins, aggressive controls of vascular risk factors, and lifestyle modifications, with no role for intracranial arterial stenting or angioplasty. For patients with small artery occlusion (ie, lacunar stroke), the therapy is similar to that used in patients with intracranial large artery atherosclerosis. Despite the constant new evidence on how to best treat patients who have suffered a stroke, the risk of stroke recurrence remains unacceptably high, thus evidencing the need for novel therapies. PMID:26300647

  15. Verbal learning and memory after childhood stroke.

    Science.gov (United States)

    Lansing, Amy E; Max, Jeffrey E; Delis, Dean C; Fox, Peter T; Lancaster, Jack; Manes, Facundo F; Schatz, Amy

    2004-09-01

    Verbal learning and memory (VLM) following pediatric stroke was characterized in a cross-sectional neuropsychological and neuroimaging study of 26 subjects, aged 5 to 17, with a history of pediatric stroke and 26 age, SES, and gender matched orthopedic controls. Further comparisons were made between the VLM profiles of stroke subjects with right versus left hemisphere lesions and early (> 12 months) versus late (12 months) strokes. Overall, stroke subjects scored significantly lower than control subjects on several VLM indices (California Verbal Learning Test-Children; CVLT-C), as well as on measures of intellectual functioning (IQ) and auditory attention/working memory (Digit Span). Subgroup analyses of the stroke population found no significant differences in VLM, Digit Span, Verbal IQ or Performance IQ when left-hemisphere lesion subjects were compared to right-hemisphere lesion subjects. In contrast, early strokes were associated with significantly fewer words recalled after delay, reduced discriminability (fewer correct hits relative to false positive errors on recognition testing), and relatively worse auditory attention/working memory scores (Digit Span). These findings indicate that pediatric stroke subjects demonstrated more VLM impairment than control subjects, and early strokes were associated with greater recall and recognition deficits. In stark contrast with adult-onset stroke, both left- and right-hemisphere lesions during childhood resulted in similar VLM performance. PMID:15327721

  16. Epidemiology of stroke in Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    Babak Daneshfard

    2015-10-01

    Full Text Available Background: Stroke is the main cause of physical disability and the second leading cause of death worldwide. Two-thirds of all strokes occur in the developing countries. Despite being preventable, stroke is increasingly becoming a major health issue in these countries. The aim of this study was to evaluate the epidemiology of stroke in Shiraz, Iran, one of the main referral centers in the southwestern part of Iran.Methods: A cross-sectional study was conducted on all stroke patients admitted to the Namazee Hospital, affiliated to Shiraz University of Medical Sciences, between August 2010 and January 2011. Patients’ demographic data, atherosclerosis risk factors, type of stroke, drug history, outcomes, and neurological signs were recorded. Chi-square test, Kolmogorov–Smirnov test, t-test, and Mann–Whitney U-test were used to analyze the data.Results: A total of 305 patients with stroke, aged 27-97 years (mean ± SD = 68.33 ± 12.99, 269 patients (88.2% had ischemic stroke (IS and 36 (11.8% had hemorrhagic stroke (HS. 133 patients (43.6% were men and 172 (56.4% were women. 11.4% of the patients with IS and 40.6% with HS died during hospitalization, causing 12.1% death in all stroke patients [Odds ratio (Or = 5.34, 95% Confidence intervals (CI = 2.35-12.11]. Hypertension, ischemic heart disease, diabetes, and recurrent stroke were the most common risk factors.Conclusion: This study provides evidence that the epidemiology of stroke in the southwestern part of Iran may be similar to other places. However, it seems necessary and helpful to design a registration system for patients with stroke in Shiraz Namazee Hospital.

  17. The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

    Science.gov (United States)

    Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi

    2015-01-01

    Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (p<0.05). This weight asymmetry pattern did not improve with either the Bobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614

  18. Altered resting-state network connectivity in stroke patients with and without apraxia of speech

    Directory of Open Access Journals (Sweden)

    Anneliese B. New

    2015-01-01

    Full Text Available Motor speech disorders, including apraxia of speech (AOS, account for over 50% of the communication disorders following stroke. Given its prevalence and impact, and the need to understand its neural mechanisms, we used resting state functional MRI to examine functional connectivity within a network of regions previously hypothesized as being associated with AOS (bilateral anterior insula (aINS, inferior frontal gyrus (IFG, and ventral premotor cortex (PM in a group of 32 left hemisphere stroke patients and 18 healthy, age-matched controls. Two expert clinicians rated severity of AOS, dysarthria and nonverbal oral apraxia of the patients. Fifteen individuals were categorized as AOS and 17 were AOS-absent. Comparison of connectivity in patients with and without AOS demonstrated that AOS patients had reduced connectivity between bilateral PM, and this reduction correlated with the severity of AOS impairment. In addition, AOS patients had negative connectivity between the left PM and right aINS and this effect decreased with increasing severity of non-verbal oral apraxia. These results highlight left PM involvement in AOS, begin to differentiate its neural mechanisms from those of other motor impairments following stroke, and help inform us of the neural mechanisms driving differences in speech motor planning and programming impairment following stroke.

  19. Effect of Wii-based balance training on corticomotor excitability post stroke.

    Science.gov (United States)

    Omiyale, Oluwabunmi; Crowell, Charles R; Madhavan, Sangeetha

    2015-01-01

    The objective was to examine the effectiveness of a 3-week balance training program using the Nintendo Wii Fit gaming system (Nintendo Wii Sports, Nintendo, Redmond, WA) on lower limb corticomotor excitability and other clinical measures in chronic stroke survivors. Ten individuals diagnosed with ischemic stroke with residual hemiparesis received balance training using the Wii Fit for 60 min/day, three times/week, for three weeks. At the end of training, an increase in interhemispheric symmetry of corticomotor excitability of the tibialis anterior muscle representations was noted (n = 9). Participants also showed improvements in reaction time, time to perform the Dual Timed-Up-and-Go test, and balance confidence. The training-induced balance in corticomotor excitability suggests that this Wii-based balance training paradigm has the potential to influence neural plasticity and thereby functional recovery. PMID:25425118

  20. Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

    Institute of Scientific and Technical Information of China (English)

    Junqi Chen; Yong Huang; Xinsheng Lai; Chunzhi Tang; Junjun Yang; Hua Chen; Tongjun Zeng; Junxian Wu; Shanshan Qu

    2013-01-01

    In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan (TE5). In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamillary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11, 20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.

  1. Prognostic value of copeptin in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Chen Hui

    2011-08-01

    Full Text Available Stroke is the second leading cause of mortality in the Chinaand one of the leading causes of severe morbidity. An earlyrisk assessment with estimate of the severity of disease andprognosis is pivotal for optimized care and allocation ofhealthcare resources. Reliable prognostic markers availableduring the initial phase after acute stroke may aid clinicaldecision-making.Vasopressin (AVP is a potent synergistic factor ofcorticotropin-releasing hormone as hypothalamic stimulator ofthe hypothalamo-pituitary-adrenal axis.1 Some studies foundincreased AVP levels in patients with ischemic stroke werecorrelated with stroke severity2 and outcome.3 Copeptin isreleased in an equimolar ratio to AVP, and is more stable inthe circulation and easy to measure.4We designed a preliminary prospective cohort study toevaluate the prognostic value of copeptin in acute strokepatients. Adult patients with a persistent neurological deficitdue to ischemic stroke were eligible. Sixty-ninenonconsecutive patients admitted at 3 hospitals with adiagnosis of acute ischemic stroke confirmed by CT scanningwere evaluated. All patients provided informed consent. Inpatients who died within 24 hours after admission or inpatients who were discharged, data from admission or untildischarge were collected. The National Institute of HealthStroke Scale (NIHSS score was assessed on admission.Functional outcome was obtained on days 90 according to themodified Rankin Scale (mRS blinded to copeptin levels. Poorfunctional outcome at 3 months was considered as a mRSscore > 2. Blood samples were collected on admission andimmediately centrifuged and sera stored at –70°C. Copeptinwas measured with a sandwich immunoluminometricassay.1 Discrete variables are summarized as counts(percentage, and continuous variables as medians andinterquartile ranges (IQRs. Two-group comparison of notnormally distributed data was performed using Mann–Whitney U test, and a Kruskal–Wallis one-way analysis

  2. Ocean General Circulation Models

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jin-Ho; Ma, Po-Lun

    2012-09-30

    1. Definition of Subject The purpose of this text is to provide an introduction to aspects of oceanic general circulation models (OGCMs), an important component of Climate System or Earth System Model (ESM). The role of the ocean in ESMs is described in Chapter XX (EDITOR: PLEASE FIND THE COUPLED CLIMATE or EARTH SYSTEM MODELING CHAPTERS). The emerging need for understanding the Earth’s climate system and especially projecting its future evolution has encouraged scientists to explore the dynamical, physical, and biogeochemical processes in the ocean. Understanding the role of these processes in the climate system is an interesting and challenging scientific subject. For example, a research question how much extra heat or CO2 generated by anthropogenic activities can be stored in the deep ocean is not only scientifically interesting but also important in projecting future climate of the earth. Thus, OGCMs have been developed and applied to investigate the various oceanic processes and their role in the climate system.

  3. Ischemic stroke and incomplete infarction

    DEFF Research Database (Denmark)

    Garcia, Javier; Lassen, N A; Weiller, C;

    1996-01-01

    The concept of selective vulnerability or selective loss o f individual neurons, with survival of glial and vascular elements as one of the consequences of a systemic ischemic-hypoxic insult (eg, transient cardiac arrest or severe hypotension), has been recognized for decades. In contrast, select......, selective neuronal death as one of the lesions that may develop in the brain after occluding an intracranial artery is an idea not readily acknowledged in the current medical literature dealing with human stroke....

  4. Dysphagia after Stroke: an Overview

    OpenAIRE

    González-Fernández, Marlís; Ottenstein, Lauren; Atanelov, Levan; Christian, Asare B.

    2013-01-01

    Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this pop...

  5. STROKE PREVENTION IN INTERNIST PRACTICE

    Directory of Open Access Journals (Sweden)

    D. A. Napalkov

    2011-01-01

    Full Text Available Stroke secondary prevention in internist practice is discussed in accordance with up to date guidelines. Modern pharmacotherapy includes antiaggregants or anticoagulants, statins, and antihypertensive drugs. The choice of drugs is mostly founded on the rules of evidence based medicine, which allow adjusting individual treatment depending on clinical conditions. The composition of perindopril and indapamide is a preferred nowadays combination of antihypertensive drugs.

  6. Trypanosoma cruzi: circulating antigens

    Directory of Open Access Journals (Sweden)

    V. Bongertz

    1981-03-01

    Full Text Available Circulating antigens were detected in sera of mice experimentally infected with a high close of Trypanosoma cruzi by reaction with sera from chronically infected mice. The immunodiffusion reaction between homologous acute and chronic sera produced four precipitation lines. By reaction with chronic mouse serum, circulating antingens were detected in sera from heavily infected hamsters, dogs, rabbits and in sera from chagasic patients. A reaction was also found in urine from acutely infected mice and dogs. Trypanosoma cruzi exoantigen was detected in trypanosome culture medium and in the supernatant of infected cell cultures. Attempts to isolate the antigens are described.Antígenos circulantes foram detectados em soros de camundongos infectados experimentalmente com elevadas doses de Trypanosoma cruzi pela reação com soros obtidos de camundongos em fase crônica de infecção. A reação de imunodifusão entre soros homólogos agudo e crônico produziu quatro linhas de precipitação. Por reação com soro crônico de camundongo antígenos circulantes foram detectados em soros de crícetos, cães e coelhos infectados com doses elevadas de Trypanosoma cruzi e em soros de pacientes chagásicos. Uma reação foi também observada com urina de camundongos e cães infectados de forma aguda. Exoantígeno de Trypanosoma cruzi foi detectado em meio de cultura de tripanosomas e em sobrenadantes de culturas de células infectadas. Tentativas de isolamento dos antigenos são descritas.

  7. Circulating endothelial cells in cardiovascular disease.

    Science.gov (United States)

    Boos, Christopher J; Lip, Gregory Y H; Blann, Andrew D

    2006-10-17

    Quantification of circulating endothelial cells (CECs) in peripheral blood is developing as a novel and reproducible method of assessing endothelial damage/dysfunction. The CECs are thought to be mature cells that have detached from the intimal monolayer in response to endothelial injury and are a different cell population to endothelial progenitor cells (EPCs). The EPCs are nonleukocytes derived from the bone marrow that are believed to have proliferative potential and may be important in vascular regeneration. Currently accepted methods of CEC quantification include the use of immunomagnetic bead separation (with cell counting under fluorescence microscopy) and flow cytometry. Several recent studies have shown increased numbers of CECs in cardiovascular disease and its risk factors, such as unstable angina, acute myocardial infarction, stroke, diabetes mellitus, and critical limb ischemia, but no change in stable intermittent claudication, essential hypertension, or atrial fibrillation. Furthermore, CEC quantification at 48 h after acute myocardial infarction has been shown to be an accurate predictor of major adverse coronary events and death at both 1 month and 1 year. This article presents an overview of the pathophysiology of CECs in the setting of cardiovascular disease and a brief comparison with EPCs. PMID:17045885

  8. Heat stroke: a comprehensive review.

    Science.gov (United States)

    Yeo, Theresa Pluth

    2004-01-01

    Heat stroke (HS) is a serious and potentially life-threatening condition defined as a core body temperature >40.6 degrees C. Two forms of HS are recognized, classic heat stroke, usually occurring in very young or elderly persons, and exertional heat stroke, more common in physically active individuals. An elevated body temperature and neurologic dysfunction are necessary but not sufficient to diagnose HS. Associated clinical manifestations such as extreme fatigue; hot dry skin or heavy perspiration; nausea; vomiting; diarrhea; disorientation to person, place, or time; dizziness; uncoordinated movements; and reddened face are frequently observed. Potential complications related to severe HS are acute renal failure, disseminated intravascular coagulation, rhabdomyolysis, acute respiratory distress syndrome, acid-base disorders, and electrolyte disturbances. Long-term neurologic sequelae (varying degrees of irreversible brain injury) occur in approximately 20% of patients. The prognosis is optimal when HS is diagnosed early and management with cooling measures and fluid resuscitation and electrolyte replacement begins promptly. The prognosis is poorest when treatment is delayed >2 hours. PMID:15461044

  9. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  10. Cause-specific mortality after stroke

    DEFF Research Database (Denmark)

    Mogensen, Ulla Brasch; Olsen, Tom Skyhøj; Andersen, Klaus Kaae;

    2013-01-01

    We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were...... registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were...... performed by cause-specific Cox regression after multiple imputation of missing data, assuming that values were missing at random. Death was due to stroke in 310 patients (31%), to heart/arterial disease in 209 patients (21%), and to nonvascular diseases in 289 patients (29%); 180 patients were still alive...

  11. Role of echocardiography in patients with stroke.

    Science.gov (United States)

    Nakanishi, Koki; Homma, Shunichi

    2016-08-01

    Investigation of potential embolic source is an important diagnostic step in treating patients with ischemic stroke and transient ischemic attack. Cardiogenic embolism has been estimated to be the causative factor in 15-30% of all cases of ischemic stroke. Cardioembolic strokes are generally severe and recurrence and mortality rate high. Various cardiac disorders including atrial fibrillation, ventricular thrombus, valvular heart disease, cardiac tumors, and structural heart defects can cause cardioembolic stroke. Although the aortic arch is not a cardiac structure, it is usually considered under source of cardiac embolism (cardioaortic source) and is reviewed in this article. Echocardiography (both transthoracic and transesophageal) is a widely used and versatile technique that can provide comprehensive information of thromboembolic risk in patients with stroke. This article reviews potential cardiac sources of stroke and discusses the role of echocardiography in clinical practice. PMID:27256218

  12. Fifty years of stroke researches in India.

    Science.gov (United States)

    Banerjee, Tapas Kumar; Das, Shyamal Kumar

    2016-01-01

    Currently, the stroke incidence in India is much higher than Western industrialized countries. Large vessel intracranial atherosclerosis is the commonest cause of ischemic stroke in India. The common risk factors, that is, hypertension, diabetes, smoking, and dyslipidemia are quite prevalent and inadequately controlled; mainly because of poor public awareness and inadequate infrastructure. Only a small number of ischemic stroke cases are able to have the benefit of thrombolytic therapy. Benefits from stem cell therapy in established stroke cases are under evaluation. Presently, prevention of stroke is the best option considering the Indian scenario through control and/or avoiding risk factors of stroke. Interventional studies are an important need for this scenario. PMID:27011621

  13. Floating anterior lens capsule: an unusual case of true exfoliation

    OpenAIRE

    Riffle, John

    2010-01-01

    A rare case of delamination and replication of the anterior lens capsule into prominent floating folds in the anterior chamber approximately 55 years after a penetrating injury to the eye and anterior lens capsule is reported. Classically, true exfoliation of the anterior lens capsule has been reported in individuals who have been exposed to intense heat over a prolonged period. However, more recently cases of true exfoliation of the anterior lens capsule have been reported in patients who ha...

  14. Comprehensive Stroke Centers May Be Associated With Improved Survival in Hemorrhagic Stroke

    OpenAIRE

    McKinney, James S; Cheng, Jerry Q.; Rybinnik, Igor; Kostis, John B.; ,

    2015-01-01

    Background Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke. Methods and Results We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracer...

  15. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients

    OpenAIRE

    Sagar Badachi; Thomas Mathew; Arvind Prabhu; Raghunandan Nadig; Gosala R. K Sarma

    2015-01-01

    Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecu...

  16. Aphasia following anterior cerebral artery occlusion

    International Nuclear Information System (INIS)

    We have report two cases of aphasia that had infarcts in the distribution of the left or right anterior cerebral artery, as confirmed by computed tomography. Case 1 is a right-handed, 65-year-old man in whom computerized tomographic scanning revealed an infarction of the territory of the left anterior cerebral artery after the clipping of the anterior communicating artery aneurysm. The standard language test of aphasia (SLTA) revealed non-fluent aphasia with dysarthria, good comprehension, almost normal repetition with good articulation, and a defectiveness in writing. This syndrome was considered an instance of transcortical motor aphasia. Although three years had passed from the onset, his aphasia did not show any improvement. Case 2 is a 37-year-old man who is right-handed but who can use his left hand as well. He was admitted because of subarachnoid hemorrhage from an anterior communicating aneurysm. Because of postoperative spasm, an infarction in the distribution of the right anterior cerebral artery developed. He was totally unable to express himself vocally, but he could use written language quite well to express his ideas and had a good comprehension of spoken language. This clinical picture was considered that of an aphemia. After several weeks, his vocalization returned, but the initial output was still hypophonic. (J.P.N.)

  17. Rehabilitation of a patient with stroke

    OpenAIRE

    Apurba Barman; Ashok K Mahapatra

    2013-01-01

    Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community a...

  18. Emerging Treatments for Motor Rehabilitation After Stroke

    OpenAIRE

    Claflin, Edward S.; Krishnan, Chandramouli; Khot, Sandeep P.

    2015-01-01

    Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, sever...

  19. Urinary Proteomics to Support Diagnosis of Stroke

    OpenAIRE

    Dawson, J.; Walters, M.; Delles, C.; Mischak, H.; Mullen, W

    2012-01-01

    Accurate diagnosis in suspected ischaemic stroke can be difficult. We explored the urinary proteome in patients with stroke (n = 69), compared to controls (n = 33), and developed a biomarker model for the diagnosis of stroke. We performed capillary electrophoresis online coupled to micro-time-of-flight mass spectrometry. Potentially disease-specific peptides were identified and a classifier based on these was generated using support vector machine-based software. Candidate biomarkers were seq...

  20. Professionals' views on interprofessional stroke team functioning

    OpenAIRE

    Cramm, Jane Murray; Nieboer, Anna Petra

    2011-01-01

    markdownabstractIntroduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals’ perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by te...